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ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.

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Common arrhythmia that one would encounter in cardiac arrest situation.

Published in: Health & Medicine, Technology

ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.

  1. 1. Arrhythmia : What you need to know for ACLS? Syed Raza
  2. 2. Introduction • Rhythm recognition is a key skill that one needs to demonstrate during cardiac arrest situation. • This can be life saving. • Early defibrillation • Decision making on the right therapy
  3. 3. Lets Keep it Simple! • Pulseless Rhythms • Tachyarrhythmias • Bradyarrhythmias
  4. 4. Pulse less Electrical Rhythm
  5. 5. Ventricular Fibrillation • Uncoordinated contractions within the ventricles of heart. • Due to multiple cardiac cells that function as pacemakers and discharge electrical impulses in a chaotic manner. • Reduced / No cardiac output : No pulse • Will result in Asystole if not treated.
  6. 6. • Commonest cause : Hypoxia /Ischemia • Types : Fine and Coarse
  7. 7. Therapy Immediate Defibrillation CPR I/V Amiodarone after 3 shocks
  8. 8. Ventricular Tachycardia • Broad Complex Tachycardia (QRS > 0.12s) • Heart rate > 180 beats /mt • Mono-morphic • Poly-morphic / Torsade Pointe • Pulse less vs with pulse
  9. 9. Mono morphic VT
  10. 10. Poly morphic VT • Torsade Pointes if Prolonged QT interval on previous ECG
  11. 11. Treatment • Pulseless : Defibrillation • With pulse : stable = Amiodarone Unstable = DC Cardio version
  12. 12. No Pulse !
  13. 13. Pulse Less Electrical Activity (PEA) • Organized electrical activity but without a pulse • Usually has underlying treatable cause • Hypovolumea and Hypoxia are the commonest causes. • If no underlying cause is identified, it will be treated same as Asystole.
  14. 14. 5 Hs and 5 Ts 5 Hs Hypovolumia Hypoxia Hydrogen Ion (Acidosis) Hyperkalemia Hypokalemia Hypoglycemia
  15. 15. 5Ts Toxins Tension Pneumothorax Tamponade Thrombosis : Coronary Thrombosis : Pulmonary Trauma
  16. 16. ASYSTOLE Follow flat line protocol – check leads and gain Not a true rhythm State of no electrical activity Terminal event Very poor prognosis : ROSC extremely unlikely Possible underlying cause : 5Hs and 5Ts Treatment : CPR and Epinephrine
  17. 17. First Degree AV Block
  18. 18. • PR interval is prolonged > 200ms • No clinical significance if asymptomatic • May lead to higher degree AV Block
  19. 19. Second Degree AV Block
  20. 20. Mobitz Type 1 • Progressive prolongation of PR interval. • Atrial impulse (P waves) may not be conducted through AVN and gets blocked and hence no QRS. • No clinical significance unless symptomatic. Mobitz Type 2 • Non prolongation and fixed PR interval. • Non conducted p waves • No ventricular activity -Drop beats / No QRS Most times Infranodal
  21. 21. Third Degree AV Block (CHB)
  22. 22. P waves with a regular pp interval QRS complexes with a regular RR interval QRS complex may be narrow or wide (escape rhythm) No relationship between P waves and QRS complexes.
  23. 23. Treatment • Trans cutaneous or Trans Venous pacemaker • Atropine (0.5 mg) may be tried Epinephrine 0.5 -1 mg /kg bw
  24. 24. Atrial Fbrillation • No p waves preceding QRS complexes as no coordinated atrial contractility • Irregular (variable) RR intervals
  25. 25. Treatment • Unstable : Synchronized DC Cardio version • Stable : Rhythm Control vs Rate Control • Rhythm : Amiodarone, Sotalol, Flecainide • Rate control : Beta blocker, Calcium channel blocker, Digoxin. • Anticoagulant if indicated.
  26. 26. Atrial Flutter • Atrial rate 250 – 350 /mt • Saw Tooth Appearance • Ventricular rate depends on Degree of AV block • Electrical foci usually in RA
  27. 27. Treatment • Rate Control • Rhythm Control • Anti coagulant • DCC if unstable
  28. 28. Supra Ventricular Tachycardia • Broad term for various supra ventricular arrhythmia • Electrical impulses above the ventricular electrical conducting system. • Inverted p waves preceding or following qrs complexes. • Review old ECG – exclude WPW
  29. 29. Treatment Vagal maneuver Adenosine •Drugs – Chemical Cardio version or Rate control. • Anti coagulant. •If unstable : sync. DCC

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