arrhythmias medical student teaching tuesday 24 th january 2012 dr karen jones, spr emergency...
TRANSCRIPT
ArrhythmiasMedical Student TeachingTuesday 24th January 2012
Dr Karen Jones, SpR Emergency Medicine
Aims:
Recognition of common arrhythmias
Identification of adverse features that indicate the risk of imminent deterioration
Understanding the treatment options
What are arrhythmias and why are they important?
Rhythms that are not produced by the SA node and transmitted through the electrical system of the heart in the normal way
Some abnormal rhythms may lead to cardiac arrest or deterioration if untreated
If you can identify an arrhythmia and institute the correct treatment you may be able to prevent deterioration
The Cardiac Conduction System
I think the patient has an arrhythmia, what should I do?
I think the patient has an arrhythmia, what should I do?
Start with ABC!
Check for a pulse
Give oxygen!
Get the patient on a cardiac monitor
Insert an iv cannula
Assess for adverse features
Get a 12 lead ECG
Adverse features
Shock
Syncope
Heart failure
Chest pain
Extreme heart rate > 150 < 40
What treatment options are there?
Do nothing
Simple clinical interventions
Drugs
Electricity
Assessing a rhythm
1.Is there any electrical activity?
2.What is the rate – fast, normal or slow?
3.Is the rhythm regular or irregular?
4.Is the QRS complex narrow or wide?
5.Are there P waves?
6.Are the P waves related to the QRS complexes?
What is the rhythm?
Asystole
What is the rhythm?
Ventricular Fibrillation
Treatment?
What is the rhythm?
Ventricular Tachycardia (VT)
Treatment?
It depends…CHECK THE PATIENT!
No pulse = ELECTRICITY (Defibrillate)
Adverse signs = ELECTRICITY (Cardioversion)
No adverse signs = DRUGS (Amiodarone)
What is the rhythm?
Torsades de Pointes
Treatment?
What is the rhythm?
Sinus Tachycardia
Treatment?
CHECK THE PATIENT!
Check for a pulse and ABC
Treat the underlying cause Pyrexia Hypoxia Hypovolaemia Pain Agitation Toxins
What is the rhythm?
AV nodal re-entry tachycardia (Supraventricular tachycardia SVT)
Treatment?
It depends…CHECK THE PATIENT!
What is the rhythm?
Atrial Fibrillation
Treatment?
It depends…CHECK THE PATIENT!
No pulse = CPR
Adverse signs = ELECTRICITY (Cardioversion)
No adverse signs = DRUGS
What is the rhythm?
Atrial Flutter
Treatment?
What is the rhythm?
Sinus Bradycardia
What is the rhythm?
First Degree AV Block
What is the rhythm?
Second Degree AV BlockMobitz Type I (Wenckebach)
What is the rhythm?
Second Degree AV BlockMobitz Type II
What is the rhythm?
Third Degree AV Block(Complete Heart Block)
Treatment?
It depends…CHECK THE PATIENT!
Adverse signs = DRUGS (Atropine)
Temporary pacing
Permanent pacing
No adverse signs = MONITOR
TAKE HOME MESSAGES!Always start with ABC
Check for adverse signs
Get a 12 lead ECG and use the 6 step approach
Treatment depends on the clinical state of the patient
CHECK THE PATIENT!
