Follow the Algorithm
What are 3 interventions you will do after identifying a tachyarrhythmia typically greater than 150?
Maintain patent airway - assist breathing if needed
Oxygen if hypoxic
cardiac monitor
IV access
ECG
What dose is adenosine given IV for 1st dose and 2nd dose?
6mg IV push
12mg IV push
Is atrial flutter usually regular or irregular?
Regular
What reversal medication do we want ready if giving propofol?
phenylephrine
What intervention is recommended for patient's with signs of unstable tachyarrhythmia?
Synchronized cardioversion.
Consider adenosine if regular narrow complex
What is the mechanism of action of calcium channel blockers?
Blocks movement of Ca into cells of heart and smooth muscle
Slows conduction through AV node
dilate coronary arteries
How can vagal maneuvers or adenosine be helpful in atrial flutter?
Slow down the rhythm allowing you to identify the flutter on ecg
What do you need to be prepared to do if after cardioversion you see pulseless tachycardia?
Unsynchronized shock
What are 3 signs of unstable tachycardia?
Hypotension, altered mental status, signs of shock, chest pain, acute heart failure
For my patient why would amiodarone have lead to ventricular fibrillation?
It prolongs action potential and refractory periods --> increases QT interval. Lengthened QT increases likelihood that a depolarization will occur during repolarization causing lethal rhythm
What is the typical atrial rate of atrial flutter?
240-300 bpm
Name 3 pieces of safety equipment you need to gather prior to cardioversion?
lifepack, defib pads, ecg electrodes for lifepack, oral airway, BVM, ETCO2, SPO2, BP, suction, sedation meds (propofol), resuscitation + reversal meds (phenylephrine) + crash cart, IV access attached to running fluids
Give 2 examples of interventions for a stable tachyarrhythmia with a narrow QRS complex?
Vagal maneuver (if regular)
Adenosine (if regular)
Beta blocker or calcium blocker
expert consult
What medication is commonly used for sedation prior to cardioversion?
Propofol
How can you identify 2:1 atrial flutter on ecg if it doesn't show a nice saw tooth like we were told we'd see?
- be suspicious of any rhythm around 150bpm that does not fluctuate, sinus should fluctuate, rhythm regular, narrow complex, difficult to ID isoelectric line
- slow the ecg time to display saw tooth
What should you check patients body for prior to shocking?
Jewelry, dentures, any metal
What infusions do we consider for stable wide complex tachyarrhythmias?
Procainamide
Amiodarone
Sotalol
What type of medication do you want your patient to already be taking prior to cardioversion?
Anticoagulant
Due to the patho of atrial flutter, why does adenosine typically not cardiovert this rhythm?
Adenosine slows conduction through the AV node but it does not affect the reentry circuit present in atrial flutter is located in the atria (not av node)
Atrial flutter is a reentrant tachycardia where an irritable site in the atria fires regularly at rapid pace
What paperwork should be completed prior to cardioversion?