Salman’s Vids

Question 1

How would you approach an unstable patient with tachycardia?

Answer 1

UNSTABLE = shock

Question 2

How would you approach an unstable patient with bradycardia? And if they were stable?

Answer 2

UNSTABLE= transcutaneous pacing
STABLE= Atropine

Question 3

P/x comes in w/ arrythmia, first thing you do is check if they’re stable or unstable.

How would you define an unstable p/x?

Answer 3

1. BP <90/70
2. Severe chest pain
3. Unconscious
4. Drowsy

Question 4

Which type of arrhythmias would you treat with a:
1. Synchronized DC shock
2. Unsynchronized shock

Answer 4

1. Synchronized DC shock for v-tachycardias with regular R-R interval:
   - Ventricular Tachycardias
   - SVT
2. Unsynchronized shock for irregular R-R interval:
   - V-Fib

Question 5

A 22 Year old male presented to you with Palpiations and shortness of breath. His BP = 60/40. He became Dizzy and Unconscious. Urgent ECG was done and showed this.
What’s the next step in management?

A- Vagal maneuver
B- Synchronized DC shock
C- Adenosine
D- Transcutaneous pacing
E- Unsynchronized DC Shock

Answer 5

B- Synchronized DC shock

ECG indicates SVT: no p-waves but regular R-R interval

unstable p/x ( ↓ bp, dizzy, unconscious) = SHOCK

Question 6

A 72 Year old male was admitted due to Syncope. While in hospital he lost his consciousness again.
His ECG is shown Below.
What is the next step in management?

A- Transcutaneous pacing
B- Atropine
C- Adenosine
D- DC shock

syncope: temporary loss of consciousness

Answer 6

A- Transcutaneous pacing

why not atropine? bc we mentioned that the p/x is unstable

ECG shows bradycardia (3rd degree HB)
- Extremely ↓ HR: 6 (# of QRS) x 6 = 36 bpm
- PR prolongation
- Random P waves

Question 7

A p/x comes in with SVT, what’s the 1st line medication would you give them?

Answer 7

Adenosine

if they were unstable → shock

Question 8

types of SVT?

Answer 8

AVRT (WPW)
AVNRT

Question 9

treatment of SVT?

Answer 9

A. Vagal maneuvar
B. Adenosine
C. Shock

if the 1st one didnt work, move on to the next

Question 10

A 24 Year old male presented with palpitations.
His ECG is shown below.
He is hemodynamically stable.
What is the first line management?

A- Amiodarone
B- Adenosine
C- Atropine
D- Shock

Answer 10

B- Adenosine

ECG shows SVT

Question 11

What’s the drug of choice for WPW?

Answer 11

Flecanide

it slows down the HR w/o affecting the AV node.

Question 12

So we give Adenosine as a 1st drug of choice for SVTs EXCEPT?
+ explain why?

Answer 12

except WPW;AVRT
reason: Adenosine ↓HR by affecting the AV node, however in WPW, the impulse is already skipping the conduction pathway (thru the AV node) & goes through the buncle of kent instead (accessory pathway), so why would we slow down the AV node.

Question 13

T/x of WPW?

Answer 13

• Flecunide (temp solution)
• Ablation of accessory pathway (permanent solution)

Question 13

A 24 Year old male presented with palpitations. His ECG is shown below.
1. Which of the following is the definitive treatment?
2. Which drug can be used in Acute setting?
3. Which drugs are contraindicated?

Shortened PR interval & Delta wave

Answer 13

1. Ablation of accessory pathway
2. Flecunide
3. ABCD (they ↓HR by affecting the AV node)

ECG showed WPW

Question 14

“irregulary irregular pulse”

Answer 14

A-Fib