Premature atrial complex
Correct the underlying cause:
-Stress reduction
-Reduce coffee
Supreventrivcular Tach
If stable:
-First try vagal maneuvers
-Next try adenonsie 6mg IV push followed by flush may repeat but give 12 mg two times.
If unstable:
Go straight to cardioversion
Atrial flutter
If rapid ventricular rate control with calcium channel blocker.
If serious S/S synchronized cardioversion
Atrial fibrillation
If patient stable with rapid ventricular rate try the following:
If cardiac function is normal:
-Calcium channel blocker
-Beta blocker
If Cardiac function impaired:
-Digoxin
-Amiodarone
Serious s/s: Synchronized Cardioversion
Junction Escape Rhythm
If the symptoms are related to slow HR consider:
-Atropine: 0.5 mg stable 1.0 mg unstable max 3 mg
-Dopamine
-Epi
Second Degree type 1
If heart is too slow and s/s caused by slow HR consider atropine and/or temporary pacing
Second Degree type 2
If symptomatic:
Transcutaneous pacing should be stated until transvenous pacemaker insertion can be done. THIS BLOCK USUALLY REQUIRES A PERMANENT PACEMAKER.
Third degree block
If QRS is narrow and pt symptomatic:
-Atropine and/or transcutaneous pacing
If QRS is wide and patient symptomatic:
Transcutaneous pacing until preparations for transvenous pacemaker
Premature Ventricular complex
Most patients with PVC require no treatment
Ventricular Tach
Stable with symptoms less than 150bpm:
-O2
-IV
-Amiodarone
Unstable without a pulse HR higher than 150bpm:
-O2
-IV
-Sedate
-Syncronized cardio version
Pulseless:
-Begin CPR until a defibrillator arrives
Torsade de pointe
Magnesium 1-2 g IV
V-fib
-Code blue
-Begin CPR until defibrillator available
-On arrival of defribillator give UNSYNCHRONIZED SHOCKS
Meds:
EPI 1mg every 3 min Vasopressin 40 units can replace 1st or second dose of EPI
Amiodarone 300mg bolus IV/IO the second 150 mg
-Prepare for en
When to defribullate
-V-Fib
-Pulseless V-tach
PEA
-code blue
-crash cart/defibrillator
-CPR
-EPI 1 mg every 3 min Vasopressin 40 units can replace 1st or second dose of epi.
-Get ready to intubate
Asytole
-Perform CPR
-confirm by 2 leads
-EPI 1 mg every 3 min Vasopressin 40 units can replace 1st or second dose of epi.