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CLASP - sudden death Flashcards

1
Q

What does the following ECG show?

A

Sinus bradycardia - divide 300 by the numbers of squares in between the QRS complexes

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2
Q

Tx for bradycardia

A

1st: Atropine IV
2nd: Transcutaenous pacing or isoprenaline or adrenaline

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3
Q

What does the following ECG show?

A

A-fib

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4
Q

What type of heart block is shown here?

A

Mobitz type 2

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5
Q

What does the following ECG show?

A

Ventricular tachycardia

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6
Q

What does the following ECG show?

A

Ventricular fibrillation

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7
Q

Mx for PEA and asystole

A

CPR should be commenced immediately with interruptions minimised

Adrenaline 1mg IV is given in the first cycle and if a non-shockable rhythm persist, every other cycle (i.e. cycles 1, 3, 5 etc.)

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8
Q

Mx for V-tach and V-fib

A

Defibrillation and CPR
If persistent, Amiodarone 300mg IV and Adrenaline 1mg IV can be given after the third shock

Amiodarone is given as a one-off dose but Adrenaline may be repeated every other cycle following a shock (i.e. cycles 3, 5, 7 etc.)

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9
Q

What does the following ECG show?

A

Long QTc syndrome

QT interval is roughly equivalent to three to four large squares (600–800 ms). A prolonged QT interval is defined as being above 440 ms in men and 470 ms in women

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10
Q

Mx for acquired LQTS

A

Address underlying cause of LQTS (e.g. cease medications or address dyselectrolytaemia)

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11
Q

Mx for congenital LQTS

A

1st: beta-blockade (as long as no bradycardia)
2nd: ICD insertion (if risk of cardiac arrest) or cardiac pacing

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12
Q

What does the following ECG show?

A

Sinus tachycardia

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13
Q

Tx for sinus tachy if there are adverse signs (e.g. shock, syncope, heart failure, myocardial ischaemia)

A

1st line = synchronised DC cardioversion +/- amiodarone.

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14
Q

Tx for sinus tachy if there are no adverse signs (e.g. shock, syncope, heart failure, myocardial ischaemia) but rhythm is regular

A

1st line = vagal manouevres
2nd line = IV adenosine. 6mg >12mg > 18mg
3rd line = verapamil or beta-blocker
4th line = synchronised DC cardioversion

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15
Q

Tx for sinus tachy if there are no adverse signs (e.g. shock, syncope, heart failure, myocardial ischaemia) but rhythm is irregular

A

Probable atrial fibrillation and to treat with beta-blockers
If there are signs of heart failure digoxin may be trialled
If onset >48h the patient will need to be anticoagulated

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16
Q

What does the following ECG show?

A

Asystole

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17
Q

Reversible causes of cardiac arrest

A

“4Hs and 4Ts”

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18
Q

What does the following ECG show?

A

Narrow complex tachy

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19
Q

What does the following ECG show?

A

Torsades de pointes

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20
Q

What does the following ECG show?

A

Ventricular tachycardia

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21
Q

What does the following ECG show?

A

Brugada syndrome - ST elevation in V1–V3, followed immediately by a negative T wave, also known as the ‘Brugada sign

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22
Q

What does the following ECG show?

A

V-fib

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23
Q

What does the following ECG show?

A

Sinus rhythm

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24
Q

What does the following ECG show?

A

Torsades de pointes

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25
VT vs V-fib in terms of consciousness
VT - conscious V-fib - unconscious
26
What does the following ECG show?
V-tach
27
What does the following ECG show?
Polymorphic VT
28
Outline ALS/BLS
29
Which drugs are given during ALS in non-shockable rhythms?
Adrenaline as soon as possible Repeat every 3-5 minutes whilst ALS continues
30
Which drugs are given during ALS in shockable rhythms?
Adrenaline + amiodarone once chest compressions have restarted after the third shock Repeat adrenaline every 3-5 minutes whilst ALS continues Repeat amiodarone after 5 shocks administered
31
Alternative to amiodarone in ALS/BLS?
Lidocaine
32
In BLS/ALS, _________ drugs should be considered if a pulmonary embolus is suspected
Thrombolytic
33
In ALS/BLS, if thrombolytic drugs are given, CPR should be continue for..
60-90 minutes
34
Metabolic acidosis and raised lactate
Sepsis
35
Most common cause of cardiac arrest in children are..
Respiratory - hypoxia
36
What does the following ECG show?
SVT
37
What does the following ECG show?
SVT
38
No discernible P waves, QRS duration 90ms
SVT
39
What does the following ECG show?
Torsades de pointes
40
Tx for Torsades de pointes
IV magnesium sulphate
41
Tx for acute SVT
Valsalva manoeuvre/Carotid sinus massage IV adenosine 6mg → 12mg → 18mg (verapamil if asthmatic) Electrical cardioversion
42
Tx for prevention of SVT
Beta-blockers Radio-frequency ablation
43
Tx for V-tach if adverse signs (systolic BP < 90 mmHg, chest pain, heart failure)
Cardioversion
44
Tx for V-tach if no adverse signs (systolic BP < 90 mmHg, chest pain, heart failure)
Amiodarone through a central line Lidocaine (use with caution in severe left ventricular impairment) Procainamide If drug therapy fails: EPS ICD
45
Differentiate between early (compensated) shock and late (decompensated) shock
46
Sepsis is characterised by..
36C - 38C HR >90 beats/min Respiratory rate >20/min WBC count >12,000/mm3 or < 4,000/mm3
47
Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause _________ peripheries, with the others causing _________ peripheries
Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause warm peripheries, with the others causing cool peripheries
48
What can cause Torsades de pointes?
Hypocalcaemia, hypokalaemia, hypomagnesaemia, hypothermia
49
increased SVR (vasoconstriction in response to low BP) Increased HR (sympathetic response) Decreased cardiac output Decreased blood pressure
Cardiogenic shock
50
Blood volume depletion e.g. haemorrhage, vomiting, diarrhoea, dehydration, third-space losses during major operations Increased SVR Increased HR Decreased cardiac output Decreased blood pressure
Hypovolaemic shock
51
Peripheral vascular dilatation causes a fall in SVR Reduced SVR Increased HR Normal/increased cardiac output Decreased blood pressure
Septic shock
52
Hypovolaemia
53
Cardiogenic shock
54
Most common cause of neutropenic sepsis?
Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis
55
Tx for neutropenic sepsis
Piperacillin with tazobactam (Tazocin) immediately If still febrile and unwell after 48 hours then meropenem +/- vancomycin If no response after 4-6 days then order investigations for fungal infections (e.g. HRCT)
56
Tx for neutropenic sepsis if anticipated they will get it (i.e prophylaxis)
Fluoroquinolone
57
Which shock is delivered in VF/pulseless VT?
Unsynchronized shock at 200 J Synchronised is used in haemodynamically stable patients and can send them to VF
58
In cases of hypothermia causing cardiac arrest, defibrillation is less effective and only 3 shocks should be administered before the patient is...
Rewarmed to 30 degrees centigrade
59
Causes of Torsades de pointes
Antiarrhythmics: amiodarone, sotalol, class 1a Tricyclic antidepressants Antipsychotics Chloroquine Terfenadine Erythromycin
60
Congenital causes of long QT
Jervell-Lange-Nielsen syndrome (deafness and is due to an abnormal potassium channel) Romano-Ward syndrome (no deafness)
61
Drug causes of long QT
Amiodarone, sotalol, class 1a antiarrhythmic drugs TCAs, SSRIs (citalopram) Methadone Chloroquine Terfenadine Erythromycin Haloperidol Ondanestron
62
Other causes of long QT
Hypocalcaemia, hypokalaemia, hypomagnesaemia Acute MI Myocarditis Hypothermia SAH
63
Long QT1 one is associated with..
Exertional syncope, often swimming
64
Long QT2 one is associated with..
Syncope occurring following emotional stress, exercise or auditory stimuli
65
Long QT3 one is associated with..
Events often occur at night or at rest
66
Mx of long QT
Avoid drugs which prolong the QT interval and other precipitants if appropriate (e.g. Strenuous exercise) Beta-blockers (NOT sotalol) ICD in high risk cases
67
The most common variants of LQTS are caused by defects in the alpha subunit of the slow delayed rectifier ________ channel
Potassium
68
A normal corrected QT interval is less than ___ms in males and ___ms in females
A normal corrected QT interval is less than 430 ms in males and 450 ms in females
69
The characteristic ECG findings of a lateral STEMI include...
ST elevation in the lateral leads (I, aVL, V5–V6) Reciprocal ST depression in the inferior leads (II, III, aVF)
70

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