Emergency/Arrhythmias

Question 1

pulseless

Answer 1

v fib
v tach
PEA
asystole

START WITH CPR

Question 2

asystole

Answer 2

epinephrine

vasoconstriction shunts blood to brain

Question 3

v fib- no organized electrical activity

Answer 3

CPR
unsynchronied cardioversion=defibrillation
epinephrine
defibrillation again
can try amiodarone or lidocaine

shock drug shock drug shock drug with CPR in between

Question 4

unsynchronized cardioversion

Answer 4

v fib

pulseless v tach

Question 5

v tach-wide complex tachycardia with regular rate

Answer 5

pulseless- shock drug shock rug w/ CPR
stable hemodynamic-amiodarone, lidocaine, procainamide
unstable hemodynamic- synchronized cardioversion several times

Question 6

hemodynamic instability for arrhythmias

Answer 6

chest pain
dyspnea/CHF
hypotension
confusion

Question 7

Pulseles electrical activity

Answer 7

electrically normal (normal EKG)
but no motor activity (no pulse)
NOT SHOCKABLE RHYTHM

correct underlying cause-tamponade, pneumothorax, hypovolemia or glycemia

Question 8

atrial fibrillatin

Answer 8

irregularly irregular
no P waves

stable

1. synchronized cardioversion
2. control rate with beta blocker, Ca2+ etc
3. antigoagulate

Question 9

atrial flutter

Answer 9

regular rhythm with saw tooth pattern

stable

1. synchronized cardioversion
2. control rate with beta blocker, Ca2+ etc
3. antigoagulate

Question 10

dabigatran

Answer 10

alternative to warfarin
does not require monitoring
oral

Question 11

superventricuar tachycardia

Answer 11

palpitations and patient stable
REGULAR narrow complex tachycardia without p waves
if see no P and thinking a fib-check how regular, if regular-think SVT
1. vagal manuevers
2. adneosine
3. beta blockers

Question 12

Wolff Parkinson White

Answer 12

SVT with occasional v tach, delta waves
Tx
1. procanamide or amiodarone
chronic-ablation
DO NOT USE digoxin or Ca2+ channel blockers

Question 13

Bradycardia

Answer 13

1. do ekg
2. asymptomatic and sinus–>no tx, symptomatic–>atropine
3. first degree- same as sinus
4. 2nd degree with lengthening (type 1 or wenkeback)-no tx if asymptomatic
5. type II-randomly dropped beat–>pacemaker
6. 3rd degree-pacemaker