arrhythmias Flashcards
history of arrhythmia presentation
prev admissions with chest pain or cardiac condition
cardiac condition
medications for cardiac conditon
operations on heart
allergies
if no pulse
start advanced life support
adverse features of bradyarrthmia
shock
syncope
myocardial ischaemia
heart failure
if adverse features of bradycardia>
atropine 500mcg IV
if satisfactory response of bradycardia w adverse features to atropine
are they at risk of asystole?
if not then continue observation if yes, consider interim measures
if not satisfactory response of bradycardia w adverse features to atropine
consider interim measures:
- 500mcg IV repeat to max 3mg
- transcutaneous pacing
- isoprenaline 5mcg min-1 IV, adrenaline 2-10mcg min-1 IV, alternative drugs
alternative drugs for bradycardia
aminophylline
dopamine
glucagon
glycopyrrolate
referrals in bradycardia
discuss w senior member contact critical care outreach referral to cardiologist referral to anaesthetist if cardioversion required consider ICU
when to consider ICU in arrhythmias
Failure to respond to medical management
Patient requires ventilator support
Patient requires blood pressure support
Deterioration of blood gas following medical management
future management of bradyarrhthmia
review by cardiologists regarding future management - medical or pacemaker
catagories of tachyarrthmia
narrow vs broad complex
extras in A-E for tachyarrhthmias
12 lead ECG
call for senior help
identify adverse features
adverse features of tachyarrthmias
shock
syncope
MI
heart failure
if adverse tachycardia features
synchronised DC shock (up to 3 attempts)
amiodarone 300mg IV over 10-20min
repeat shock
then amiodarone 900mg over 24hr
no adverse features of tachycardia but broad ORS
irregular or regular?
no adverse features of tachycardia but broad ORS which is irregular
AF bundle branch block = treat as narrow complex
pre-excited AF consider amioarone
no adverse features of tachycardia but broad ORS which is regular
if VT:
- amiodarone 300mg IV over 20-60min then 900mg over 24hr
if SVT with bundle branch block - treat as regular narrow complex
no adverse features of tachycardia but narrow ORS which is regular
vasovagal manouverse
adenosonine 6mg rapid IV bolus
(no affect, give 12 then further 12)
monitor/record ECG continuously
no adverse features of tachycardia but narrow ORS which is irregular
probs AF:
control rate w beta blocker or ditiazem
if heart failure consider digoxin or amiodarone
assess thromboembolitc risk and consider anticoagulation
no adverse features of tachycardia but narrow ORS which is regular BUT SINUS RHYTHM NOT ACHEIVED WITH TREATMENT
seek expert help
possible atrial flutter - control rate w beta blocker
no adverse features of tachycardia but narrow ORS which is regular w SINUS RHYTHM NOT ACHEIVED WITH TREATMENT
probable re-entry paroxysmal SVT
- record 12 lead ECG in sinus rhythm
- SVT recurs treat again and consider anti-arrhthmic prophylaxis
referrals for tachyarrhthmias
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
future mangement of tachyarrthmuas
reveiw by cardiologist regarding future management
medical or surgical ablation of accessory pathway
