Interventions

Question 1

A Fib (Atrial Fibrillation)

Answer 1

Normal cardiac function: give CCBs and BBs
Impaired function: Digoxin, Amiodarone

Serious: cardioversion

Long-term: anticoags, BB/Digoxin

Question 2

Atrial Flutter

Answer 2

(saw tooth fence)
Vagal maneuvers (bearing down, squat, face in water, carotid massage)

If serious: cardioversion

Question 3

SVT

Answer 3

Vagal maneuvers
Adenosine
Cardioversion (if Adenosine doesn’t work)

Question 4

Cardioversion

Answer 4

defibrillator, delivers shock at timed interval for QRS

SVT, A fib, A flutter, VT (WITH PULSE)

Question 5

Junctional escapes (basically SVT)

Answer 5

Stop Digoxin
Start Atropine
Transcutaneous pacing

May start Dopamine/Epi IV

Question 6

PVCs

Answer 6

Find cause and eliminate/decrease (eg stress, caffeine, electrolyte imbalance)
If acute, as in MI, use ONAM!

Question 7

V Tach

Answer 7

Stable pt: O2, IVF, anti-dysrhythmic meds
Unstable (WITH pulse): O2, IVF, sedation, cardioversion

Pulseless (unstable): CPR til defibrillator arrives

Question 8

Polymorphic V Tach (eg Torsades)

Answer 8

12 lead ECG
Stop anti-dysrhythmics, over drive pacing
OR..
give Magnesium, Isoproterenol, Lidocaine, Phenytoin
May need defibrillator is sustained episode

Question 9

V Fib

Answer 9

Check the pulse first!
CPR
Defibrillator
Intubation
IV access
Meds per resuscitation guideline

Question 10

Defibrillation

Answer 10

Produces momentary asystole

V fib, pulseless VT, sustained TdP
In the case of delayed synchronized cardioversion

Question 11

Asystole

Answer 11

DO NOT shock
Confirm no pulse
CPR
Confirm no rhythm with 2 lead
Intubation
IV
Treat the cause if possible
Transcutaneous pacing