Arrhythmia Emergency

Question 1

What is Cardiac Collapse?

Answer 1

A sudden loss of effective blood flow that is caused by cardiac or peripheral vascular factors that may revert spontaneously (e.g., syncope) or only with interventions (e.g., cardiac arrest).

Question 2

What is Cardiac Arrest?

Answer 2

No mechanical heart activity confirmed by no pulse, unresponsive, apnea or gasping for breath.

Question 3

What is Sudden Cardiac Death?

Answer 3

Sudden cardiac death is a natural death of cardiac cause that is preceded by an abrupt loss of consciousness within 1 hour of the onset of an acute change in cardiovascular status.

Question 4

What are the two types of electrical therapy?

Answer 4

1. Defibrillation: asynchronous electrical shock delivered without regard for the cardiac cycle.
2. Synchronous Cardioversion: electrical shock given when the patients ventricular depolarization is sensed (QRS complex sensed).

Question 5

Treatment for Ventricular Fibrillation (patient usually unconscious).

Answer 5

Step 1: defibrillation

2. CPR
3. Epinephrine (Epi) or Vasopressin (ADH)
4. Amiodarone or Lidocaine
5. Repeat defibrillation and CPR between each step

Question 6

What characteristics indicate an UNSTABLE arrhythmia?

Answer 6

Lightheadedness
SOB
Diaphoresis
Hypotension		
Chest discomfort

Question 7

Tx for stable Monomorphic V. tach.

Answer 7

Amiodarone or Procainamide or Sotalol

Question 8

T for unstable Monomorphic V. tach.

Answer 8

With Pulse: stable cardioversion

Pulseless: 1. Defibrillation

2. CPR
3. Epi or ADH
4. Amiodarone or Lidocaine
5. Repeat defib and CPR

Question 9

Tx for sustained Polymorphic V. tach.

Answer 9

Defibrillation: even with a pulse b/c it may indicate hemodynamic compromise

Question 10

Tx for unsustained Polymorphic V. tach.

Answer 10

Magnesium sulfate if it results in TdP.

-these patients often present with seizures or syncope

Question 11

Tx for ventricular asystole.

Answer 11

1. Check Leads
2. CPR
3. Get IV access
4. Epi or ADH
5. Check and treat underlying cause

Question 12

Tx for pulseless electrical activity (PEA).

Answer 12

Treat the cause!

Meanwhile:

1. CPR
2. IV access
3. Epi or ADH

Question 13

Tx for Sinus Tachycardia.

Answer 13

Treat the underlying cause

-can also treat the symptoms (pain, anxiety, fever)

Question 14

Tx for A. fib.

Answer 14

Unstable: immediate synchronized cardioversion

Stable: anticoagulant + (beta blocker or CCB nondihydro or digoxin)

Question 15

Tx for A. flutter

Answer 15

Unstable: immediate synchronized cardioversion

Stable: anticoagulant + (beta blocker or CCB nondihydro or digoxin)

Question 16

What 5 arrhythmias fit into the category of wide QRS tachycardia?

Answer 16

VT (most common)
SVT or AF with aberrant ventricular conduction
SVT or AF with preexisting BBB
SVT or AF with nonspecific preexisting IVCD
Preexcited tachycardia

Question 17

How are the 5 wide QRS tachycardia arrhythmias treated?

Answer 17

Unstable
Monomorphic: synchronous cardioversion
Polymorphic: defibrillation

Stable: adenosine
or amiodarone, procainamide, sotalol

Question 18

Tx for sinus bradycardia

Answer 18

If asymptomatic usually just observation

1. Treat underlying cause
2. Atropine if symptomatic
3. Implantable pacemaker as last resort

(includes all AV blocks)