1. Normal sinus rhythm 2. SINUS BRADYCARDIA
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1 1. Normal sinus rhythm 2. SINUS BRADYCARDIA No signs and symptoms observe There are severe signs or symptoms o What are the signs and symptom Hypotension <90 PVCS Altered mental status Chest pain Dyspnea Ischemia or Infarction Atropine (0.5 to 1mg) Transcutaneous pacing if available
2 Dopamine (5-20 micro g/kg/min Epinephrine (2-10 micro g/kg/min Isoproternol (2-10 micro g/kg/min) 3. PULSELESS ELECTRICAL ACTIVITY CPR IV access Epinephrine Intubation if possible Review for the most frequent causes 1. Hypovolemia. What is the treatment? 1. Tablets (drug overdose) 2. Hypoxia What is the ttt? 2. Tamponade 3. Hydrogen ions (acidosis) 3. Tension Pneumothorax 4. Hypo and Hyperkalaemias 4. Thrombosis (coronary) 5. Hypothermia 5. Thrombosis (pulmonary embolism)
3 4. ASYSTOLE start CPR IV access Endotracheal intubation Confirmation in more than one lead Consider transcutaneous pacing Epinephrine (1mg iv push, repeat every 3-5 minutes) Consider the cause Withold or cease resuscitative efforts? Consider quality or resuscitation? Atypical clinical features present? Support for cease efforts in place? 1. Hypovolemia. What is the treatment? 1. Tablets (drug overdose) 2. Hypoxia What is the ttt? 2. Tamponade 3. Hydrogen ions (acidosis) 3. Tension Pneumothorax 4. Hypo and Hyperkalaemias 4. Thrombosis (coronary) 5. Hypothermia 5. Thrombosis (pulmonary embolism)
4 5. ATRIAL TACHYCARDIA
5 6. VENTRICULAR TACHYCARDIA (With Pulse) / Pulseless VT Stable - Oxygenation - IV access - MONA - Amiodarone - DC cardioversion Unstable signs and symptoms? - chest pain - dyspnea - hypotension systolic <90 - congestive heart failure - ischemia, infarction, unconscious Prepare for immediate cardioversion May give brief trial for medication based on arrhythmia Pulseless VT as VF
6 7. VF (VENTRICULAR FIBRILLATION) SHOCK as soon as available (ONE TIME) CPR Shock Rhythm Epinephrine (1mg IV) & CPR SHOCK Intubate if possible Shock Consider antiarrhythmics - Amidarone - Lidocaine - Magnesioum - Procainamide Shock Drugs Consider bicarbonate Shock drugs
7 8. FIRST DEGREE AV BLOCK
8 9. SECOND DEGREE A-V BLOCK TYPE 1 No signs and symptoms observe There are severe signs or symptoms - What are the signs and symptoms? Hypotension <90 PVCs Altered mental status Chest pain dyspnea Ischemia or Infarction Atropine (0.5 to 1 mg) Transcutaneous pacing if available Dopamine (5-20 micro g/kg/min Epinephrine (2-10 micro g/ min Isoproternol (2-10 micr g/min
9 10. SECOND DEGREE A-V BLOCK TYPE 2 No serious signs or symptoms observation There are serious signs or symptoms What are the serious signs and symptoms? - Hypotension <90 - PVCS - Altered mental status - Chest pain - Dyspnea - Ischemia or - Infarction Prepare for transvenous pacer Use transcutaneous pacemaker Until transvenous pacer placed
10 11. 3 RD DEGREE HEART BLOCK No serious signs or symptoms observation There are serious signs or symptoms What are the serious signs and symptoms? - Hypotenison < 90 - PVCS - Altered mental status - Chest pain - Dyspnea - Ischemia or - Infarction Prepare for transvenous pacer Use transcutaneous pacemaker Until transvenous pacer placed
11 12. NORMAL SINUS RHYTHM WITH UNIFOCAL PVCS 13. NORMAL SINUS RHYTHM WITH MULTI-FOCAL PVCS( BIGIMINY)
12 14. COUPLET PVC S 15. ATRIAL FLUTTER
13 16. ATRIAL FIBRILLATION
14 17. JUNCTIONAL RHYTHM No signs and symptoms observe There are severe signs and symptoms What are the signs and symptoms? Hypotension <90 PVCS Altered mental status Chest pain Dyspnea Ischemia or Infarction Atropine (0.5 to 1mg) Transcutaneous pacing if available Dopamine (5-20 micro g/kg/min) Epinephrine (2-10 micro g/min) Isoproternol (2-10 micro g/min)
15 18. JUNCTIONAL TACHYCARDIA 19. IDIOVENTRICULAR RHYTHM
16 20. PVCs Assess for need of acute suppressive therapy Rule our treatable causes Consider serum potassium - Digitalis level - Bradycardia - Drugs Lidocaine what is the dose? 1mg/kg If not suppressed repeat lidocaine what is the dose? 0.5mg/kg If not suppressed procainamide what is the dose? 20mg/min If not suppressed consider over drive pacing 21. PACs
17 22. PJC s 23. PACEMAKER RHTYHM
18 24. PACEMAKER 80, P PACEMAKER LOSS OF CAPTURE
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