Fast, irregular, broad complex tachyWPW AF until proved otherwiseRare but importantWe can kill young people with wrong...
WPW AFElectricity or Procainamide200JSync or unsynch?
Synch if they have a pulse
Sedation for cardioversionGet senior help if you have timeOtherwise Fentanyl eg 100mcg, or 50mcg in frail elderly + Mi...
VF Shock 200J un-synch CPR 2 min Check rhythm Repeat PRN Adrenaline 1mg after 2ndshock and every 3 minutes Amiodaron...
No pulse
Wide complex tachyNo pulseTreatment as forVT
Pulse normal BP, no CP
Wide complex tachyRx electricity200J synched
Key questions?
Fast AF with CP and hypotensionIs there anything driving the AF? Sepsis, CCF, dehydrationHow long has she been in AF? ...
Fast AF with CP and hypotensionNew onset ( < 48 hours): fluid load, phenylephrine,analgese (fentanyl) sedate and cardiove...
Pure alpha = vasoconstriction
10mg vial in 100ml Normal Saline= 1mg in 10ml= 100mcg in 1ml2ml bolus = 200mcg
13 year old male with palpitation while playing play stationHx of asthma and recent knee surgery
Questions?Comments?Suggestions?
Sinus tachy or SVT?
Sinus tachy or SVT?Sinus tachy P waves Rate varies – watch the monitor Will slow with reassurance, analgesia Usually ...
SVTManagement?
SVTVagal manoeuvres Valsalva Carotid sinus massage (age < 60) Face in ice waterAdenosine Big IV line Can mix with b...
Dialysis patient
Hyper KTreatment?
Hyper KSalbutamol 10mg nebCalcium gluconate 1 amp = 10mmolArrange urgent dialysisThen think about glucose + insulin, H...
40M, drowsy, BP 90/60. Hx of depression.
TCA overdoseHCO3 1-2mmol/kg, repeat ? Q5min till QRS < 120msIntubateHyperventilate
Sinus tachy with LBBB
70M, CP, hypotensive
70M, CP, hypotensiveInferior MIDo a R sided ECG – may well have a R ventricular infarctTry atropine – unlikely to work...
Other options for bradycardia Consider toxins Digoxin Beta blocker Calcium channel blocker -> specific treatments Ot...
Narrow ComplexTachyNarrow complex regular Sinus tachy: treat cause SVT: Vagal; adenosine; verapamil or diltiazemNarrow...
Wide ComplexTachy Treat causeNa channel blockers esp tricycylics -> bicarb andhyperventilationHyperK: Salbutamol, calci...
BradycardiaConsider RV infarct -> fluid loadingConsider toxins -> specific treatmentsAtropineTranscutaneous then trans...
ReferencesSee http://emtutorials.com/2013/05/funky-rhythms/ forreferences
Dysrhythmias april 2013
Dysrhythmias april 2013
Dysrhythmias april 2013
Dysrhythmias april 2013
Dysrhythmias april 2013
Dysrhythmias april 2013
Dysrhythmias april 2013
Upcoming SlideShare
Loading in …5
×

Dysrhythmias april 2013

1,793 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,793
On SlideShare
0
From Embeds
0
Number of Embeds
830
Actions
Shares
0
Downloads
12
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Raised BP and reflex bradycardia
  • Dysrhythmias april 2013

    1. 1. Fast, irregular, broad complex tachyWPW AF until proved otherwiseRare but importantWe can kill young people with wrong RxRx?
    2. 2. WPW AFElectricity or Procainamide200JSync or unsynch?
    3. 3. Synch if they have a pulse
    4. 4. Sedation for cardioversionGet senior help if you have timeOtherwise Fentanyl eg 100mcg, or 50mcg in frail elderly + Midazolam 1-2mg IV
    5. 5. VF Shock 200J un-synch CPR 2 min Check rhythm Repeat PRN Adrenaline 1mg after 2ndshock and every 3 minutes Amiodarone 300mg in after 3ndshock
    6. 6. No pulse
    7. 7. Wide complex tachyNo pulseTreatment as forVT
    8. 8. Pulse normal BP, no CP
    9. 9. Wide complex tachyRx electricity200J synched
    10. 10. Key questions?
    11. 11. Fast AF with CP and hypotensionIs there anything driving the AF? Sepsis, CCF, dehydrationHow long has she been in AF? Chronic AF unlikely to cardiovert and may throw of a clot ifdoes cardiovert
    12. 12. Fast AF with CP and hypotensionNew onset ( < 48 hours): fluid load, phenylephrine,analgese (fentanyl) sedate and cardiovertChronic AF: fluid load, phenylephrine, analgese (fentanyl)+/- treat for ACS
    13. 13. Pure alpha = vasoconstriction
    14. 14. 10mg vial in 100ml Normal Saline= 1mg in 10ml= 100mcg in 1ml2ml bolus = 200mcg
    15. 15. 13 year old male with palpitation while playing play stationHx of asthma and recent knee surgery
    16. 16. Questions?Comments?Suggestions?
    17. 17. Sinus tachy or SVT?
    18. 18. Sinus tachy or SVT?Sinus tachy P waves Rate varies – watch the monitor Will slow with reassurance, analgesia Usually caused by something eg pain, illness Not usually the presenting complaint Gradual onset and offsetSVT Fast onset Constant rate – watch the monitor Usually presenting complaint
    19. 19. SVTManagement?
    20. 20. SVTVagal manoeuvres Valsalva Carotid sinus massage (age < 60) Face in ice waterAdenosine Big IV line Can mix with big flush 12, 18mgVerapamil 5mg IV
    21. 21. Dialysis patient
    22. 22. Hyper KTreatment?
    23. 23. Hyper KSalbutamol 10mg nebCalcium gluconate 1 amp = 10mmolArrange urgent dialysisThen think about glucose + insulin, HCO3Resonium probably does more harm than good
    24. 24. 40M, drowsy, BP 90/60. Hx of depression.
    25. 25. TCA overdoseHCO3 1-2mmol/kg, repeat ? Q5min till QRS < 120msIntubateHyperventilate
    26. 26. Sinus tachy with LBBB
    27. 27. 70M, CP, hypotensive
    28. 28. 70M, CP, hypotensiveInferior MIDo a R sided ECG – may well have a R ventricular infarctTry atropine – unlikely to workAvoid GTN, avoid morphine (use fentanyl for pain)FLUID LOAD (may need litres of fluid) before trying pacing/ inotropesReperfuse ASAP – PCI preferred
    29. 29. Other options for bradycardia Consider toxins Digoxin Beta blocker Calcium channel blocker -> specific treatments Otherwise Atropine Transcutaneous pacing Transvenous pacing Chronotrope eg isoprenaline/dopamine Bypass / ECMO
    30. 30. Narrow ComplexTachyNarrow complex regular Sinus tachy: treat cause SVT: Vagal; adenosine; verapamil or diltiazemNarrow complex irregular Treat driver eg CCF, sepsis, ischaemia, hypoxia If still too fast or rate contributing to ischaemia or ↓BP < 48 hours: cardiovert + anticoagulation > 48 hours: rate control + anticoagulation↓BP: fluid, phenylephrine, diltiazem, magnesium oramiodaroneNormal BP: diltiazem or beta blocker
    31. 31. Wide ComplexTachy Treat causeNa channel blockers esp tricycylics -> bicarb andhyperventilationHyperK: Salbutamol, calcium gluconate etcProlonged QT ie Torsades: Mag Otherwise: electrical cardioversion
    32. 32. BradycardiaConsider RV infarct -> fluid loadingConsider toxins -> specific treatmentsAtropineTranscutaneous then transvenous pacingIsoprenaline / dopamine
    33. 33. ReferencesSee http://emtutorials.com/2013/05/funky-rhythms/ forreferences

    ×