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The Basics of Arrhythmia

The Basics of Arrhythmia. Arrhythmias - the bare bones. Basic Physiology reminder. Basic ECG reminder. Rate Rhythm PR interval QRS complex Width Any Q waves? Axis Lateral lead R wave progression ST and T waves. Basic ECG reminder. What is an arrhythmia?.

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The Basics of Arrhythmia

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  1. The Basics of Arrhythmia Arrhythmias - the bare bones

  2. Basic Physiology reminder

  3. Basic ECG reminder • Rate • Rhythm • PR interval • QRS complex • Width • Any Q waves? • Axis • Lateral lead R wave progression • ST and T waves

  4. Basic ECG reminder

  5. What is an arrhythmia? • Abnormalities of electrical rhythm • Supraventricular • SVT, AF, Atrial flutter • Re-entrant tachycardias • Ventricular • VT, VF, Torsdaes de pointes • Asystole and PEA

  6. Clinical manifestations • Palpitations • Syncope • If going fast enough, can precipitate cardiac ischaemia and chest pain • Cardiac failure • Decreased level of consciousness • Hypoperfusion of all organs • Cardiac arrest

  7. Common arrhythmias Ventricular • VT • VF • Torsades Bradyarrhytmia • Medication • AV block • SSS Atrial • AF • A Flutter • Paroxs. SVT • AVNRT • AVRT (WPW) • Multifocal atrial tachycardia

  8. Ventricular fibrillation

  9. What rhythm is it? • Is it sinus? • Is it going at a life-theratening rate? • 220 minus age • Is it regular? • If it is ‘dead regular’ could it be A Fib? • Is it a broad complex?

  10. Atrial Fibrillation • Questions to ask yourself • What made it happen? • How long have they been in it? • Do they need anticoagulation? • Do I need to slow it down? • How do I slow it down?

  11. Atrial fib with LBBB

  12. How to approach a regular SVT? • Is it AF, Aflutter, AVNRT, AVRT??? • Valsalva? • Adenosine - blocks the AV node • Caution with adenosine, dig and calcium channel blockers • If they’re compromised, have some paddles on

  13. Broad complex tachycardias • Always VT until proven otherwise! • Look for concordance, evidence of AV dissociation, and very wide QRS WPW with AF

  14. Broad complex tachycardias • Electrolytes • High K, Ca++ • Low K, Mg, Ca++ • Drugs (prolong QT interval) • Methadone, amiodarone, lithium, sotalol,quinolones, Stemetil, chlorpromazine • Syndromes • Ischaemia and cardiac scarring

  15. VT with clear AV dissociation

  16. What do you need to do? • Try and work out what rhythm it is in • If it’s faster than physiologic, then it’s life threatening (220 minus age) • If there’s suggestion of ischaemia, it’s life threatening • If it’s too fast - Slow it down until • If it’s too slow – Speed it up

  17. In an arrest • Defib VF and VT only • Get the paddles on! • Push hard and fast! – all the way to shock • Push onto a hard surface! • 100% oxygen, 1 SMALL breath EVERY 30 seconds, SLOW and steady!

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