ALS Rhythms

Question 1

Life threatening features?

Answer 1

Shock, syncope, myocardial iscahemia, severe heart failure/pulmonary oedema

Question 2

Broad QRS

Answer 2

< 0.12 s
Irregular - AF with BBB? Treat as for irregular NCT

TDP - give Mg 2g in 10 mins

Regular - amiodarone 300mg IV 10-60 mins

Previous SVT with BBB? - treat as NCT regular if ineffective DCCV x 3

Question 3

Narrrow QRS < 0.12 s

Answer 3

Regular - vagal followed by adenosine 6/12/18mg monitor ECG if ineffective verapamil 2.5-5mg or BB atenolol 5mg over 5 mins repeat after 10

Irregular - probable AF, control rate BB, consider dig or amio if HF, anticoagulate > 48hrs

Question 4

Bradycardia with life threatening signs, recent asystole, mobitz 2, CHB or vent pauses > 3 secs extreme Brady

Answer 4

Atropine 500mcg up to 3mg max, isoprenaline 5mcg/min, adrenaline 2-10mcg/min or pace +/- transvenous

Question 5

How to pace?? Pads, energy, rate, consider??

Answer 5

Pads R pec/apical or ant post if device
Set lowest energy gradually increase usually 50-100ma will capture, rate 60-90
Hyperkalaemia May prevent capture

Remove hair, rarely succusefup if no p waves

Question 6

ALS style of reading ECG 1-6

Answer 6

1 is there electrical activity
2 what is the vent rate, count R waves 30 large squares x 10 or 15 x 20
3 is QRS regular or irregular
4 is QRS narrow or broad
5 is the atrial activity preset
6 is atrial activity related to ventricles

Question 7

Hyperkalaemia ECG signs and treatment

Answer 7

Long PR
Wide QRS
Tented tall T
Flat P
Give 50ml/50% Dex with 10units AR
Salbutamol
Calcium chloride 10% 10mmols

Question 8

Hypokalaemia ECG and treatment

Answer 8

PR long
ST down
T flat/inverted
Rapid 20mmol 2mmol/min for 10 mins plus 10mmol over 5-10 mins if unstable ideally CVC

Question 9

Cardio version pad positions?

Answer 9

Can use conventional

AP ant R sternal border for A Fib / Flutter

Question 10

Cardioversion shock energies

Answer 10

BCT 120-150J
A Fib Max used to be 120-150J
A flutter of NCT 70-120J