arrhythmias

Question 1

history of arrhythmia presentation

Answer 1

prev admissions with chest pain or cardiac condition

cardiac condition

medications for cardiac conditon

operations on heart

allergies

Question 2

if no pulse

Answer 2

start advanced life support

Question 3

adverse features of bradyarrthmia

Answer 3

shock
syncope
myocardial ischaemia
heart failure

Question 4

if adverse features of bradycardia>

Answer 4

atropine 500mcg IV

Question 5

if satisfactory response of bradycardia w adverse features to atropine

Answer 5

are they at risk of asystole?

if not then continue observation if yes, consider interim measures

Question 6

if not satisfactory response of bradycardia w adverse features to atropine

Answer 6

consider interim measures:

• 500mcg IV repeat to max 3mg
• transcutaneous pacing
• isoprenaline 5mcg min-1 IV, adrenaline 2-10mcg min-1 IV, alternative drugs

Question 7

alternative drugs for bradycardia

Answer 7

aminophylline
dopamine
glucagon
glycopyrrolate

Question 8

referrals in bradycardia

Answer 8

discuss w senior member
contact critical care outreach 
referral to cardiologist
referral to anaesthetist if cardioversion required
consider ICU

Question 9

when to consider ICU in arrhythmias

Answer 9

Failure to respond to medical management

Patient requires ventilator support

Patient requires blood pressure support

Deterioration of blood gas following medical management

Question 10

future management of bradyarrhthmia

Answer 10

review by cardiologists regarding future management - medical or pacemaker

Question 11

catagories of tachyarrthmia

Answer 11

narrow vs broad complex

Question 12

extras in A-E for tachyarrhthmias

Answer 12

12 lead ECG
call for senior help
identify adverse features

Question 13

adverse features of tachyarrthmias

Answer 13

shock
syncope
MI
heart failure

Question 14

if adverse tachycardia features

Answer 14

synchronised DC shock (up to 3 attempts)

amiodarone 300mg IV over 10-20min
repeat shock
then amiodarone 900mg over 24hr

Question 15

no adverse features of tachycardia but broad ORS

Answer 15

irregular or regular?

Question 16

no adverse features of tachycardia but broad ORS which is irregular

Answer 16

AF bundle branch block = treat as narrow complex

pre-excited AF consider amioarone

Question 17

no adverse features of tachycardia but broad ORS which is regular

Answer 17

if VT:
- amiodarone 300mg IV over 20-60min then 900mg over 24hr

if SVT with bundle branch block - treat as regular narrow complex

Question 18

no adverse features of tachycardia but narrow ORS which is regular

Answer 18

vasovagal manouverse

adenosonine 6mg rapid IV bolus
(no affect, give 12 then further 12)

monitor/record ECG continuously

Question 19

no adverse features of tachycardia but narrow ORS which is irregular

Answer 19

probs AF:

control rate w beta blocker or ditiazem

if heart failure consider digoxin or amiodarone

assess thromboembolitc risk and consider anticoagulation

Question 20

no adverse features of tachycardia but narrow ORS which is regular BUT SINUS RHYTHM NOT ACHEIVED WITH TREATMENT

Answer 20

seek expert help

possible atrial flutter - control rate w beta blocker

Question 21

no adverse features of tachycardia but narrow ORS which is regular w SINUS RHYTHM NOT ACHEIVED WITH TREATMENT

Answer 21

probable re-entry paroxysmal SVT

• record 12 lead ECG in sinus rhythm
• SVT recurs treat again and consider anti-arrhthmic prophylaxis

Question 22

referrals for tachyarrhthmias

Answer 22

Discuss with senior member of the team

Contact critical care outreach team

Referral to cardiologists

Referral to anaesthetists if cardioversion is required

Consider referral to Intensive Care Unit (ICU

Question 23

future mangement of tachyarrthmuas

Answer 23

reveiw by cardiologist regarding future management

medical or surgical ablation of accessory pathway