CARDIOLOGY EMERGENCIES ON CALL DR. ALI ROOMI CARDIOLOGY ST3 23RD JULY 2016
|
|
|
- Myles Hoover
- 5 years ago
- Views:
Transcription
1 CARDIOLOGY EMERGENCIES ON CALL DR. ALI ROOMI CARDIOLOGY ST3 23RD JULY 2016
2 + OBJECTIVES Diagnosis and management of ACS When to liaise with tertiary centre Complications of ACS Tachyarrhythmias Bradyarrhythmias
3 + WHAT TO DO WHEN YOUR BLEEP GOES OFF? Stay calm! Clarify patient observations with nursing staff Prioritise tasks Interim management? ABCDE review Peri-arrest?
4 + SCENARIO 1 Bleeped at 1am by nursing staff 63M, admitted 2/7 diabetic foot infection On IV antibiotics, awaiting surgical debridement Patient is complaining of chest pain Afebrile, HR 74, BP 159/81, RR 18, sats 95% RA
5 + WHAT WILL YOU DO? 1. Stop what you re doing and urgently review the patient 2. Advise nursing staff to administer simple analgesia - day team to review in the morning 3. Request a 12 lead ECG whilst you make you way to the ward 4. Put out a peri-arrest call Answer: 3
6 Lateral TWI + ECG 1
7 + HISTORY Cardiovascular risk factors? Sudden onset? Heavy/tight? Any radiation - jaw/arm? Associated symptoms? SOB? Diaphoresis? Ongoing pain?
8 +?LATERAL NSTEMI Dynamic changes? Serial ECGs!! Compare to admission ECG Known IHD? Previous intervention? hstroponin 0 and 6 hrs
9 + INITIAL MANAGEMENT GTN spray IV/oral morphine Aspirin 300 mg + Clopidogrel 300 mg Fondaparinux 2.5 mg
10 + ADDITIONAL MANAGEMENT Beta blocker/acei/statin - can normally wait till morning BM monitoring +/- sliding scale (dry) GRACE score FBC, U&E, coagulation screen, CXR GRACE score - predictor of in-hospital and 6-month mortality
11 + WHAT NEXT? Re-review Ongoing chest pain - GTN infusion, repeat ECG Stable - handover to morning team/cardiology
12 When to refer to tertiary centre?
13 + CONSIDER IF Pain refractory to GTN infusion High risk NSTEMI STEMI Cardiogenic shock
14 Wellen Syndrome - prox LAD disease + ECG 2
15 Wellen Syndrome - biphasic T waves + ECG 3
16 Benign early repolarisation + ECG 4
17 + ECG 5 LMS/ostial LAD disease STE avr
18 + ECG 6 Pericarditis Concave STE PR depression ST depression avr
19 + ECG 7 PE Sinus tachycardia RBBB RAD S1 Q3 T3
20 + ECG 8 Hyperacute anterior STEMI Q waves anteriorly Peaked T waves Reciprocal ST depression III
21 Evolving anterior STEMI + ECG 9
22 + PATIENT IS NOW BREATHLESS Afebrile, HR 110, BP 161/93, RR 29, sats 89% 15L Diaphoretic ABG: ph 7.43, pco2 5.3, po2 8.2, BE -1.3, Lac 1.7 ECG unchanged Diffuse coarse crackles and wheeze
23 + CXR
24 + IMMEDIATE NEXT MANAGEMENT? mg salbutamol nebuliser 2. 5 mg metoprolol IV 3. GTN infusion 4. IV furosemide 40 mg Avoid beta blockers in acute pulmonary oedema Answer: 3
25 + PULMONARY OEDEMA GTN Infusion - titrate to SBP (aim > 110 mmhg) IV morphine IV furosemide mg High flow O2/CPAP/optiflow Catheterise Senior help!
26 + PATIENT IS NOW LIGHTHEADED Afebrile, HR 200, BP 103/50, RR 21, sats 93% RA Denies any chest pain GCS 15
27 Monomorphic VT + EGG 10
28 + IMMEDIATE NEXT MANAGEMENT? 1. Synchronised DC Cardioversion 2. Adenosine 12 mg IV 3. Metoprolol 10 mg IV 4. Amiodarone 300 mg IV Answer: 4
29 + VENTRICULAR TACHYCARDIA Any signs of compromise? Synchronised DCCV Chest pain Shock Heart Failure Syncope Stable? IV Amiodarone 300 mg
30 + SCENARIO 2 77F Known COPD admitted with infective exacerbation Not on any home nebs/ltot Afebrile, HR 180, BP 103/60, RR 24, sats 93% 2L O2 WCC 16, CRP 140, Cr 145 (baseline 93), Troponin 68
31 AF with RVR + ECG 11
32 + IMMEDIATE NEXT MANAGEMENT? 1. Metoprolol 10 mg IV 2. Amiodarone 300 mg IV 3. Adenosine 12 mg IV 4. Synchronised DCCV Answer: 1
33 + ATRIAL FIBRILLATION Paroxysmal/persistent/permanent Acute onset? IV Amiodarone 300 mg Duration unknown? Stable BP? Labile BP? Beta blocker Calcium channel blocker Digoxin Compromised? Synchronised DCCV Caveat - digoxin not useful in the longterm with paroxysmal AF or non-sedentary patients
34 Warfarin/NOAC - if CHADSVASc > 1 + ANTICOAGULATION
35 + SCENARIO 3 42M Sudden onset palpitations and chest pain No CVRF Afebrile, HR 230, BP 131/82, RR 19, sats 97% RA Troponin 37
36 + ECG 12 SVT - likely AVRT/AVNRT. No discernible p waves
37 + IMMEDIATE NEXT MANAGEMENT? 1. Synchronised DC Cardioversion 2. Amiodarone 300 mg IV 3. Adenosine 12 mg IV 4. Metoprolol 10 mg IV Answer: 3
38 + ECG 13 Pre-excitation Delta waves Short PR interval Orthodromic AVRT (because narrow complex QRS during SVT phase)
39 + ECG 14 SVT with ventricular rate ?Atrial Flutter with 1:1 block?avrt/avnrt
40 + ADENOSINE
41 + TACHYCARDIA ALGORITHM Adult Tachycardia (with pulse) Algorithm Assess using the ABCDE approach Monitor SpO2 and give oxygen if hypoxic Monitor ECG and BP, and record 12-lead ECG Obtain IV access Identify and treat reversible causes (e.g. electrolyte abnormalities) Synchronised DC Shock* Up to 3 attempts Yes - Unstable Adverse features? Shock Myocardial ischaemia Syncope Heart failure Seek expert help Amiodarone 300 mg IV over min Repeat shock Then give amiodarone 900 mg over 24 h! No - Stable Is QRS narrow (< 0.12 s)? Broad Narrow Broad QRS Is QRS regular? Regular Narrow QRS Is rhythm regular? Irregular Irregular Seek expert help Possibilities include: AF with bundle branch block treat as for narrow complex Pre-excited AF consider amiodarone! Regular If VT (or uncertain rhythm): Amiodarone 300 mg IV over min then 900 mg over 24 h If known to be SVT with bundle branch block: Treat as for regular narrowcomplex tachycardia Vagal manoeuvres Adenosine 6 mg rapid IV bolus if no effect give 12 mg if no effect give further 12 mg Monitor/record ECG continuously Sinus rhythm achieved? Yes No Probable re-entry paroxysmal SVT: Record 12-lead ECG in sinus rhythm If SVT recurs treat again and consider anti-arrhythmic prophylaxis Probable AF: Control rate with beta-blocker or diltiazem If in heart failure consider digoxin or amiodarone Assess thromboembolic risk and consider anticoagulation Seek expert help! Possible atrial flutter: Control rate (e.g. with beta-blocker) *Conscious patients require sedation or general anaesthesia for cardioversion
42 + SCENARIO 4 83F Admitted with 5/7 dizziness and syncope HTN, T2DM, OA, prev R NOF # Afebrile, HR 42, BP 161/75, RR 17, sats 96% RA Currently denies any presyncope
43 + ECG 15 Complete Heart Block Junctional escape - 42 bpm
44 + IMMEDIATE NEXT MANAGEMENT? 1. Synchronised DC Cardioversion 2. Transcutaneous pacing 3. Atropine 500 mcg IV 4. Monitored bed and observe Answer: 4
45 + ECG 16 Complete Heart Block Broad complex ventricular escape - rate 27 bpm High risk of asystole
46 + BRADYCARDIA ALGORITHM Adult Bradycardia Algorithm Assess using the ABCDE approach Monitor SpO2 and give oxygen if hypoxic Monitor ECG and BP, and record 12-lead ECG Obtain IV access Identify and treat reversible causes (e.g. electrolyte abnormalities) Shock Syncope Yes Adverse features? Myocardial ischaemia Heart failure No Atropine 500 mcg IV Satisfactory response? No Yes Consider interim measures: Atropine 500 mcg IV repeat to maximum of 3 mg OR Transcutaneous pacing OR Isoprenaline 5 mcg min -1 IV Adrenaline 2-10 mcg min -1 IV Alternative drugs* Seek expert help Arrange transvenous pacing! Yes Risk of asystole? Recent asystole Mobitz II AV block Complete heart block with broad QRS Ventricular pause > 3 s No Continue observation * Alternatives include: Aminophylline Dopamine Glucagon (if bradycardia is caused by beta-blocker or calcium channel blocker) Glycopyrrolate (may be used instead of atropine)
47 + CONCLUSION Stay calm! ABCDE If in doubt, seek senior help Enjoy yourselves!
48 + REFERENCES
49 Questions?
Adult Basic Life Support
Adult Basic Life Support UNRESPONSIVE? Shout for help Open airway NOT BREATHING NORMALLY? Call 112* 30 chest compressions 2 rescue breaths 30 compressions *or national emergency number Fig 1.2_Adult BLS
Arrhythmic Complications of MI. Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine
Arrhythmic Complications of MI Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine Objectives Brief overview -Pathophysiology of Arrhythmia ECG review of typical
national CPR committee Saudi Heart Association (SHA). International Liason Commission Of Resuscitation (ILCOR)
2 It is our pleasure to present to you this work as a result of team work of the national CPR committee at the Saudi Heart Association (SHA). We adapted the 2010 guidelines as per International Liason
1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material
1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material Arrhythmia recognition This tutorial builds on the ECG lecture and provides a framework for approaching any ECG to allow the
Case #1. 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136
Tachycardias Case #1 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136 Initial Assessment Check Telemetry screen if pt on tele Telemetry
Huseng Vefali MD St. Luke s University Health Network Department of Cardiology
Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Learning Objectives Establish Consistent Approach to Interpreting ECGs Review Essential Cases for Paramedics and first responders
Arrhythmias. A/Prof Drew Richardson. The Canberra Hospital May MB BS (Hons) FACEM Grad CertHE MD
Arrhythmias A/Prof Drew Richardson MB BS (Hons) FACEM Grad CertHE MD The Canberra Hospital May 2013 Objectives Recognise the features of the common nonlethal arrhythmias Describe the emergency treatment
ECG Interactive Session
SA HEART 2018 PRE-CONGRESS WORKSHOP 4 OCTOBER 2018 ECG Interactive Session Ashley Chin Cardiologist/Electrophysiologist University of Cape Town Groote Schuur Hospital ECG 1 Which ONE of the following is
You Don t Want to Miss This One! Focus on can t miss EKG tracings
You Don t Want to Miss This One! Focus on can t miss EKG tracings Renaissance St. Louis Grand Hotel Convention Center October 23, 2014 David K. Tan, M.D., EMT-T, FAAEM EMS Section Chief, Division of Emergency
Core Content In Urgent Care Medicine
Palpitations/Arrhythmias Ebrahim Barkoudah, MD Clinical Instructor in Internal Medicine Harvard Medical School Assistant in Internal Medicine & Pediatrics Massachusetts General Hospital MGH Chelsea Chelsea,
Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD
Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD OBJECTIVES 1. Identify the basic electrophysiology of the four causes of wide complex tachycardia. 2. Develop a simple framework for acute management
The most common. hospitalized patients. hypotension due to. filling time Rate control in ICU patients may be difficult as many drugs cause hypotension
Arrhythmias in the critically ill ICU patients: Approach for rapid recognition & management Objectives Be able to identify and manage: Atrial fibrillation with a rapid ventricular response Atrial flutter
SIMPLY ECGs. Dr William Dooley
SIMPLY ECGs Dr William Dooley 1 No anatomy just interpretation 2 Setting up an ECG 3 Setting up an ECG 1 V1-4 th Right intercostal space at sternal border 2 V2-4 th Left intercostal space at sternal border
Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions
Emergency Admissions Dos and Don t in Cardiac Arrhythmia Tom Wong, MD, FESC Consultant Cardiologist, Honorary Senior Lecturer Royal Brompton & Harefield Hospitals National Heart and Lung Institute, Imperial
ECGs and Arrhythmias: Family Medicine Board Review 2012
Overview ECGs and Arrhythmias: Family Medicine Board Review 2012 Jess Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Bundle branch blocks Quick review of ischemia Arrhythmias
ECGs and Arrhythmias: Family Medicine Board Review 2009
Rate Rhythm Intervals Hypertrophy ECGs and Arrhythmias: Family Medicine Board Review 2009 Axis Jess (Fogler) Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Ischemia Overview
DYSRHYTHMIAS. D. Assess whether or not it is the arrhythmia that is making the patient unstable or symptomatic
DYSRHYTHMIAS GENERAL CONSIDERATIONS A. The 2015 American Heart Association Guidelines were referred to for this protocol development. Evidence-based science was implemented in those areas where the AHA
Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy
Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias
ECGs: Everything a finalist needs to know. Dr Amy Coulden As part of the Simply Finals series
ECGs: Everything a finalist needs to know Dr Amy Coulden As part of the Simply Finals series Aims and objectives To be able to interpret basic ECG abnormalities To be able to recognise commonly tested
SIMPLY ECGs. Dr William Dooley
SIMPLY ECGs Dr William Dooley Content Basic ECG interpretation pattern Some common (examined) abnormalities Presenting ECGs in context Setting up an ECG Setting up an ECG 1 V1-4 th Right intercostal space
Step by step approach to EKG rhythm interpretation:
Sinus Rhythms Normal sinus arrhythmia Small, slow variation of the R-R interval i.e. variation of the normal sinus heart rate with respiration, etc. Sinus Tachycardia Defined as sinus rhythm with a rate
Treatment of Arrhythmias in the Emergency Setting
Treatment of Arrhythmias in the Emergency Setting Zian H. Tseng, M.D. Assistant Professor of Medicine Cardiac Electrophysiology Section Cardiology Division University of California, San Francisco There
Adult Acute Myocardial. Infarction
Adult Acute Myocardial Infarction Preclinical stable CAD Acute Coronary Syndrome No cardiac enzyme elevation cardiac enzyme elevation Ischemia Cell Injurydeath UA NSTEMI STEMI Definition of Coronary Artery
Management of Arrhythmias The General Practitioners role
Management of Arrhythmias The General Practitioners role Rohan Gunawardena MD, FRCP, FCCP, FACC Consultant Cardiac Electrophysiologist National Hospital of Sri Lanka Arrhythmias not common Palpitations
Acute Arrhythmias in the Hospitalized Patient
Acute Arrhythmias in the Hospitalized Patient Gregory M Marcus, MD, MAS Associate Professor of Medicine Division of Cardiology University of California, San Francisc Disclosures Medtronic: Research Support
Update on Palpitations and AF February 28 th 2018
Update on Palpitations and AF February 28 th 2018 Dr Mrinal Andrew Saha MA(Cantab) MBBS FRCP PhD Consultant Interventional Cardiologist GHNHSFT Dr Mrinal Saha Appointed 2010 Special interests: Angioplasty,
Anti arrhythmic drugs. Hilal Al Saffar College of medicine Baghdad University
Anti arrhythmic drugs Hilal Al Saffar College of medicine Baghdad University Mechanism of Arrhythmia Abnormal heart pulse formation Abnormal heart pulse conduction Classification of Arrhythmia Abnormal
Cardiovascular Emergencies: Diagnosis and Immediate Management
Cardiovascular Emergencies: Diagnosis and Immediate Management Royal College of Psychiatrists 11 th September 2017 Dr Rob Hatrick Consultant Cardiologist Western Sussex Hospitals NHS Foundation Trust Mental
THE EVIDENCED BASED 2015 CPR GUIDELINES
SAUDI HEART ASSOCIATION NATIONAL CPR COMMITTEE THE EVIDENCED BASED 2015 CPR GUIDELINES (EXECUTIVE SUMMARY) Page 1 FORWARD Since 2000, the International Liaison Committee on Resuscitation (ILCOR) has published
Review Packet EKG Competency This packet is a review of the information you will need to know for the proctored EKG competency test.
Review Packet EKG Competency 2015 This packet is a review of the information you will need to know for the proctored EKG competency test. Normal Sinus Rhythm Rhythm: Regular Ventricular Rate: 60-100 bpm
CSI Skills Lab #5: Arrhythmia Interpretation and Treatment
CSI 202 - Skills Lab #5: Arrhythmia Interpretation and Treatment Origins of the ACLS Approach: CSI 202 - Skills Lab 5 Notes ACLS training originated in Nebraska in the early 1970 s. Its purpose was to
Advanced Cardiac Life Support G 2010
Advanced Cardiac Life Support G 2010 Produced by the Advanced Cardiac Life Support Council of the Irish Heart Foundation March 2012 Introduction: The Arrhythmia and ACLS Councils of the Irish Heart Foundation
Cardiac Arrhythmias & Drugs used in Advanced Life Support and Cardiac Emergencies
Cardiac Arrhythmias & Drugs used in Advanced Life Support and Cardiac Emergencies CNHE Ballarat Health Services Valid from 1 st March 2016 to 31 st June 2018 1 Supraventricular Tachycardia (SVT) An atrial
APPROACH TO TACHYARRYTHMIAS
APPROACH TO TACHYARRYTHMIAS PROF.DR.MD.ZAKIR HOSSAIN PROFESSOR AND HEAD DEPARTMENT OF MEDICINE SZMCH TACHYARRYTHMIA Cardiac arrythmia is a disturbance of electrical rhythm of heart. Cardac arrythmia with
UNDERSTANDING YOUR ECG: A REVIEW
UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described
REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book
Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A
INSTITUTE FOR MEDICAL SIMULATION & EDUCATION ACLS PRACTICAL SCENARIOS
Practical Teaching for Respiratory Arrest with a Pulse (Case 1) You are a medical officer doing a pre-operative round when 60-year old patient started coughing violently and becomes unconscious. Fortunately
ADVANCED CARDIAC LIFE SUPPORT (ACLS) RECERTIFICATION EXAMINATION
ADVANCED CARDIAC LIFE SUPPORT (ACLS) RECERTIFICATION EXAMINATION 1. Ten minutes after an 85 year old woman collapses, paramedics arrive and start CPR for the first time. The monitor shows fine (low amplitude)
Heart Rhythm Disorders
Heart Rhythm Disorders Dr Husain Shabeeh Consultant Cardiologist & Cardiac Electrophysiologist Croydon University Hospital and King s College Hospital My interests Diagnosis and management of heart rhythm
THE EVIDENCED BASED 2015 CPR GUIDELINES
SAUDI HEART ASSOCIATION NATIONAL CPR COMMITTEE THE EVIDENCED BASED 2015 CPR GUIDELINES Page 1 Chapter 3 ACLS AND SPECIAL SITUATIONS CHAPTER The International Liaison Committee on Resuscitation (ILCOR)
ACLS Prep. Preparation is key to a successful ACLS experience. Please complete the ACLS Pretest and Please complete this ACLS Prep.
November, 2013 ACLS Prep Preparation is key to a successful ACLS experience. Please complete the ACLS Pretest and Please complete this ACLS Prep. ACLS Prep Preparation is key to a successful ACLS experience.
EKG Rhythm Interpretation Exam
as EKG Rhythm Interpretation Exam Name: Date: ID# Unit Assume each strip is a 6 second strip. Passing is 80%. 1. Identify the following rhythm: a. Asystole b. Ventricular fibrillation c. Atrial fibrillation
Cardiac arrhythmias. Janusz Witowski. Department of Pathophysiology Poznan University of Medical Sciences. J. Witowski
Cardiac arrhythmias Janusz Witowski Department of Pathophysiology Poznan University of Medical Sciences A 68-year old man presents to the emergency department late one evening complaining of increasing
ECGs on the acute admission ward. - Cardiology Update -
ECGs on the acute admission ward - Cardiology Update - Dr Simon Fynn Consultant Cardiologist Papworth Hospital, Cambridge RCP London Oct 2017 ECG 1 1. AF with BBB 2. Pre-excited AF 3. SVT with BBB 4.
AF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management
AF in the ER: Common Scenarios Atrial fibrillation is a common problem with a wide spectrum of presentations. Below are five common emergency room scenarios and the management strategies for each. Evan
Case-Based Practical ECG Interpretation for the Generalist
Case-Based Practical ECG Interpretation for the Generalist Paul D. Varosy, MD, FACC, FAHA, FHRS Director of Cardiac Electrophysiology VA Eastern Colorado Health Care System Associate Professor of Medicine
3. AV Block 1. First-degree AV block 1. Delay in AV node 2. Long PR interval 3. QRS complex follows each P wave 4. Benign, no tx
1. Rhythms & arrhythmias SA nodal rhythms Sinus rhythm Sinus tachycardia Sinus bradycardia Sinus arrhythmia Sick sinus syndrome SA block Sinus arrest AV blocks First-degree Second-degree Mobitz Type I
ECG Workshop. Carolyn Shepherd And Anya Horne UWE Principles of Cardiac Care
ECG Workshop Carolyn Shepherd And Anya Horne UWE Principles of Cardiac Care ECG workshop case study1 44 Year old male. Reports SOB, Lethargy, tiredness. PMH: Hypertension, nil else. What tests? What treatment?
CORONARY ARTERIES. LAD Anterior wall of the left vent Lateral wall of left vent Anterior 2/3 of interventricluar septum R & L bundle branches
CORONARY ARTERIES RCA Right atrium Right ventricle SA node 55% AV node 90% Posterior wall of left ventricle in 90% Posterior third of interventricular septum 90% LAD Anterior wall of the left vent Lateral
Top tips for surviving your first on call Dr Maleeha Rizvi
Top tips for surviving your first on call Dr Maleeha Rizvi Specialist Registrar in Cardiology University Hospital Lewisham Overview Practical points The Bleep and prioritising on call Cardiac arrests Prescribing
ARRHYTHMIAS IN THE INTENSIVE CARE UNIT
ARRHYTHMIAS IN THE INTENSIVE CARE UNIT Nicole Van Israël, DVM, CESOpht, CertSAM, CertVC, DECVIM-CA (Cardiology), MSc, MRCVS European Specialist in Veterinary Cardiology Animal CardioPulmonary Consultancy
2) Heart Arrhythmias 2 - Dr. Abdullah Sharif
2) Heart Arrhythmias 2 - Dr. Abdullah Sharif Rhythms from the Sinus Node Sinus Tachycardia: HR > 100 b/m Causes: o Withdrawal of vagal tone & Sympathetic stimulation (exercise, fight or flight) o Fever
ECG pre-reading manual. Created for the North West Regional EMET training program
ECG pre-reading manual Created for the North West Regional EMET training program Author:- Dr Juan Carlos Ascencio-Lane juan.ascencio-lane@ths.tas.gov.au 1 Disclaimer This handbook has been created for
Unstable: Hypotension/Shock, Fever, Altered Mental Status, Chest discomfort, Acute Heart Failure Saturation <94%, Systolic BP < 90mmHg
Bradycardia Heart Rate less than 50/min Stable: Monitor Seek expert help Treat Reversible Causes Unstable Signs and Symptoms: chest pain, shortness of breath, altered mental status, weak, Hypotension,
Atrial Fibrillation 10/2/2018. Depolarization & ECG. Atrial Fibrillation. Hemodynamic Consequences
Depolarization & ECG Atrial Fibrillation How to make ORDER out of CHAOS Julia Shih, VMD, DACVIM (Cardiology) October 27, 2018 Depolarization & ECG Depolarization & ECG Atrial Fibrillation Hemodynamic Consequences
Arrhythmias. Sarah B. Murthi Department of Surgery University of Maryland Medical School R. Adams Cowley Shock Trauma Center
Arrhythmias Sarah B. Murthi Department of Surgery University of Maryland Medical School R. Adams Cowley Shock Trauma Center 2012 Clinical Congress Presenter Disclosure Slide American College of Surgeons
Don t Forget the Basics
Scary Arrhythmias in the Hospital Gregory M Marcus, MD, MAS Assistant Professor of Medicine Division of Cardiology University of California, San Francisc Don t Forget the Basics 79 yo man with a history
Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014
Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Financial disclosures Consultant Medtronic 3 reasons to evaluate and treat arrhythmias
ECG S: A CASE-BASED APPROACH December 6,
ECG S: A CASE-BASED APPROACH December 6, 2018 1 Faculty Disclosure Faculty: Lorne Gula MD, FRCPC Professor, Western University Cardiologist, Hearth Rhythm Specialist Director, Electrophysiology Laboratory,
European Resuscitation Council
European Resuscitation Council Objectives To know basic elements to evaluate patients with rythm disturbance To know advanced treatment of paediatric cardiac arrest To know emergency treatment of most
Masqueraders of STEMI
Masqueraders of STEMI Steven M. Costa, M.D. Assistant Professor Department of Medicine Division of Cardiology Scott & White Memorial Hospital and Clinic Texas A&M University Health Science Center Disclosures
Atrial Fibrillation. A guide for Southwark General Practice. Key Messages. Always work within your knowledge and competency
Atrial Fibrillation A guide for Southwark General Practice Key Messages 1. Routinely offer pulse checks to patients at high risk of AF 2. Use the CHA 2 DS 2 VASc score to identify patients for anticoagulation
ANTI-ARRHYTHMICS AND WARFARIN. Dr Nithish Jayakumar
ANTI-ARRHYTHMICS AND WARFARIN Dr Nithish Jayakumar Contents 1. Anti-arrhythmics Pacemaker and myocardial potentials Drug classes mechanisms; s/e; contra-indications Management of common arrhythmias 2.
ECG Interpretation Made Easy
ECG Interpretation Made Easy Dr. A Tageldien Abdellah, MSc MD EBSC Lecturer of Cardiology- Hull University Hull York Medical School 2007-2008 ECG Interpretation Made Easy Synopsis Benefits Objectives Process
Final Written Exam ASHI ACLS
Final Written Exam ASHI ACLS Instructions: Identify the choice that best completes the statement or answers the question. Questions 1 and 2 pertain to the following scenario: A 54-year-old man has experienced
ECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology
ECG Cases and Questions Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology 32 yo female Life Insurance Physical 56 yo male with chest pain Terminology Injury ST elevation Ischemia T wave inversion
How To Think About Rhythms and Conduction
How To Think About Rhythms and Conduction Frank Yanowitz, MD Professor of Medicine (Cardiology) University of Utah School of Medicine Medical Director, IHC ECG Services Intermountain Healthcare http://ecg.utah.edu
10 ECGs No Practitioner Can Afford to Miss. Objectives
10 ECGs No Practitioner Can Afford to Miss Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine University of Missouri School of Medicine No disclosures Objectives 1.
Dysrhythmias. Hyperkalemia & The ECG. Who develops hyperkalemia? 2/13/17. What we will discuss today. Hyperkalemia-related bradycardia
Dysrhythmias What we will discuss today Hyperkalemia-related bradycardia Bradycardia & AV Block William J Brady, MD Professor of Emergency Medicine, University of Virginia wjbrady@virginia.edu Atrial fibrillation
MEDICATIONS CARDIOVASCULAR URGENCIES & EMERGENCIES 12/29/14. Cardiovascular Emergency Medications. Cardiovascular Emergency Medications
CARDIOVASCULAR URGENCIES & EMERGENCIES Steven Ganzberg, DMD, MS Director of Anesthesiology, Century City Outpatient Surgery Center Clinical Professor of Anesthesiology, UCLA School of Dentistry sganzberg@ucla.edu
Angina Luis Tulloch, MD 03/27/2012
Angina Luis Tulloch, MD 03/27/2012 Acute coronary syndromes ACS STE > 1 mm, new LBBB* Increased cardiac enzymes STEMI Yes Yes NSTEMI No Yes UA No No *Recognize Wellen s sign/syndrome, posterior wall MI,
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC The following is a summary of the key issues and changes in the AHA 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac
Updated Policies and Procedures # s 606, 607, 610, 611, 612, 613, 625, 628, 630, 631, and 633 (ACLS Protocols and Policies)
SLO County Emergency Medical Services Agency Bulletin 2012-09 PLEASE POST Updated Policies and Procedures # s 606, 607, 610, 611, 612, 613, 625, 628, 630, 631, and 633 (ACLS Protocols and Policies) July
Management of ATRIAL FIBRILLATION. in general practice. 22 BPJ Issue 39
Management of ATRIAL FIBRILLATION in general practice 22 BPJ Issue 39 What is atrial fibrillation? Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in primary care. It is often
Review guidance for patients on long-term amiodarone treatment
Review guidance for patients on long-term amiodarone treatment This review guidance document has been produced in response to: 1. Current supply shortages of branded and generic versions of 100mg and 200mg
Lecture outline. Electrical properties of the heart. Automaticity. Excitability. Refractoriness. The ABCs of ECGs Back to Basics Part I
Lecture outline The ABCs of ECGs Back to Basics Part I Meg Sleeper VMD, DACVIM (cardiology) University of Florida Veterinary School Electrical properties of the heart Action potentials Normal intracardiac
McHenry Western Lake County EMS System Optional CE for EMT-B, Paramedics and PHRN s Bradycardia and Treatments Optional #7 2018
McHenry Western Lake County EMS System Optional CE for EMT-B, Paramedics and PHRN s Bradycardia and Treatments Optional #7 2018 This month we will be looking at a specific ECG Rhythm and its treatments
Dr.Binoy Skaria 13/07/15
Dr.Binoy Skaria binoyskaria@hotmail.com binoy.skaria@heartofengland.nhs.uk 13/07/15 Acknowledgement Medtronic, Google images & Elsevier for slides Natalie Ryan, Events Manager, HEFT- for organising the
Objectives: This presentation will help you to:
emergency Drugs Objectives: This presentation will help you to: Five rights for medication administration Recognize different cardiac arrhythmias and determine the common drugs used for each one List the
Advanced ECG Interpretation Pt. II
Advanced ECG Interpretation Pt. II Dysrhythmias Amal Mattu, MD, FAAEM Professor and Vice Chair Director, Emergency Cardiology Fellowship Department of Emergency Medicine University of Maryland School of
MAT vs AFIB. Henry Clemo. Fast & Easy ECGs, 2E 2013 The McGraw-Hill Companies, Inc. All rights reserved.
MAT vs AFIB Henry Clemo 1 Multifocal Atrial Tachycardia (MAT) > 3 P wave morphologies HR > 100 HR < 100 wandering pacemaker I 2 Multifocal Atrial Tachycardia 3 Multifocal Atrial Tachycardia 4 Multifocal
Basic electrocardiography reading. R3 lee wei-chieh
Basic electrocardiography reading R3 lee wei-chieh The Normal Conduction System Lead Placement avf Limb Leads Precordial Leads Interpretation Rate Rhythm Interval Axis Chamber abnormality QRST change What
Ablation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group
Ablation Update and Case Studies Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Disclosures No financial relationships to disclose Objectives At the conclusion of this activity,
Arrhythmias on the AMU
Arrhythmias on the AMU Dr Andrew R. Houghton United Lincolnshire Hospitals NHS Trust @arh_cardio An arrhythmia is present in 10% of admissions to the AMU Case history AMU referral to cardiology 25 yr 2-3
ARRHYTHMIAS IN THE ICU
ARRHYTHMIAS IN THE ICU Nora Goldschlager, MD MACP, FACC, FAHA, FHRS SFGH Division of Cardiology UCSF IDENTIFIED VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar) Electrolyte imbalance Proarrhythmia
FLB s What Are Those Funny-Looking Beats?
FLB s What Are Those Funny-Looking Beats? Reading Assignment (pages 27-45 in Outline ) The 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis=
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
Atrial fibrillation in the ICU
Atrial fibrillation in the ICU Atrial fibrillation Preexisting or incident (new onset) among nearly one in three critically ill patients Formation of arrhythogenic substrate usually fibrosis (CHF, hypertension,
TACHYARRHYTHMIAs. Pawel Balsam, MD, PhD
TACHYARRHYTHMIAs Pawel Balsam, MD, PhD SupraVentricular Tachycardia Atrial Extra Systole Sinus Tachycardia Focal A. Tachycardia AVRT AVNRT Atrial Flutter Atrial Fibrillation Ventricular Tachycardia Ventricular
15 16 September Seminar W10O. ECG for General Practice
15 16 September 2012 Seminar W10O ECG for General Practice Speaker: Ms Natasha Eaton ECG for General Practice Speaker: Natasha Eaton Cardiac CNC Executive Representative Electrocardiography The graphic
KNOW YOUR ECG. G. Somasekhar MD DM FEp Consultant Electro physiologist, Aayush Hospital, Vijayawada
KNOW YOUR ECG G. Somasekhar MD DM FEp Consultant Electro physiologist, Aayush Hospital, Vijayawada CASE DETAILS A 48-year-old female non hypertensive, non diabetic presented with history of shortness of
Return to Basics. ECG Rate and Rhythm. Management of the Hospitalized Patient September 25, 2009
Management of the Hospitalized Patient September 25, 2009 ECG Refresher and Update 2009 Return to Basics Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare with
Atrial Fibrillation Cases. Dr Paul Broadhurst Consultant Cardiologist
Atrial Fibrillation Cases Dr Paul Broadhurst Consultant Cardiologist November 2011 Mr TH age 72 Routine medical for hypertension check Denies any symptoms despite close questioning PMH: hypertension, MI,
Return to Basics. Normal Intervals & Axes. ECG Rate and Rhythm
Return to Basics Management of the Hospitalized Patient October 15, 2010 ECG Refresher and Update 2010 Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare with
PEDIATRIC CARDIAC RHYTHM DISTURBANCES. -Jason Haag, CCEMT-P
PEDIATRIC CARDIAC RHYTHM DISTURBANCES -Jason Haag, CCEMT-P General: CARDIAC RHYTHM DISTURBANCES - More often the result and not the cause of acute cardiovascular emergencies - Typically the end result
TACHYARRHYTHMIAS IN INFANTS AND CHILDREN
Principles of Management SVT Algorithm VT Algorithm Interpretations of ECG Supra-ventricular Tachycardia (SVT) background SVT Management SVT Ongoing Care Ventricular Tachycardia (VT) References Principles
FUNDAMENTAL CARDIAC WORKBOOK
FUNDAMENTAL CARDIAC WORKBOOK SELF DIRECTED TESTS A MARK OF 100% MUST BE ACHIEVED IN ALL TESTS IN ORDER TO RECEIVE A CERTIFICATE AND PROGRESS TO THE ADVANCED CARDIAC STUDY DAY COMPREHENSION EXERCISES MODULE
Adenosine. poison/drug induced. flushing, chest pain, transient asystole. Precautions: tachycardia. fibrillation, atrial flutter. Indications: or VT
Adenosine Indications: 1. Narrow complex PSVT 2. Does not convert atrial fibrillation, atrial flutter or VT 1. Side effects include flushing, chest pain, transient asystole 2. May deteriorate widecomplex
Please check your answers with correct statements in answer pages after the ECG cases.
ECG Cases ECG Case 1 Springer International Publishing AG, part of Springer Nature 2018 S. Okutucu, A. Oto, Interpreting ECGs in Clinical Practice, In Clinical Practice, https://doi.org/10.1007/978-3-319-90557-0
Antiarrhythmic Drugs
Antiarrhythmic Drugs DR ATIF ALQUBBANY A S S I S T A N T P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y C O N S U L T A N T C A R D I O L O G Y & I N T E R V E N T I O N A L E P A C H D /