Resus Pearls, part 3

Question 1

the antiarrhythmic of choice for wide-complex tachycardia in a stable patient

Answer 1

Procainamide

Amiodarone and lidocaine are less effective

Question 2

Considered to have nonsustained ventricular tachycardia

Answer 2

patients with greater than 3 PVCs in a row

Question 3

Remarks on CHA2S2-VASc

Answer 3

a CHADS2 score of 0
or CHA2DS2-VASc socre of 0 or 1
are low-risk patients

Question 4

Remarks on paroxysmal atrial fibrillation

Answer 4

1. For patients with paroxysmal atrial fibrillation or acute medical conditions producing atrial fibrillation, a period of observation and traetment in the ED is appropriate as the atrial fibrillation may spontaneously convert within 48 to 72 hours
2. Ventricular rate control may help symptoms until conversion.
3. The goal for rate control is a ventricular rate of <100 bpm at rest

Question 5

For patients with recent-onset atrial fibrillation and a rapid ventricular response that is producing hypotension, myocardial ischemia, or pulmonary edema, treat with _________

Answer 5

urgent electrical cardioversion

Question 6

What is a complex atrial fibrillation

Answer 6

1. In situations involving atrial fibrillation with rapid ventricular response and an active, significant underlying acute medical issue (e.g., sepsis, severe hypovolemia, pulmonary embolism, alcohol withdrawal), the presentation can be described as complex atrial fibrillation
2. In these presentations, management priority is focused on treating the underlying medical issue while NOT emplOying standard rate and rhythm control therapies in the early stages of care

Question 7

Remarks on disposition with atrial fibrillation

Answer 7

1. No proven benefit for conversion of all new atrial fibrillation patients to sinus rhythm while in the ED.
2. The patient with new-onset atrial fibrillation who is stable can certainly be managed with rate control alone, either as an inpatient or outpatient depending on overall clinical condition

Question 8

Should be avoided in WPW patients

Answer 8

Agents that can enhance conduction in the accessory tract and/or block conduction in the AV node.
These include adenosine, amiodarone, B-blockers, CCBs

Question 9

Most common clinical feature of Long QT syndrome

Answer 9

Syncope

Question 10

Most common dysrhythmia in symptomatic patients with long QT sndrome

Answer 10

Torsades de Pointes

Question 11

Most common adverse effect of hyperbaric oxygen treatment

Answer 11

middle ear barotrauma