Peri-arrest rhythms Flashcards

1
Q

What does the management of bradycardia depend on?

A
  1. Identifying the presence of signs indicating haemodynamic compromise - ‘adverse signs’
  2. Identifying the potential risk of asystole
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2
Q

Give examples of advserse signs which indicate heamodynamic compromise during peri-arrest bradycardia?

A
  1. Shock:
  • hypotension (systolic blood pressure < 90 mmHg)
  • Pallor
  • Sweating
  • Cold
  • Clammy extremities
  • Confusion or impaired consciousness
  1. Syncope
  2. Myocardial ischaemia
  3. Heart failure
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3
Q

What is the treatment for advserse signs during bradycardia?

A
  1. Atropine (500mcg IV) is the first line treatment in this situation
  2. If there is an unsatisfactory response the following interventions may be used:
  • 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.

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4
Q

What are risk factors of asystole?

A
  • Complete heart block with broad complex QRS
  • Recent asystole
  • Mobitz type II AV block
  • Ventricular pause > 3 seconds

Even** if there is a **satisfactory response to atropine** specialist help is indicated to consider the need for **transvenous pacing

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5
Q

What should be given in the event of adverse signs in perri-arrest tachycardias?

A
  1. Synchronised DC shocks should be given
  2. Treatment following this is given according to whether the:
    • QRS complex is narrow or broad
    • Rhythm regular or irregular
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6
Q

If there are adverse signs then what is the patient classified as?

A

Unstable

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7
Q

Management for broad-complex tachycardia with regular rhythm?

A
  • Assume ventricular tachycardia (unless previously confirmed SVT with bundle branch block)
  • Loading dose of amiodarone followed by 24 hour infusion
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8
Q

Management of broad-complex tachycardia with irregular rhythm?

A
  1. AF with bundle branch block - treat as for narrow complex tachycardia
  2. Polymorphic VT (e.g. Torsade de pointes) - IV magnesium
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9
Q

What is the management for narrow-complex tachycardia with regular rhythm?

A
  1. vVgal manoeuvres followed by IV adenosine
  2. If above unsuccessful consider diagnosis of atrial flutter and control rate (e.g. Beta-blockers)
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10
Q

Management of narrow-complex tachycardia with irregular rhythm?

A
  1. Probable atrial fibrillation
  2. If onset < 48 hr consider electrical or chemical cardioversion
  3. Rate control (e.g. Beta-blocker or digoxin) and anticoagulation
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