Peri-arrest arrhytmias

Question 1

What are 4 adverse features that would suggest an unstable patient?

Answer 1

Question 2

What patients can you not use adenosine for ?

Answer 2

Patients with asthma

Question 3

What is the INITIAL management of a patient with Adult tachyacrdia ?

Answer 3

SPO2 >94
IV access.
Monitor ECG.
12 lead ECG.
BP.

Look for reversible causes.

Life threatening features

Question 4

This is your patient:

RR 18
BP 87/50
SPO2 94%
HR 170

What is this?
What is your management?

Answer 4

IV access

Unstable Tachycardia

Cardioversion - Up to 3 attempts.

If unsuccessful amiodarone 300mg IV over 10-20 hocks then repeat synchronised DC shock.

Question 5

This is your patient

rr 16
Bp 120/80
spo2 98%
HR 170
Concious.

What is our management.?

Answer 5

Vagal Manoevoures.

If ineffective

1 - Give adenosine 6mg rapid IV bolus.

2- If unsuccessful give 12 mg rapid IV bolus.

3- If unsuccessful give 18 mg rapid IV bolus.

• MONITOR ECG CONTINOULSY.

If ineffective try veramapril or beta blocker.

If ineffective synchronised DC should take up to 3 attempts after anaesthesia if concious.

Question 6

This is your patient:

RR 18
BP 111/32
spo2 96
Pulse 150

They have raised JVP >4 cm
Pitting Odema to both legs
Bi basal crackles

What is your management ?

Answer 6

Broad Spectrum unstable VT

IV access

Unstable Tachycardia

Cardioversion - Up to 3 attempts.

If unsuccessful amiodarone 300mg IV over 10-20 hocks then repeat synchronised DC shock.

Question 7

This is your patient:

RR 18
BP 111/32
spo2 96
Pulse 150

What is your management?

Answer 7

IV Access

Amiodarone 300mg IV over 10-60 minutes.