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Houseman (break your leg) > ECG + ACLS > Flashcards

ECG + ACLS Flashcards

1
Q

Sinus bradycardia

A

Investigation

  • Drugs
  • ECG, vitals
  • CK/TNT, TFT, LFT, UCTB

Asymptomatic: no treatment required

Symptomatic

  • Atropine 0.6-1.2mg
  • Pacemaker if recurrent

Etiology: MI, sick sinus, hypothermia, hypoT4, cholestatic jaundice, ICP, drugs (BB, digoxin, verapamil)

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2
Q

Sinus tachycardia

A

Investigation

  • Drugs
  • PE for heart failure
  • ECG
  • TFT, UPT, catecholamine

Etiology: anxiety, fever, anemia, heart failure, thyrotoxicosis, preg, pheo, drugs (B-agonist bronchodilator)

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3
Q

Sick sinus

A

Etiology: fibrosis, degenerative, ischemia of AN

Character: variety of arrhythmia (sinus brady, sinoatrial block, pAF, patrail tachy, AVB)

S/S: palpitation, dizziness, syncope

Mx: pacemaker

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4
Q

Atrial ectopic (extrasystole, premature beat)

A

ECG: P diff morphology

S/S: no Sx, sensation of missed/ strong beat

Significance: herald AF

Mx: BB if bothering symptoms

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5
Q

Atrial tachycardia

A

Etio: automacity, sick sinus, digoxin

ECG: narrow complex tachy with abn P wave +- AVB

Mx: BB if rapid, catheter ablation (ectopic site) for recurrent

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6
Q

Atrial flutter

A

Pathophysio: re-entry within right atrium

ECG: 300bpm, saw tooth, + AVB (2:1, 3:1, 4:1)

S/S: HD compromise

Mx: carotid sinus massage, IV adenosine

  • digoxin, BB, verapamil to control ventricular rate
  • DC cardioversion/ IV amiodarone
  • Cathter ablation
  • NOT flecainide (slow flutter wave> 1:1 AVB> paradoxical tacy)
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7
Q

AF

A

Pathophysio: abn automatic firing (pul veins/ atrial tissue) + multiple re-entry (enlarge atria/ slow conduction)> structural remodelling (fibrosis/ dilatation)

Etiology: CAD, valvular, HTN. hyperthyroidism, chest infection, PE, alcohol, Cm, sick sinus, Congenital heart, pericardial

ECG: irregular QRS, no P wave

Types:

  • Paroxysmal: intermittent, self term in 7days
  • Persistent: prolonged
  • Permanent
  • Lone: structurally normal hearts

S/S: palpitation, SOB, fatigue, chest pain

Ix: Hx, PE, 12leadECG, ECHO, TFT

Mx:
- Paroxysmal: no treatment, BB if bothering symptoms, class1c (propafenine/ flecainide) if no CAD/ LV dysfunction, class3 (amiodarone) if resistant, catheter ablation (disconnect pul vein/ conduction block in atria)

  • Persistent/ permanent
    &raquo_space;> Rhythm control: pharmacological (flecainide/ amiodarone) after IV heparin, electrical DC after warfarn 4/52 with INR 2.0, anticoagulant 3/12 post-cardioversion
    »> Rate control: digoxin, BB, CCB (verapamil/ diltiazem)
    »> Anticoagulation (X atrial contract/ LAD): CHA2DVAS2 score for warfarin (INR 2-3), dabigatran apixaban rivaroxaban

Warfarin reduces stroke by 65%, annual risks of bleeding 1-1.5%
Monitor bleeding condition: peptic ulcer, uncontrolled HTN, alcohol, freq fall, poor drug compliance in anticoagulated patients

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8
Q

AVNRT

A

ECG: 120-240bpm, narrow QRS

Etiology: no structural heart ds

S/S: sudden rapid forceful heartbeat, chest discomfort, lightheadedness, SOB, polyuria (ANP)

Mx: carotid sinus pressure/ valsalva, IV adenosine 3-12mg rapid/ IV verapamil 5mg over 1min, IV BB/ flecainide, DC cardioversion, catheter ablation

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9
Q

WPW

A

Pathophysiology: accessory pathway> premature ventricular activation; + AF = pre-excited AF(!sudden death)

ECG: PR shorten, delta wave, widen QRS

S/S: collapse, syncope, death

Mx: carotid sinus/ valsalva, IV adenosine 3-12mg rapid, DC cardioversion, catheter ablation, prophylactic antiarrhythmic (flecainide/ propafenone)

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10
Q

Ventricular ecotopic

A

ECG: premature, wide, bizarre QRS

Pathophysio: ventricles sequential activation (not simultaneous)> low stroke vol since incomplete filling

Etiology: aging (disappear with exercise)

Types:

  • unifocal (single ectopic focus) v multifocal
  • couplet/ triplet: successive ventricular ectopics
  • bigeminy (alternating sinus and ventricular)

S/S: irregular HB

Mx:

  • healthy sbj: no treatment, BB/ catheter ablation if symptomatic; Ix for underlying cardiac ds (ECHO, exercise stress test)
  • underlying heart ds: BB, anti-arrhythmic, underlying cause
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11
Q

Ventricular tachy

A

Etiology: extensive ventricular ds, hypoK/Mg, acidosis, hypoxemia

Pathophysiology: ventricle automated/ triggered (ischemic focus)> re-entry (scar tissue)

ECG: 120bpm, v broad QRS (>140ms), AV dissociation, capture/ fusion beat, extreme left axis, no response to carotid sinus massage/ adnenosine

Significance: HD compromise, herald VF

S/S: palpitation, dizziness, SOB, syncope

Types:

  • slow VT (idioventricular rhythm in postMI): reperfusion of infarct territory
  • normal heart VT

Mx

  • SBP <90: synchronized DC cardioversion
  • No HD compromise: IV amiodarone, lidocaine (if not LV dysfunction)
  • Correct VT underlying cause
  • Prevent recurrence: BB, amiodarone, cardiac defibrillator if LV dysfuction, HD compromise)
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12
Q

Torsades de pointes

A

Form of polymorphic VT

Due to prolonged ventricular repolarization (QT >0.43 in women, >0.45 in men)

Etiology:

  • bradycardia
  • electrolyte (hypoK, hypoMg, hypoCa)
  • drugs (flecainide, sotalol, amiodarone, chlorpromazine, erythromycin/ doxycyline)
  • congenital long QT

Mx:

  • IV Mg 8mmol over 15mins, then 72mmol over 24hours
  • IV isoprenaline/ pacing
  • LT: BB, defibrillator if extreme prolong QT>500/ congenital, left stellate ganglion block if resistant
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13
Q

AVB

A

first degree: prolong PR >0.2, no Sx

second degree:

  • Mobitz I/ wenckebach: progressive long then drop, due to physio (rest/sleep/athelete) OR patho
  • Mobitz II: constant long with drop

third degree (complete heart block):

  • due to congenital, fibrosis, MI, inflam (IE abscess, sarcoidosis), trauma, drugs (digoxin, BB)
  • AV dissociation, ventricular by escape
  • ventricular rate 25-50min
  • large volume pulse (compensatory increase stroke vol)
  • cannon wave

stoms adams attack

  • ventricular asystole complicating Mobitz II/ CHB
  • sudden LOC without warning, collapse, rapid recovery

Mx

  • symptomatic + second/ third degree: IV atropine 0.6mg, temporary pacemaker
  • asystole: IV atropine 3mg/ IV isoprenaline 2mg in 500mL D5 infused at 10-60mL/H, transcutaneous pacing
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14
Q

BBB

A

/

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15
Q

ACLS Bradycardia approach

A
  • <50bpm
  • ABC
  • cardiac monitor, BP SpO2, IV access
  • 12 lead ECG
  • HD unstable: (hypotension, mental, shock sign, chest discomfort, acute heart failure)
  • Atropine IV: 0.5mg bolus, repeat 3-5mins, max 3 mg
  • If atropine ineffective:
    &raquo_space;» transcutaneous pacing
    &raquo_space;» dopamine infusion: 2-20mcg /kg per min
    &raquo_space;» epinephrine infusion: 2-10mcg per min infusion
  • Consult + transvenous pacing
  • HD stable: observe
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16
Q

ACLS tachycardia approahc

A
  • > 150bpm
  • ABC
  • cardiac monitor, bp, SpO2
  • HD unstable: (hypotension, mental, shock, chest discomfort, acute heart failure)
  • Synchronized CD +- adenosine (narrow)
  • HD stable + wide complex
    &raquo_space;» synchronized CD
    &raquo_space;» adenosine IV 6mg rapid push then NS flush> 2nd dose 12mg prn if REGULAR MONOMORPHIC
    &raquo_space;» procainamide IV 20-50mg/min till arrhythmia suppressed + hypotension ensue + QRS duration inc >50% (max dose 17mg/kg) then maintenance 1-4mg/min for maintenance (NOT for QT prolong/ CHF)
    &raquo_space;» amiodarone IV 150mg over 10mins, repeat if VT recur, then maintenance 1mg/min in first 6H
    &raquo_space;» sotalol IV 100mg (1.5mg/kg) over 5 mins (NOT for QT prolong)
 - HD stable + narrow complex
 >>>> IV access + 12 leadECG
 >>>> vagal maneouver
 >>>> adenosine IV 6mg rapid push then NS flush > 2nd dose 12mg prn
 >>>> BB/ CCB
17
Q

ACLS VF/ pVT vs PEA/ asystole

A
  • CPR + O2 + defib
  • shockable (VF/pVT): shock > CPR 2min > shock > CPR 2min + epinephrine IV 1mg q3-5mins> shock > CPR 2mins + amiodarone IV 300mg bolus then 150mg 2nd dose
  • non-shockable (PEA/ aystole): CPR 2min + epinephrine IV 1mg q3-5min > CPR 2 min > CPR 2 min + epinephrine IV 1mg q3-5min
  • THINK cause: hypovolemia, hypoxia, H+, hypohyperK, hypothermia/ tension PTX, tamponade, toxin, thrombosis x2
18
Q

ACLS ROSC

A
  • pulse and bp
  • abrupt sustained inc PETCO2 (>50mmHg)
  • Spontaneous arterial pressure with IA monitoring
  1. optimize oxygenation (SpO2 >94%, advanced ariway and waveform capnography)
  2. treat hypotension (SBP <90): IV bolus, vasopressor, treatable cause
    &raquo_space;» IV bolus 1-2L NS/ lactated ringer
    &raquo_space;» epinephrine IV 0.1-0.5mcg/kg per min (70kg ~7-35mcg permin)
    &raquo_space;» dopamine IV 5-10mcg/kg per min
    &raquo_space;» norepinephrine IV 0.1-0.5mcg/kg per minute
  3. 12 lead ECG
  4. targeted temp managmement (32-36 at least 24H)
  5. command?

Houseman (break your leg) (23 decks)

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