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Emergency Medicine > Arrythmia Management > Flashcards

Arrythmia Management Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

How would you initially manage someone with an arrythmia?

A

ABCDE approach

  • Assess for adverse signs
  • Apply cardiac monitoring
  • Review ECG
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2
Q

If someone with an arrythmia had no pulse, what would you do?

A

Commence ALS algorithm

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3
Q

What are adverse signs associated with arrythmias which would prompt immediate intervention?

A
  • Syncope
  • Shock (SBP <90)
  • Myocardial ischaemia - chest pain or on ECG
  • Heart Failure
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4
Q

How would you manage a tachyarrhythmia with adverse signs?

A

Synchronised DC cardioversion

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5
Q

How would you manage bradycardia with adverse signs?

A

Atropine +/- pacing

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6
Q

How would you manage sinus tachycardia?

A

Treat the cause

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7
Q

How would you manage paroxysmal SVT?

A
  • First line - Vagal manoevure
  • 2nd line - adenosine
  • 3rd line - B-blocker
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8
Q

When would you not use adenosine to treat paroxysmal SVT?

A

Asthmatics - use CCB

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9
Q

How would you manage AF?

A
  • Rate Control
  • Rhythm Control
  • Anticoagulation
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10
Q

When would you use rate control to treat AF?

A

>65 yrs and has IHD/is not suitable for cardioversion

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11
Q

What medications are used for rate control in AF?

A
  • Beta blocker
  • Diltiazem
  • Digoxin
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12
Q

When is digoxin used to manage AF?

A
  • Sedentary lifestyle
  • Hypotension
  • Heart Failure
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13
Q

When would you consider rhythm control for controlling AF?

A

If patient is < 65 and doesn’t have IHD/is suitable for cardioversion

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14
Q

How would you approach rhythm control in someone with AF?

A

Assess when it started:

  • If <48 hours and -ve TOE - electrical/pharmacological intervention
  • If >48 hours - 4 weeks anticoagulation then ehythm control
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15
Q

What pharmacological approaches can be used for rhythm control in AF?

A
  • Flecanide
  • Amiodarone
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16
Q

What two broad categories of tachycardia are recognised in the Peri-arrest algorithm?

A

Narrow and broad complex tachycardias

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17
Q

What are the main recognised narrow complex tachycardia rhythms?

A
  • Sinus Tachycardia
  • Paroxysmal SVT
  • Atrial Fibrillation/Flutter
18
Q

What are the recognised Broad complex tachycardia rhythms?

A
  • Ventricular tachyarrythmias
  • Broad complex tachycardias of SV origin
19
Q

If someone had a narrow complex tachycardia with no adverse signs, what would you want to distinguish before determining how to manage the patient?

A

Whether it was regular or irregular

20
Q

What are examples of Ventricular tachyarrythmias?

A
  • Monomorphic VT
  • pVT
  • Polymorphic VT/Torsades de pointes
21
Q

What would you want to assess if someone had monomorphic VT before deciding how to manage them?

A

Whether they had a pulse

  • Pulseless = ALS algorithm
  • Pulse = amiodarone
22
Q

How would you manage monomorphic VT with a pulse?

A

Amiodarone

23
Q

How would you manage polymorphic VT?

A

Magnesium Sulphate

24
Q

What are examples of broad complex tachyarrythmias of SV origin?

A
  • SVT with aberrant conduction - SVT or AF with R/LBBB
  • AF/Flutter with pre-excitation
25
Q

How would you manage SVT with aberrant conduction?

A

Treat as for SVT

26
Q

How would you manage AF/flutter with pre-excitation?

A

Flecanide or DC cardioversion

27
Q

How would you distinguish broad complex tachycardia of SV origin from VT?

A

Mimics VT

  • SV origin if - Previous ECG with BBB, Delta waves, same shape QRS or irregular QRS
  • Not SV origin - QRS > 160, L axis deviation, AV dissociation
28
Q

What bradycardias are at risk of asystole?

A
  1. Recent asystole
  2. Mobitz II AV block
  3. Complete HB with broad QRS
  4. Ventricular pauses > 3 secs
29
Q

If someone with bradycardia was showing no adverse signs, what would you want to do?

A

Assess risk of asystole

30
Q

If someone with bradycardia was showing adverse signs, what would you do?

A

Give atropine

31
Q

What are causes of bradycardia?

A
  • Sinus bradycardia
  • SA node dysfunction (sick sinus syndrome)
  • AV node dysfunction (heart block)
32
Q

What are causes of sinus bradycardia?

A
  • Drugs
  • Neurally mediated syndromes - carotid sinus hypersensitivity, vasovagal
  • Hypothermia
  • Hypothyroidism
  • SA node dysfunction
33
Q

What types of AV node dysfunction can cause bradycardia?

A

2nd/3rd degree HB

34
Q

What can sick sinus syndrome result in?

A
  • Sinus bradycardia
  • Sinus pauses
  • SA arrest with escape rhythms
35
Q

If you had treated a bradycardia with adverse signs with atropine and response was satisfactory, what would you do next?

A

Assess risk of asystole

36
Q

If someone with bradycardia initially treated with atropine was still displaying haemodynamic compromise, what options are evailable for management?

A
  • Atropine IV repeat to max of 3 g
  • Transcutaneous pacing
  • Isoprenaline/adrenaline infusion
37
Q

What are indications for permanent pacing in someone with bradycardia?

A
  • Mobitz II HB
  • 3rd Degree HB
  • Symptomatic bradycardias
  • Symptomatic pauses
  • Trifascicular block with syncope/pre-syncope
38
Q

Describe the following for adenosine use in arrythmia management:

  1. Dose
  2. Route and procedure of admin
  3. Subsequent dosing
A
  1. 6mg IV
  2. IV - wide bore cannula with immediate flush
  3. 12mg followed by 12 mg
39
Q

Describe the following for amiodarone use in arrythmia management:

  1. Dose
  2. Route and procedure of admin
  3. Subsequent dosing
A
  1. 300 mg IV
  2. IV over 20-60 minutes
  3. 900mg over 24 hours through large vein
40
Q

Describe the following for atropine use in arrythmia management:

  1. Dose
  2. Route and procedure of admin
  3. Subsequent dosing
  4. Max dosing
A
  1. 500 mcg IV
  2. IV
  3. Repeat 500 mcg every 3-5 mins
  4. 3 mg
41
Q

Describe the following for magnesium sulphate use in arrythmia management:

  • Dose
  • Route and procedure of admin
  • Subsequent dosing
A
  1. 2g IV
  2. IV over 10-15 minutes
  3. Nil

Emergency Medicine (32 decks)

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