Arrhythmia Treatment

Question 1

Narrow Stable Regular Tachycardia

Answer 1

• > Vagal maneuvers
• > Adenosine 6mg/12mg
• > Cardizem 0.25mg/kg first dose, may repeat 0.35 (usual dose 15-20mg) may repeat 0.35mg/kg maintainance 5-15mg/hr
• > Metoprolol 5mg q 5 minutes max 15mg

Question 2

Narrow Stable Irregular Tachycardia

Answer 2

• > Vagal Manuevers
• > Cardizem 0.25mg/kg (usual dose 15-20mg) may repeat 0.35mg/kg 5-15mg/hour maintainance
• > Metoprolol 5mg q 5 min max 15mg

If pt is taking a beta blocker, give them a beta blocker, if pt is taking a Ca2+ channel blocker, give them a Ca2+ channel blocker

Question 3

Wide Stable Regular Tachycardia-V Tach

Answer 3

• > Adenosine-> 6mg/then 12mg followed by 20cc NS

- > Amiodarone-> 150mg over 10 minutes maintenance 1mg/min 1st 6 hours

Question 4

Tachycardia Unstable

->Synchronized Cardioversion

Answer 4

Cardioversion

• > Narrow Regular-> 50-100j
• > Narrow Irregular-> 120-200j
• > Wide Regular-> 100j
• > Wide Irregular (V-Fib)->Defibrillate at 200j

Question 5

Bradycardia Stable

Answer 5

• > Asymptomatic-> monitor/observe pt

- > Symptomatic-> Atropine 0.5 q3-5 minutes MAX 3mg

Question 6

Bradycardia Unstable

Answer 6

-> TRANSCUTANEOUS PACE
Start pacer at 60ppm 30ma
Once you have electrical capture, check for mechanical capture (femoral pulse)