NBME Shelf Review (Part 6) – Common Arrhythmias
Summary: <br> “Unstable” Arrhythmias<br> <br> <br> <br> * Arrhythmias that cause* Hypotension* Pulmonary Edema* Chest Pain* Altered Mental Status<br> <br> <br> <br> Supraventricular Tachycardia (SVT)<br> <br> <br> <br> * Stable* Vagal maneuver* Adenosine* Beta blocker or calcium channel blocker* Unstable* SYNCHRONIZED cardioversion<br> <br> <br> <br> Monomorphic Ventricular Tachycardia (VT)<br> <br> <br> <br> * Stable* Amiodarone* Procainamide* Lidocaine* Unstable* SYNCHRONIZED cardioversion* Pulseless* Defibrillation<br> <br> <br> <br> Polymorphic Ventricular Tachycardia (aka Torsades de Pointes)<br> <br> <br> <br> * Known complication of prolonged QTc* Side effect of multiple medications* Antipsychotics* Methadone* Ondansetron* Give Magnesium Sulfate<br> <br> <br> <br> High yield EKG patterns<br> <br> <br> <br> * Long QTc* Wolf Parkinson White (WPW)* Brugada Pattern<br> <br> <br> <br> Atrial Fibrillation<br> <br> <br> <br> * 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<br> <br> <br> <br> Bradycardia<br> <br> <br> <br> * 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<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Life in the Fast Lane EKG Library <a href="https://litfl.com/ecg-library/">(LITFL)</a>* Tachycardias <a href="http://www.emclerkship.com/tachycardia/">(EM Clerkship)</a>* Bradycardias <a href="http://www.emclerkship.com/bradycardia/">(EM Clerkship)</a><br>
