Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3: Medicine Block CARDIORESPIRATORY year 5 > Peri-Arrest Rhythms > Flashcards

Peri-Arrest Rhythms Flashcards

1
Q

What do you generally look for in any Arrhythmias?

A
  • Chest pain
  • Hypotension
  • Pulmonary Oedema
  • Palpitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are general tests for Arrhythmias?

A
  • Bloods: FBC, U &E’s, calcium levels, magnesium levels, TSH.
  • ECG: look for signs of IHD, Atrial Fibrillation, Short PR interval (WPW syndrome), Long QT interval (metabolic imbalance, drugs, congenital), U waves (hypokalaemia), -
  • 24h ECG monitoring
  • Echocardiography: structural heart disease
  • Provocation tests: Exercise ECG, Cardiac Catheterization +- electrophysiological studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are categories of patients in Bradycardia?

A
  • Patients with rate is less than 40 bpm and symptomatic
  • Patients who are asymptomatic and rate is more than 40 bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are factors to consider in patient who have a rate of less than 40 bpm and symptomatic?

A
  • Shock
  • Syncope
  • Myocardial ischaemia
  • Heart failure

Signify haemodynamic compromise and need for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are symptoms of shock?

A
  • Hypotension (systolic blood pressure < 90 mmHg)
  • Pallor
  • Sweating
  • Cold
  • Clammy extremities
  • Confusion
  • Impaired consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are factors to consider in patient who have a rate of more than 40 bpm and asymptomatic?

A

Look for a cause such as:

  • Drugs and stop
    • beta blocker
    • digoxin
  • Sick sinus syndrome
  • Hypothyroidism

Dont treat in this case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of Periarrest: Bradycardia?

A

1st Line: Atropine (500mcg IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of Periarrest: Bradycardia if no response to Atropine?

A

If there is an unsatisfactory response,

  • Atropine, up to maximum of 3mg
  • Transcutaneous pacing
  • Isoprenaline/adrenaline infusion titrated to response

Specialist help should be sought for consideration of transvenous pacing if there is no response to the above measures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are risk factors for Asystole?

A
  • Complete heart block with broad complex QRS
  • Recent asystole
  • Mobitz type II AV block
  • Ventricular pause > 3 seconds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is done if risk factors for Asystole identified but Atropine works?

A

Specialist help is indicated to consider the need for transvenous pacing:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is Sick Sinus Syndrome managed?

A

Dual chamber pacing is recommended for the management of symptomatic bradycardia due to sick sinus syndrome, atrioventricular block or a combination of Sick sinus syndrome and atrioventricular block (except in frail patients who won’t benefit or patient with continuous atrial fibrillation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Sick Sinus Syndrome?

A

Symptomatic Bradycardia (sick sinus syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are patients classified in Periarrest: Tachycardia?

A

ABCDE assessment to classify patients as stable or unstable according to the presence of any adverse signs:

  • Shock
  • Syncope
  • Myocardial ischaemia
  • Heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is done with unstable patient in Periarrest: Tachycardia?

A

Synchronised DC shocks should be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the narrow complex tachycardia?

A

Narrow complex tachycardia

  • Rate is >100bpm
  • QRS width <120).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are differentials for narrow complex tachycardia?

A
  • Sinus Tachycardia: normal P wave followed by normal QRS
  • Supraventricular Tachycardia: P wave absent or inverted after QRS
  • Atrial Flutter: atrial rate is usually 300 bpm giving flutter waves or sawtooth base line, ventricular rate often 150 bpm
  • Atrial Tachycardia: abnormally shaped P waves, may outnumber QRS (consider digoxin, Maintain potassium at 4-5mmol/L)
  • Multifocal Atrial Tachycardia: 3 or more P wave morphologies, irregular QRS complexes (commonly COPD. Correct hypoxia and hypercapnia. Consider verapamil or beta-blocker if rate remains >110bpm)
  • Junctional Tachycardia: rate is 150-250 bpm, P wave either buried in QRS complex or occurring after QRS complex
17
Q

How are Regular Rhythm Periarrest tachycardias managed?

A
  • Vagal Manoeuvres (carotid sinus massage, Valsalva manoeuvre) transiently increase AV block and may unmask underlying atrial rhythm
  • Give IV adenosine if unsuccessful with vagal manoeuvres which causes transient AV block.
  • If above unsuccessful consider diagnosis of atrial flutter and control rate (e.g. Beta-blockers)
18
Q

How are Irregular rhythm Periarrest tachycardias managed?

A
  • Probable Atrial fibrillation
    • If onset < 48 hr consider electrical or chemical cardioversion
    • Rate control (e.g. Beta-blocker or digoxin) and anticoagulation
19
Q

What is maintenance therapy in Periarrest tachycardias?

A

Maintenance therapy is

  • Beta-blockers
  • Verapamil
20
Q

What is a Broad complex tachycardia?

A

Broad complex tachycardia

  • >100bpm
  • QRS >120ms
21
Q

What are the differential diagnosis in Broad Complex Tachycardia?

A
  • Ventricular Tachycardia including torsade de pointes
  • Supraventricular tachycadia with aberrant conduction eg AF, Atrial Flutter
22
Q

What are investigations for Periarrest Broad Complex Tachycardia?

A
  • ECG: positive QRS in concordance in chest leads, marked left axis deviate, AV dissociation or 2:1 or 3:1 AV block
  • Fusion beats or capture beats
23
Q

What is done in patient with ventricular fibrillation?

A

DC shock

24
Q

What is used to treat Regular Broad Complex Ventricular Tachycardia?

A

Loading dose of Amiodarone followed by 24 hour infusion

25
Q

What is used to treat Irregular Broad Complex Ventricular Tachycardia?

A

AF with bundle branch block

  • Treat as for narrow complex tachycardia

Polymorphic VT (e.g. Torsade de pointes) - IV magnesium

26
Q

What are general management procedures with Periarrest Tachycardia?

A
  • Give high flow oxygen if indicated
  • Obtain IV access: send U&E’s, Cardiac enzymes, Ca2+, Mg2+.
  • Correct low K+ or Mg2+
  • Obtain a 12 lead ECG
  • Arterial Blood Gases if evidence of pulmonary oedema, reduced conscious level, sepsis
27
Q

When is an implantable cadioverter defribillation indicated for Ventricular Arrhythmia?

A

Treating people with previous serious ventricular arrhythmia without treatable cause:

  • Survived a cardiac arrest caused by either ventricular tachycardia or ventricular fibrillation or
  • Spontaneous sustained ventricular tachycardia causing syncope or significant haemodynamic compromise or
  • Sustained ventricular tachycardia without syncope or cardiac arrest and also have associated reduction in left ventricular ejection fraction of less than 35% and their symptoms are no worse than class 3.

Treating people who:

  • Have a familial cardiac condition with a high risk of sudden death such as long QT syndrome, hypertrophic cardiomyopathy, brugada syndrome or arrhythmogenic right ventricular dysplasia

Year 3: Medicine Block CARDIORESPIRATORY year 5 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions