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25 Cards in this Set
- Front
- Back
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What are the first three things you do
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1) assess airway
2) assess breathing 3) give oxigen |
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What are the first three things to monitor in a hospital setting
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1)ECG (identify rhythem)
2) blood pressure 3)oximetry |
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What do you treat immediately?
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any obvious reversible causes
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What is the first thing to ask yourself
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Is the patient stable?
ie 1) altered mental status 2) ongoing chest pain 3) hypotension |
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Rate related symptoms are uncommon unless HR gets this high
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150bpm
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if patient is unstable what do you do
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1) PERFORM IMMEDIATE CARDIOVERSION
---establish IV access and give sedation if pt is conscious but do not delay cardioversion-- |
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If patient is stable what two things should you do
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1) establish IV access
2) obtain 12 lead ECG |
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What two things do you look for on ECG?
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1) QRS-narrow or wide
2) Rhythem - regular or irregular |
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your patient is tachycardic with a rate of 180 but is stable and has a regular rhythem with narrow QRS. What do you do?
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1) attempt vagal maneuvers and
2) give ADENOSINE 6 mg in rapid IV push -if rhythem does not convert within 2 min. give 12 mg rapid IV push -if rhythem does not convert within 2 min. give another 12 mg rapid IV push |
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Rhythem does not convert, what are the possible diagnoses
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1)atrial flutter
2) ectopic atrial tachycardia 3) junctional tachycardia |
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How do you treat this person with regular narrow complex tachycardia refractory to adenosine?
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Control rate with diltiazam or Beta blockes
Cardiology consult and try to determine underlying cause |
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What if this person with regular narrow complex tachycardia converted with adenosine? What would be the probable diatnosis?
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reentry supraventricular tachycardia
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how do you treat this person with reentry supraventricular tachycardia in the acute setting after they have responded to adenosine
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observe and treat again with adenosine if they have a recurrance of tachycardia
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what are some longer acting av nodal blocking agents that can be used for someone with reentry supraventricular tachycardia
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diltiazem
beta blockers |
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Stable patient with narrow QRS but irregular rhythem--what are the three probable diagnosis
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atrial fibrillation, atrial flutter or multifocal atrial tachycardia
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What do you do for this stable patient with narrow QRS and irregular rhythem?
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rate control with diltiazem or beta blockers and call cardiology consult
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what patients do you need to use caution using beta blockers with
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those with pulmonary disease or CHF
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your patient has tachycardia with a wide QRS and a regular rythem, what do you have to determine in diagnosing?
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is this vetricular tachycardia or
SVT with aberrancy |
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How do you treat vetricular tachycardia ?
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1) prepare for elective synchronized cardioversion
2) Amiodarone 150 mg IV over 10 minutes, repeat as needed to a maimum dose of 2.2g over 24 hours |
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How do you treat SVT with aberrancy
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adenosine
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your patient has tachycardia with a wide QRS and an irregular rythem, what do you have to determine in diagnosing
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Determine if it is 1) atrial fibrillation with aberrancy vs. 2) pre-exited atrial fibrillation (AF + WPW) vs. 3)recurrent polymorphic ventricular tachycardia vs. 4) torsades de points
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how do you treat atrial fibrillation with aberrancy
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diltiazam or betablockers
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how do you treat pre-exited atrial fibrillation (AF+WPW)
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1) Avoid AV nodal blocking agents (adenosine, digoin, diltiazem, verapamil)
2)consider antiarrythim (e.g. amioderone 150 mg IV over 10 minutes). |
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how do you treat recurrent polymorphic VT
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seek epert consultation
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how do you treat torsades de pointes
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magnesium 1-2 g over 5-60 min, then infusion
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