11.04.2018 - By Zack Olson, MD and Michael Estephan, MD
“Unstable” Arrhythmias
* Arrhythmias that cause* Hypotension* Pulmonary Edema* Chest Pain* Altered Mental Status
Supraventricular Tachycardia (SVT)
* Stable* Vagal maneuver* Adenosine* Beta blocker or calcium channel blocker* Unstable* SYNCHRONIZED cardioversion
Monomorphic Ventricular Tachycardia (VT)
* Stable* Amiodarone* Procainamide* Lidocaine* Unstable* SYNCHRONIZED cardioversion* Pulseless* Defibrillation
Polymorphic Ventricular Tachycardia (aka Torsades de Pointes)
* Known complication of prolonged QTc* Side effect of multiple medications* Antipsychotics* Methadone* Ondansetron* Give Magnesium Sulfate
High yield EKG patterns
* Long QTc* Wolf Parkinson White (WPW)* Brugada Pattern
Atrial Fibrillation
* Stable* Patient presents immediately after onset (<24-48 hours)* Synchronized cardioversion* Rhythm control medications* Amiodarone* Procainamide* Flecanide* Patient does not present immediately (or unknown onset)* Rate control* Beta blockers* Metoprolol* Calcium channel blocker* Diltiazem* Anticoagulation (heparin)* Unstable* Synchronized cardioversion* Atrial fibrillation with extremely fast rate (200+) is common in WPW* Atrial fibrillation with slow rate is common with Digoxin toxicity
Bradycardia
* AV Blocks* 1st Degree* 2nd degree (type 1)* 2nd degree (type 2)* 3rd degree* If symptomatic and stable…* Atropine* If they become unstable… * Transcutaneous or transvenous pacing
Additional Reading
* Life in the Fast Lane EKG Library (LITFL)* Tachycardias (EM Clerkship)* Bradycardias (EM Clerkship)