NBME Shelf Review (Part 6) – Common Arrhythmias

“Unstable” Arrhythmias * Arrhythmias that cause* Hypotension* Pulmonary Edema* Chest Pain* Altered Mental Status Supraventricular Tachycardia (SVT) * Stable* Vagal maneuver* Adenosine* Beta blocker or calcium channel blocker* Unstable* SYNCHRONIZED cardioversion Monomorphic Ventricular Tachycardia (VT) * Stable* Amiodarone* Procainamide* Lidocaine* Unstable* SYNCHRONIZED cardioversion* Pulseless* Defibrillation Polymorphic Ventricular Tachycardia (aka Torsades de Pointes) * Known complication of prolonged QTc* Side effect of multiple medications* Antipsychotics* Methadone* Ondansetron* Give Magnesium Sulfate High yield EKG patterns * Long QTc* Wolf Parkinson White (WPW)* Brugada Pattern Atrial Fibrillation * 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 Bradycardia * 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 Additional Reading * Life in the Fast Lane EKG Library (LITFL)* Tachycardias (EM Clerkship)* Bradycardias (EM Clerkship)