Arrhythmia management

Question 1

Initial approach

Answer 1

ABCDE approach

No pulse - ALS algorithm

Adverse signs (SBP <90, syncope, CP / ECG ischaemia, HF):
Tachy - synchronised DC cardioversion
Brady - atropine +- pacing

Apply 3-lead monitoring, tx underlying cause, review ECG

Question 2

Narrow complex tachycardia

HR > 100, QRS < 120 ms/ 3 ss

Answer 2

Caused by supraventricular tachyarrhythmias

Sinus tachycardia - managed by tx cause
Paroxysmal SVT - vagal manoeuvres, adenosine / verapamil, BB
Atrial fibrillation / flutter - rate or rhythm control, anticoagulation

Question 3

Broad complex tachycardia

HR > 100, QRS > 3ss

Answer 3

Monomorphic VT - amiodarone 
Polymorphic VT (torsades de pointes) - magnesium sulphate

Question 4

Bradycardias

Answer 4

Sinus bradycardia
SA node dysfunction
AV node dysfunciton

Management:
Treat cause
Atropine
Ongoing compromise / risk of asystole then pacing is required

Question 5

Risk of asystole

Answer 5

Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
Ventricular pauses > 3 s