Arrythmia Management Flashcards
How would you initially manage someone with an arrythmia?
ABCDE approach
- Assess for adverse signs
- Apply cardiac monitoring
- Review ECG
If someone with an arrythmia had no pulse, what would you do?
Commence ALS algorithm
What are adverse signs associated with arrythmias which would prompt immediate intervention?
- Syncope
- Shock (SBP <90)
- Myocardial ischaemia - chest pain or on ECG
- Heart Failure
How would you manage a tachyarrhythmia with adverse signs?
Synchronised DC cardioversion
How would you manage bradycardia with adverse signs?
Atropine +/- pacing
How would you manage sinus tachycardia?
Treat the cause
How would you manage paroxysmal SVT?
- First line - Vagal manoevure
- 2nd line - adenosine
- 3rd line - B-blocker
When would you not use adenosine to treat paroxysmal SVT?
Asthmatics - use CCB
How would you manage AF?
- Rate Control
- Rhythm Control
- Anticoagulation
When would you use rate control to treat AF?
>65 yrs and has IHD/is not suitable for cardioversion
What medications are used for rate control in AF?
- Beta blocker
- Diltiazem
- Digoxin
When is digoxin used to manage AF?
- Sedentary lifestyle
- Hypotension
- Heart Failure
When would you consider rhythm control for controlling AF?
If patient is < 65 and doesn’t have IHD/is suitable for cardioversion
How would you approach rhythm control in someone with AF?
Assess when it started:
- If <48 hours and -ve TOE - electrical/pharmacological intervention
- If >48 hours - 4 weeks anticoagulation then ehythm control
What pharmacological approaches can be used for rhythm control in AF?
- Flecanide
- Amiodarone
What two broad categories of tachycardia are recognised in the Peri-arrest algorithm?
Narrow and broad complex tachycardias
What are the main recognised narrow complex tachycardia rhythms?
- Sinus Tachycardia
- Paroxysmal SVT
- Atrial Fibrillation/Flutter
What are the recognised Broad complex tachycardia rhythms?
- Ventricular tachyarrythmias
- Broad complex tachycardias of SV origin
If someone had a narrow complex tachycardia with no adverse signs, what would you want to distinguish before determining how to manage the patient?
Whether it was regular or irregular
What are examples of Ventricular tachyarrythmias?
- Monomorphic VT
- pVT
- Polymorphic VT/Torsades de pointes
What would you want to assess if someone had monomorphic VT before deciding how to manage them?
Whether they had a pulse
- Pulseless = ALS algorithm
- Pulse = amiodarone
How would you manage monomorphic VT with a pulse?
Amiodarone
How would you manage polymorphic VT?
Magnesium Sulphate
What are examples of broad complex tachyarrythmias of SV origin?
- SVT with aberrant conduction - SVT or AF with R/LBBB
- AF/Flutter with pre-excitation
How would you manage SVT with aberrant conduction?
Treat as for SVT
How would you manage AF/flutter with pre-excitation?
Flecanide or DC cardioversion
How would you distinguish broad complex tachycardia of SV origin from VT?
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
What bradycardias are at risk of asystole?
- Recent asystole
- Mobitz II AV block
- Complete HB with broad QRS
- Ventricular pauses > 3 secs
If someone with bradycardia was showing no adverse signs, what would you want to do?
Assess risk of asystole
If someone with bradycardia was showing adverse signs, what would you do?
Give atropine
What are causes of bradycardia?
- Sinus bradycardia
- SA node dysfunction (sick sinus syndrome)
- AV node dysfunction (heart block)
What are causes of sinus bradycardia?
- Drugs
- Neurally mediated syndromes - carotid sinus hypersensitivity, vasovagal
- Hypothermia
- Hypothyroidism
- SA node dysfunction
What types of AV node dysfunction can cause bradycardia?
2nd/3rd degree HB
What can sick sinus syndrome result in?
- Sinus bradycardia
- Sinus pauses
- SA arrest with escape rhythms
If you had treated a bradycardia with adverse signs with atropine and response was satisfactory, what would you do next?
Assess risk of asystole
If someone with bradycardia initially treated with atropine was still displaying haemodynamic compromise, what options are evailable for management?
- Atropine IV repeat to max of 3 g
- Transcutaneous pacing
- Isoprenaline/adrenaline infusion
What are indications for permanent pacing in someone with bradycardia?
- Mobitz II HB
- 3rd Degree HB
- Symptomatic bradycardias
- Symptomatic pauses
- Trifascicular block with syncope/pre-syncope
Describe the following for adenosine use in arrythmia management:
- Dose
- Route and procedure of admin
- Subsequent dosing
- 6mg IV
- IV - wide bore cannula with immediate flush
- 12mg followed by 12 mg
Describe the following for amiodarone use in arrythmia management:
- Dose
- Route and procedure of admin
- Subsequent dosing
- 300 mg IV
- IV over 20-60 minutes
- 900mg over 24 hours through large vein
Describe the following for atropine use in arrythmia management:
- Dose
- Route and procedure of admin
- Subsequent dosing
- Max dosing
- 500 mcg IV
- IV
- Repeat 500 mcg every 3-5 mins
- 3 mg
Describe the following for magnesium sulphate use in arrythmia management:
- Dose
- Route and procedure of admin
- Subsequent dosing
- 2g IV
- IV over 10-15 minutes
- Nil
