Cardiology: Peri-Arrest Rhythms Flashcards
What is the management of bradycardia depend centered around?
1) Identifying the presence of signs indicating haemodynamic compromise - ‘adverse signs’
2) Identifying the potential risk of asystole
What adverse signs indicate haemodynamic compromise and hence the need for treatment in extreme bradycardia?
1) shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
2) syncope
3) myocardial ischaemia
4) HF
1st line management of extreme bradycardia with adverse signs?
Atropine (500mcg IV)
What is the max dose of atropine that can be used in the management of severe bradycardia?
Up to 3mg
Stepwise management of severe bradycardia with adverse signs?
1) atropine 500mcg IV
2) atropine 500mcg IV, repeat to maximum of 3mg
3) transcutaneous pacing
4) isoprenaline/adrenaline infusion titrated to response
5) transvenous pacing (seek expert help)
If there is a satisfactory response to IV atropine in severe bradycardia, what is the next step?
Figure out is there a risk of asystole?
If yes –> go back to other intermin measures:
- atropine 500mcg IV, repeat to maximum of 3mg
- transcutaneous pacing
- isoprenaline/adrenaline infusion titrated to response
- transvenous pacing (seek expert help)
If no –> observe
What are some risk factors for asystole in patients with severe bradycardia?
1) complete heart block
2) recent asystole
3) Mobitz type II AV block
4) ventricular pause > 3 seconds
What is the approach to adult tachycardia?
1) ABCDE approach
2) Identify is there are any life-threatening features (adverse signs)?
3) If yes –> Synchronised DC shock up to 3 attempts
4) If no –> is the QRS narrow or broad (< or >0.12s)
5) For both broad and narrow QRS, is it regular or irregular?
Manage accordingly.
What adverse signs indicate the need for synchronised DC shock in adult tachycardia?
1) shock features: hypotension, pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
2) syncope
3) myocardial ischaemia
4) severe HF
If adverse signs are present in an adult with tachycardia, what is the immediate management?
Synchronised DC shocks (up to 3).
After this, seek expert help.
How many synchronised DC shocks can be given in tachycardia with adverse signs?
Up to 3
If tachycardia is broad complex with REGULAR rhythm, what should you assume it is?
Assume ventricular tachycardia (VT) unless previously confirmed SVT with bundle branch block.
Management of ventricular tachycardia?
Loading dose of amiodarone (300mg IV over 10-60 mins) followed by 24 hour infusion.
If patient with broad complex regular tachycardia has previously confirmed SVT with bundle branch block, what is managemnet?
Treat as for regular narrow complex tachycardia (i.e. vagal maouevres –> adenosine –> verapamil or beta blockers –> synchronised DC shocks).
If tachycardia is broad complex with IRREGULAR rhythm, what are the possibilities of causes?
1) AF with bundle branch block - most likely cause in stable patient
2) AF with ventricular pre-excitation
3) torsades de points