Peri-arrest arrhythmias Flashcards
What adverse features are signs of potential deterioration in an arrhythmia?
Shock - Low BP, Pallor, Sweating, Cold, Confusion, Low S/S
Syncope - Transient LOC
HF - Pulmonary Oedema / Raised JVP
M. Ischaemia - CP or on ECG
Extremes of HR (> 150 or < 40) (This may be less in people with severe lung disease or HF)
What are Tx options for peri-arrest arrhythmia?
None
Vagal manoeuvres, Percussion pacing
Drugs
Electrical
Correct electrolyte abnormalities
In Synchronised Shock, when is the shock delivered
On the R wave
What Joules for cardioversion
Broad QRS or AF - 120-150J
Narrow QRS or Flutter - 70-120J
If cardioversion fails, then what (and adverse features remain)?
Give amiodarone 300mg IV over 10-20 mins and attempt another shock
Then give 900mg amiodarone over 24 hours
What is broad vs narrow complex?
0.12 s (3 small squares) or larger is broad - They can be ventricular or SVT with aberrant conduction like a BBB
<0.12 s is narrow
What are the potential rhythms of irregular broad complex?
AF, or AF with pre-excitation like WPW, or polymorphic VT like torsade de pointes
What are common narrow complex tachycardias?
ST, AVNRT, AVRT, Atrial flutter or AF
Do NOT treat ST - Treat the underlying problem
Tx of regular narrow complex tachyarrhythmia?
Synchronised cardioversion if unstable
Otherwise, vagal and adenosine
You can try vagal / adenosine while defib is being prepared
If in SVT and not flutter, adenosine is contraindicated or doesn’t work, what other drug can you try?
Verapamil 2.5-5mg over 2 min
What kind of rhythm is an irregular narrow complex tachycardia?
AF and much less common is Atrial flutter with variable AV conduction
If in AF for greater than 48 hours, what needs to happen before cardioversion
TOE or fully anticoagulated
After cardioversion of AF, what drug therapies should be immediately started?
low molecular weight heparin or unfractionated heparin
If amiodarone is used with AF, how?
300mg over 20-60 mins and then the 900mg over 24 hrs
Run through the Tachy Algo
Run through the Brady Algo
Be wary of atropine in mi / ischaemia as it can worsen damage
What rate is brady?
< 60 HR
What causes bradycardia?
Sleep, fitness
AV block, sinus disease, MI
Vagal, low temp, hypothyroid, hyperk+
Beta block, diltiazem, digoxin, amiodarone
When to be weary with atropine?
MI or ischaemia
Do not give atropine to heart transplant patients - hearts are denervated - causing sinus arrest or AV block
If torsades, what tx
If adverse features, then what
If pulseless, then what
Stop all qt prolongation drugs
Correct electrolytes (esp hypokalemia)
Consider mgso4 2g over 10 minutes
Seek expert help and sync cardioversion
If pulseless, defib immediately
If the patient is narrow complex tachy but with no pulse
This is an exception to pea rules
Gets immediate synchronised shock at 200j or if not possible just defib
