Cardiac arrhythmia management

Question 1

What is pulseless electrical activity (PEA)

Answer 1

1. no pulse found -> Cardiac arrest

2. ECG shows electrical activity

Question 2

Management of PEA

Answer 2

1. e.g. Asystole / normal electrical activity on ECG w/o pulse
   - No shock
   - CPR only
   - Adrenaline
2. Ventricular tachycardia
   - may present without pulse
   - Shock is needed in this case
   - CPR aswell

Question 3

Ventricular tachycardia

Answer 3

1. Fine VF - small amplitude, gets weaker and weaker
2. Coarse VF - greater amplitude
3. Originates from ventricles -> Broad complex tachycardia
4. Ventricular tachycardia - no P waves, broad and regular

Question 4

Cardiac causes of bradycardia

Answer 4

1. Cardiac conduction blocks
   2, no cardiac - drugs, toxins, metabolic ( beta blockers)
2. electrolytes - K and Mg
3. Hypothyroidism

Question 5

initial management of adult bradycardia

Answer 5

1. Heart rate < 50 bpm
2. A, B , C ( airway, breathing and circulation)
3. Blood pressure and IV access
4. ECG

Question 6

Which redflags identified in bradycardia management

Answer 6

1. Hypotension
2, Altered mental state
3. Signs of shock
4. Ischaemic discomfort
5. Acute heart failure
If no - MONITOR + OBSERVE

Question 7

Redflags have been identified in bradycardia

Answer 7

1. Give atropine
   if ineffective ;
2. Transcutaneous pacing
3. Dopamine or epinephrine infusion

Question 8

atropine

Answer 8

1. used in the treatment of bradycardia
   2, an ACh receptor antagonist to decrease Parasympathetic nervous system and increase sympathetic nervous system
   3, Contraindic - patient is predisposed to narrow-angle glaucoma

Question 9

First degree heartblock

Answer 9

1. PR interval is longer than expected

2. slower conduction mabe due to beta blocker use

Question 10

Second degree heart block

Mobitz type I

Answer 10

1. PR interval gets longer and longer –> until QRS suddenly disappears

Question 11

Second degree heart block

Mobitz type II

Answer 11

1. QRS suddenly drops - no PR prolonging

2. Risk of deteriorating int o asystole

Question 12

Third degree heart block

Answer 12

1. regular P waves and QRS but they do not talk to each other
2. SAN creates own rythm - atria contract but not contact via AV noe
3. No AVN firing - escape beats only
4. risk of asystole is high and pacemaker is needed

Question 13

Managment of atrial tachycardia

Answer 13

1. Heart rate > 150 bpm
2. A, B , C
3. IV access and ECG
4. Check for red flags
5. Vagal manoeuvres - increase activity of Vagus nerve
   2, Adenosine - to chemically cardiovert the heart

Question 14

Redflag in supraventricular tachycardia

Answer 14

1. hypotension
2. acutely altered mental status
3. signs of shock
4. chest pain
5. heart failure
   - -> NO
6. is QRS wider than > 0.12 secs?
   - –>NO
7. Vagal maneuvers
8. Adenosine
9. Beta blocker/Calcium channel blockers

Question 15

management of Ventricular tachycardia

Answer 15

1. Shock

2. Amiadorone