Arrythmias

Question 1

What are the Therapeutic Goals of Post-resus care

Answer 1

Maintain Stable Electrical, Hemodynamic, and Central Nervous System Status

Question 2

What are the components of Post-resus syndrome

Answer 2

• Brain Injury
• Myocardial Dysfunction
• Systemic Ischemia-Reperfusion Responses
• Control of Persistent Precipitating Factors

Question 3

How to prevent post-arrest encephalopathy?

Answer 3

• Therapeutic Hypothermia to 33°C or 34°C (Non shockable Rhythm)
• Gradual Rewarming to 37°C after 24-48 Hours of Cooling

Question 4

How to manage general metabolic state?

Answer 4

• Improve Oxygenation and Reverse Acidosis
• Intravenous Sodium Bicarbonate for Bicarbonate-Responsive Acidosis, Certain Drug Overdoses
• Caution Against Excessive Sodium Bicarbonate Use

Question 5

What is a Blackout?

Answer 5

‘Blackout’ is used to describe transient loss of consciousness with complete recovery
Presyncope is the near loss of consciousness with light headedness, muscular weakness, blurred vision, and feeling faint

Question 6

What are the DDX’s of a blackout?

Answer 6

• Neurocardiogenic syncope aka vasovagal - most common
• Situational syncope
• Carotid sinus syncope
• Postural/orthostatic hypotension
• Cardiac arrythmia
• Occult haemorrhage
• Postural orthostatic tachycardia syndrome (POTS)

Question 7

How might cardiac arrythmias cause a blackout?

Answer 7

The reduction in blood pressure that occurs when there is a long pause between heart beats (>3 secs)

Question 8

What factors contribute to Neurocardiogenic/Vasovagal syncope

Answer 8

3P’s:
* Posture: typically after prolonged standing, uncommon when sitting or lying
* Provoking factors: fear, pain, phobia of blood, crowded places, extreme heat, dehydration
* Progressive prodrome which lasts a few seconds before losing consciousness: pallor, sweating, nausea/vomiting
Caused by activation of the parasympathetic nervous system in response to emotional or environmental triggers (causes bradycardia, vasodilation of peripheral blood vessels, and drop in blood pressure )

Question 9

What are the Investigations for syncope?

Answer 9

• Take Obs to differentiate to an arrest
• Blood glucose
• FBC for aneamia
• Assess cognitive function
• 12 lead ECG to look for an arrythmia
• 24 hr ECG if needed
• Echo is PMHX of CHD

Question 10

What is the management for syncope?

Answer 10

• Initial management: laying the individual supine with legs elevated
• Position person on the ground, leaning forwards with their head between their knees for 15 minutes
• If syncope caused by cardiac disease, treat underlying cause: pacemakers, defibrillators
• For vasovagal syncope: advise on possible triggers, advise early recognition of prodromal symptoms, adequate fluid intake, review drug treatments
• May need to notify DVLA

Question 11

What is a Palpatation?

Answer 11

An abnormal awareness of a heart beat

Question 12

2 Side effects of amiodorone

Answer 12

Pulmonary Fibrosis
Hepatotoxic

Question 13

Regular broad complex tachy

Answer 13

VT until proven otherwise (lifethreatening)

Question 14

Defibrillation va Cardioversion

Answer 14

Defib - uncsynchronisedshock
Cardioversion - synchronised shock for someone with cardiac output