Arrhythmias Flashcards
List the 5 H’s and 4 T’s:
1- hypovolemia 2- hypoxia 3- hyponatremia 4- hyperkalemia 5- hypothermia
1- tamponade
2- toxins
3- thrombosis (MI or PE)
4- tension pneumothorax
IO access: (locations-4)
- proximal tibia (preferred site)
- distal tibia
- proximal humerus
- distal femur
Complications of IO access:
- osteomyelitis
- subQ abscess
- compartment syndrome
- fractures
Triggering Factors for Atrial Fibrillation: (9)
1- hypoxia 2- caffeine 3- medications (beta-agonists, theophylline) 4- etoh intake 5- etoh withdrawal 6- surgery, particularly heart and lung 7- thyrotoxicosis 8- pericarditis 9- chest trauma
Persistent AF:
> 7 days; likely requires pharm tx or cardioversion
Paroxysmal AF:
2+ episodes, lasting <7 days (commonly less than 24h)
Permanent AF:
Lasting >1 year and cardioversion not attempted or failed
Lone AF:
Pts. <60 y.o. w/ any type of AF w/o structural changes
MC in young male pts. W/ specific trigger
1/3 w/ familial hx of a. Fib
MC AF sxs:
DOE
Fatigue
Decreased endurance
- can range from asxs to HF sxs
Atrial fibrillation dx test:
EKG, evaluating for CLUB
- conduction system dz, LVH, underlying MI, baseline QT interval
AF w/u:
- new onset: require TTE
- cardiac enzymes (3 sets Q6-8 hours)
- BNP
- TSH and free T4
- baseline CBC, Renal fx, glucose level and UA
- if ischemia sxs, consider stress testing/cath
- normal ekg, consider holster monitoring or event device implant
Unstable A. Fib tx:
Immediate synchronized cardioversion
Stable A. Fib treatment:
- telemetry bed and admission
- Rate control:
1- cardizem: 10-20 mg IV bolus, followed by titration IV drip for a HR 80-100
2- metoprolol IV bolus w/ cardiac ischemia or infarction
3- digoxin IV bolus for hypotension
4- amiodarone IV bolus (potential to re-cardiovert) - begin A.fib w/u
- anticoagulate if appropriate and >48h
Describe CHADS-2 VAS criteria:
CHF HTN Age >65 y.o. DM Secondary prevention of emboli events (ischemia/stroke) Vascular dz (PAD, MI, aortic dz) Age >75 y.o. Sex (women)
Describe CHADS-2 VAS scoring system:
0-1: ASA only
2: ASA vs. anticoagulant (preferred)
3 or more: warfarin or NOAC
Describe HAS-BLED criteria for warfarin use:
HTN w/ SBP >160 mm Hg Abnormal liver or renal fx Stroke Bleeding hx (major: IC, hospitalization, hgb drop 2 gm, or required transfusion) Labeled INRs Elderly (>65 y.o.) Drugs: antiplatelets or etoh
HAS BLED scoring system:
> 3 indicates high risk
If a pt. has valvular atrial fibrillation and you need to anticoagulate, what should you use?
Warfarin
MC cause of third degree AV heart block: (3)
MI
Chronic degeneration
Drug toxicity (digitalis toxicity)
Describe the process of synchronized cardioversion: (6)
*this is a controlled and planned process
1- consent pt.
2- hook pt. up to CMU w/ airway support ready
3- establish IV access
4- Give sedation and anti-anxiety meds (versed and fentanyl)
5- ekg pre and post procedure
6- verify cardioversion threshold and voltage
Unstable Atrial fibrillation cardioversion voltage:
150-200 joules
Unstable Atrial flutter cardioversion voltage:
100 joules
What conditions should you do unsynchronized cardioversion defibrillation?
1- ventricular fibrillation
2- pulseless vtach
3- polymorphic v tach (torsades)
- 200 joules
C/I to unsynchronized cardioversion defibrillation:
1- NSR 2- PEA 3- asystole 4- stable v-tach 5- dangerous operator conditions (wet paint or surroundings)
