Tachydysrhythmia

Question 1

Tachydysrhythmia Indications

Answer 1

Symptomatic tachydysrhythmia

Question 2

VALSALVA MANEUVER
Conditions
Age?
LOA?
HR?
SBP?
Other?

Answer 2

Age: ≥ 18 years
LOA: Unaltered
HR: ≥150
SBP: Normotension
Other: Narrow complex AND Regular Rhythm

valsalva for stable SVT

Question 3

VALSALVA MANEUVER
Contraindications

Answer 3

Sinus Tachycardia
Atrial Fibrillation
Atrial Flutter

Question 4

VALSALVA MANEUVER
Describe modified technique
How many Attempts? Lasting how long in duration each?

Answer 4

Have pt sitting position, blow into 10cc syringe for 10 seconds, stop blowing into syringe, lay pt down and bring feet up - hold position
Max # of attempts: 2
Duration: last 10 - 20 seconds each

Question 5

ADENOSINE
Conditions
Age?
LOA?
HR?
SBP?
Other?

Answer 5

Age: ≥ 18 years
LOA: Unaltered
HR: ≥150
SBP: Normotension
Other: Narrow complex AND Regular Rhythm

adenosine for stable SVT

Question 6

ADENOSINE
Contraindications

Answer 6

1. Allergy or sensitivity
2. Sinus Tachycardia, Atrial Flutter, Atrial Fibrillation
3. patient taking DYPRIDAMOLE or CARBAMAZEPINE
4. Bronchoconstriction on exam

Carbamazepine - TEGRETOL
Dypridamole - PERSANTINE

Question 7

ADENOSINE
Route - IV
Initial Dose?
Subsequent Dose?
Dosing Interval?
Max # of Doses?

Answer 7

Initial Dose: 6mg
Subsequent Dose: 12mg
Dosing Interval: 2mins
Max # of Doses: 2

Rapid push followed by immediate flush
Half life less than 10sec

Question 8

AMIODARONE
Conditions
Age?
LOA?
HR?
SBP?
Other?

Answer 8

Age: ≥ 18 years
LOA: Unaltered
HR: ≥120
SBP: Normotension
Other: WIDE complex AND Regular Rhythm

Amio - Class 3 - K channel blocker some Na, Ca & Beta antagonist as well

Question 9

LIDOCAINE
Conditions
Age?
LOA?
HR?
SBP?
Other?

Answer 9

Age: ≥ 18 years
LOA: Unaltered
HR: ≥120
SBP: Normotension
Other: WIDE complex AND Regular Rhythm

Lido - Class 1b - Na channel Blocker

Question 10

AMIODARONE
Route - IV
Initial Dose?
Subsequent Dose?
Max. Single Dose?
Dosing Interval?
Max # of Doses?
How long should be infused over?

Answer 10

Initial Dose: 150mg
Subsequent Dose: 150mg
Max. Single Dose: 150mg
Dosing Interval: 10mins
Max # of Doses: 2
How long should be infused over: infused over 10 mins

Question 11

LIDOCAINE
Route - IV
Initial Dose?
Subsequent Dose?
Max. Single Dose?
Dosing Interval?
Max # of Doses?

Answer 11

Initial Dose: 1.5mg/kg
Subsequent Dose: 0.75mg/kg
Max. Single Dose: 150mg
Dosing Interval:10mins
Max # of Doses: 2

Question 12

Synchronized Cardioversion
Conditions
Age?
HR?
SBP?
OTHER?

Answer 12

Age: ≥ 18 years
HR: ≥ 120 [wide] OR ≥ 150 [narrow]
SBP: Hypotension
Other: Altered mental status, Ongoing Chest pain, Signs of Shock

Question 13

Synchronized Cardioversion
Patch Failure energy settings?

Answer 13

100J, 200J and maximum manufacterer setting

Question 14

Mandatory Patch Points in Tachydysrhythmia medical directive?

Answer 14

1. Synchronized Cardioversion (usually ask for sedation as well)
2. To run amiodarone or push lidocaine IV
3. Adenosine for wide monomorphic complex rhythm

Question 15

Maximum safe dose of Lidocaine (mg/kg)?

Answer 15

3mg/kg

Question 16

Topical Doses and IV doses of Lidocaine are to be considered towards total dose (mg/kg)?

Answer 16

Yes any dose of lidocaine given is to be attributed to maximum allowance of 3mg/kg