Cardio Emergencies

Question 1

What is the first line management of pulseless electrical activity/asystole?

Answer 1

IV adrenaline 1g

Question 2

How do you treat haemodynamically unstable broad or narrow complex tachycardia?

Answer 2

1) Synchronised DC cardioversion (shocks) - up to 3
2) Amiodarone 300mg IV

Question 3

How do you treat haemodynamically stable VT?

Answer 3

1) Amiodarone 300mg IV
2) Synchronised DC shock

Question 4

How do you treat haemodynamically stable polymorphic VT e.g. torsades de pointes (irregular)?

Answer 4

Magnesium (sulfate) 2g IV

Question 5

How do you treat haemodynamically stable broad complex tachycardia with known history of SVT and BBB?

Answer 5

Adenosine (treat as narrow complex tachycardia)

Question 6

How do you treat ventricular fibrillation/pulseless VT?

Answer 6

Non-synchronised DC shock

Question 7

How do you treat haemodynamically stable regular narrow complex tachycardia?

Answer 7

1) Vagal manœuvres

2) Adenosine IV or verapamil if adenosine CI or fails

Question 8

What do you do after sinus rhythm is achieved in haemodynamically stable narrow complex tachycardia?

Answer 8

• Probable paroxysmal re-entrant SVT
• Assess ECG for e.g. WPW
• If recurrent consider referral for electrophysiology/prophylaxis

Question 9

What do you do after sinus rhythm is not achieved in haemodynamically stable narrow complex tachycardia?

Answer 9

• Possible atrial flutter

- Control rate e.g. beta blocker

Question 10

How do you treat haemodynamically stable AF (irregular narrow complex tachycardia)?

Answer 10

1) Beta blocker e.g. metoprolol IV
2) Verapamil IV (rate limiting CCB)
3) Digoxin = alternative in HF
4) Amiodarone
5) Consider anticoagulation with warfarin or NOAC to reduce risk of stroke

Question 11

How can you treat haemodynamically stable AF if the onset is definitely < 48h or if effectively anticoagulated for > 3 weeks?

Answer 11

1) Synchronised DC cardioversion
2) Flecainide 300mg PO (chemical cardioversion) - only if def no structural heart damage
3) Amiodarone 300mg IV

Question 12

How do you treat haemodynamically unstable bradycardia?

Answer 12

1) Atropine 500mcg IV (max 3mg)
2) Transcutaneous pacing
3) Transvenous pacing

Question 13

What increases risk of asystole in bradycardia?

Answer 13

• Recent asystole
• Mobitz II AV block
• Complete heart block with broad QRS
• Ventricular pause > 3s

Question 14

What do you have to do if someone is at risk of asystole?

Answer 14

• Interim measures

- Arrange transvenous pacing