approach to dysrhythmias Flashcards Preview

Emergency Medicine > approach to dysrhythmias > Flashcards

Flashcards in approach to dysrhythmias Deck (45)
Loading flashcards...
31

A-fibb tx

  • A-Fib = Rate control: Be careful If…
  • WPW
    • Regular: Consider Adenosine (can send into overdrive), Electricity 
    • Irregular: No AV nodal blocker--> Yes Electricity (synchronized), Procainamide (anti-arrhythmic)
    • Torsades = Magnesium

32

how does tx for stable SVT work

vagal maneuvers

6 rapid push (doesn't last long)

12

(can do 18)

synchronized cardioversion 

33

unstable rapid irregular narrow tx

rapid high synch cardioversion

can sedate with etomidate +ketamine (less risk of dropping BP but still some)

Elevating BP to decrease irritation on heart increase profusion and improve chances of cardioverting 

 

target diastolic >60mg) 

push dose pressors with phnylephrine 50-299mcgIVP

 

 

34

chronic A-fib 

35

6 step approach

  1. ABC’s, IV, O2, Monitor
  2. Stable or Unstable
  3. Regular or Irregular
  4. Fast or Slow

36

appraoch to the brady pt (big 3)

DRUGS

ISCHEMIA

ELECTROLYTES

37

WHAT DO WE NEED TO THINK ABOUT HWEN LOOKING AT BRADY  (other than big 3)

  • Block is below AV node
  • Slower rhythm
  • More likely to stop/asystole
  • Not atropine sensitive

38

Brady treatment 

  • Algorithm Bradys Are Too Darn Easy 
  • Atropine: start 0.25-0.5mg bolus
  • Transcutaneous Pacing: Sedation (might need transvenous pacer in obese pt)
  • Dopamine: 2-10 mcg/kg per min
  • Epinephrine: 2-10 mcg per min
    • 1ml of crash cart epi (1:10,000) = 100mcg
    • Put 1ml in 100ml of NS = 1mcg per ml 

Pacemaker for all 3rd degree AVB + symptomatic Mobitz Type II

39

which AV blocks are unstable 

mobitz type two can move into third degree

and of course third degree

40

electrolyte abnormalities that could lead to pronloged qt

 

Electrolyte abnormalities 

 

hypokalemia

hypocalcemia 

hypomagnesmia 

Na channel blockers 

miscellaneous: elevated ICP, ACS

hypothermia, hereditary 

41

what are the considerations with determining prolonged QT

if QT lengthening due to stretching of ST segment = hypocalcemia and hypothermia 

 

if QT lengthen due to stretching of T wave=ischemia 

42

2 EKG findings for burgadas

cove type (Seal)

saddle type 

43

treatment is brugada

defibb 

(ICD)

44

leads to focus on when suspecting cardiomyopathy 

lateral 

 

look at Q waves if super sharb and super deep (dagger like) thing hypertrophic cardiomyopathy 

45

41 y/o female no sig past medical hx c/o CP over the past 2 days, no sx now

  • : Wellen’s  → Highly specific to LAD → V2-V3, +/- V4
  • type 1 = deep symmetric T-wave in precordial leads
  • type 2= biphasic T waves in precordial leads
  • needs PCI with proximal LAD lesion 
  •