Peri-arrest rhythms; bradycardia & tachycardia

Question 1

What are the adverse signs of bradycardia and peri-arrest?

Answer 1

1. shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
2. syncope
3. myocardial ischaemia
4. heart failure

Question 2

First line treatment for bradycardia and peri-arrest?

Answer 2

Atropine (500mcg IV) is the first line treatment in this situation.

Question 3

What are the risk factors for asytsole in bradycardia (peri-arrest) even with a satisfactory response to atropine?

Answer 3

The following are risk factors for asystole. Even if there is a satisfactory response to atropine specialist help is indicated to consider the need for transvenous pacing:
• complete heart block with broad complex QRS
• recent asystole
• Mobitz type II AV block
• ventricular pause > 3 seconds

Question 4

What are the adverse signs of tachycardia and peri-arrest?

Answer 4

1. shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
2. syncope
3. myocardial ischaemia
4. heart failure

Question 5

First line treatment for tachycardia and peri-arrest?

Answer 5

If any of the above adverse signs are present then synchronised DC shocks should be given. Up to 3 shocks can be given; after this expert help should be sought.

Question 6

What are the 2 categories for broad complex tachycardia?

Answer 6

1. Regular

2. Irregular

Question 7

What are the causes of irregular broad complex tachycardia?

Answer 7

1. atrial fibrillation with bundle branch block
2. atrial fibrillation with ventricular pre-excitation
3. torsade de pointes

Question 8

Treatment for regular & irregular broad complex tachycardia

Answer 8

Regular
> assume ventricular tachycardia (unless previously confirmed SVT with bundle branch block)
> loading dose of amiodarone followed by 24-hour infusion

Irregular
> seek expert help.

Question 9

Treatment for regular & irregular Narrow complex tachycardia

Answer 9

Regular
> vagal manoeuvres followed by IV adenosine

Irregular
> if onset < 48 hr consider electrical or chemical cardio version
> rate control: beta-blockers are usually first line unless there is a contraindication

Question 10

What are the 2 categories for narrow complex tachycardia?

Answer 10

1. Regular

2. Irregular