Arrhythmias

Question 1

A patient is in resus and all of a sudden their heart rate shoots to 250.

They feel dizzy and pass out.

What should you do?

Answer 1

ABCDE

Then DC shock with defibrillator
Up to 3 attempts

GET HELP

Then IV amiodarone 300mg over 10-20mins

Repeat shock

Then IV amiodarone 900mg over 24hrs

Question 2

A patient is in resus and all of a sudden their heart rate shoots to 250.

They feel palpitations but don’t pass out.

You should look at the ECG.

What might you see that would help you decide how to manage?

Answer 2

They’re stable

Look at ECG, are QRS complexes narrow or broad?

NARROW:

• regular = SVT: vagal manouvres, adenosine 6mg IV bolus, can give two further 12mg bolus
• irregular = AF: rate control (B blockers, Ca Ch) rhythm control (amiodarone)

BROAD

Probable VT: IV amiodarone 300mg over 10-20 mins, then 900mg over 24 hrs

Question 3

Which rhythms are shockable?

Answer 3

VF

VT

Question 4

A patient is in resus and their heart rate drops to 30

They feel dizzy and pass out.

What should you do?

Answer 4

ABCDE

Give IV atropine 500mcg

If no response, give again
Or consider transcutaneous pacing
Or isoprenaline or adrenaline