Peri-arrest rhythms Flashcards
What does the management of bradycardia depend on?
- Identifying the presence of signs indicating haemodynamic compromise - ‘adverse signs’
- Identifying the potential risk of asystole
Give examples of advserse signs which indicate heamodynamic compromise during peri-arrest bradycardia?
- Shock:
- hypotension (systolic blood pressure < 90 mmHg)
- Pallor
- Sweating
- Cold
- Clammy extremities
- Confusion or impaired consciousness
- Syncope
- Myocardial ischaemia
- Heart failure
What is the treatment for advserse signs during bradycardia?
- Atropine (500mcg IV) is the first line treatment in this situation
- 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.
What are risk factors of asystole?
- 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
What should be given in the event of adverse signs in perri-arrest tachycardias?
- Synchronised DC shocks should be given
- Treatment following this is given according to whether the:
- QRS complex is narrow or broad
- Rhythm regular or irregular
If there are adverse signs then what is the patient classified as?
Unstable
Management for broad-complex tachycardia with regular rhythm?
- Assume ventricular tachycardia (unless previously confirmed SVT with bundle branch block)
- Loading dose of amiodarone followed by 24 hour infusion
Management of broad-complex tachycardia with irregular rhythm?
- AF with bundle branch block - treat as for narrow complex tachycardia
- Polymorphic VT (e.g. Torsade de pointes) - IV magnesium
What is the management for narrow-complex tachycardia with regular rhythm?
- vVgal manoeuvres followed by IV adenosine
- If above unsuccessful consider diagnosis of atrial flutter and control rate (e.g. Beta-blockers)
Management of narrow-complex tachycardia with irregular rhythm?
- Probable atrial fibrillation
- If onset < 48 hr consider electrical or chemical cardioversion
- Rate control (e.g. Beta-blocker or digoxin) and anticoagulation