Assessment, management and treatment of arrythmias Flashcards
What considerations, aside from an ECG, should be accounted for when assessing a patient for arrythmias?
Resp rate, heart rate, blood pressure, cap refill, GCS, any other adverse signs and family history.
What are the red flags that could signify an arrythmia?
Chest pain, difficulty breathing, palpitations, loss of consciousness, pre-syncope, nausea and vomiting. There is still a possibility of the patient presenting as asymptomatic.
Explain the difference between stable and unstable arrythmias, and name some symptoms of unstable arrythmias.
Stable arrythmias are normally sustainable and are known to the patient, while unstable arrythmias require treatment but can be a worsening of an existing arrythmia. The symptoms of these can include pallor, sweating, breathlessness, hypotension and impaired consciousness.
What criteria can put a patient at higher risk of asystole?
Previous history of asystole, Second degree Mobitz type 2 AV block, Third degree AV block, ventricular standstill.
What should be done if a patient is presenting with absolute bradycardia (pulse rate below 40)?
Once assessed, administer atropine, with a second dose if first is unsuccessful and they are not at risk of asystole. Whether one or two doses were administered, patient should be transferred to ED.
Explain transcutaneous pacing.
A non-invasive form of pacing, involving external pads being placed on the patient’s chest and works to resume the heart rate to a normal level as an alternative treatment to medication (if possible).
What should be done if a patient is presenting with absolute tachycardia (pulse more than 150)?
If adverse features are present, convey to ED. If not, assess QRS complex. If broad QRS, convey to ED. If narrow QRS and regular, consider Valsalva manoeuvre. If sinus rhythm achieved, advice needed for conveyance. In any other scenario, convey to ED.
Explain cardioversion.
The process of delivering a shock in a similar way to defibrillation, except it generates the shock with a pulse, it produces less energy and it is produced at a different part of the cardiac cycle.
Explain the Valsalva manoeuvrer and the modified Valsalva manoeuvrer.
Usually done while supine, blow into a loosened syringe to increase intrathoracic pressure. The modified version is done the same, aside from tilting the patient backwards and lifting their legs after they blow for 15 seconds.
