Category: Fundamentals If patients with bradycardia develop signs or symptoms of poor perfusion (altered mental status, chest pain, hypotension, shock), IV atropine (0.5 mg every 3 to 5 minutes, up to 3 mg total dose) should be immediately administered.
Category: Fundamentals In patients with pulseless ventricular tachycardia or ventricular fibrillation, high-quality cardiopulmonary resuscitation (CPR) should be immediately initiated until a defibrillator or automated external defibrillator (AED) arrives.
Category: Fundamentals For administration of drug therapy during an episode of pulseless ventricular tachycardia or fibrillation, while IV access is preferred, the guidelines recommend the intraosseous (IO) route as an alternative if IV access cannot be established.
Category: Fundamentals Ventricular fibrillation is usually not preceded by any symptoms and always results in a loss of consciousness and eventually death if not treated. Immediate treatment is essential in patients who develop pulseless ventricular tachycardia or fibrillation.
Category: Fundamentals The majority of cases of sudden cardiac death can be attributed to ventricular fibrillation. Sustained ventricular tachycardia usually precedes VF and most commonly occurs in patients with coronary artery disease.
Category: Fundamentals If the patient is in ventricular tachycardia and hemodynamically unstable (hypotension), synchronized direct current cardioversion is first-line therapy. If the patient is stable, IV amiodarone, procainamide or sotalol is considered.
Category: Fundamentals Ventricular tachycardia that persists for at least 30 seconds or that requires electrical or pharmacological termination because of hemodynamic instability is known as sustained ventricular tachycardia.
Category: Fundamentals Adenosine does not produce hypotension to the degree that verapamil does If a total of 30 mg of adenosine does not successfully terminate paroxysmal supraventricular tachycardia, further doses of this agent are unlikely to be effective.
Category: Fundamentals If vagal maneuvers are unsuccessful or paroxysmal supraventricular tachycardia recurs after vagal maneuvers, second-line therapy is antiarrhythmic drugs. The drug of choice for paroxysmal supraventricular tachycardia is adenosine.
Category: Fundamentals Hemodynamically unstable paroxysmal supraventricular tachycardia requires synchronized direct current cardioversion to restore sinus rhythm in order to correct hemodynamic compromise.
Category: Fundamentals When the duration of AF is definitively known to be less than 48 hours, a prolonged period of anticoagulation is not necessary before electrical or pharmacological cardioversion because the risk of thromboembolism is deemed low.
Category: Fundamentals If AF has been present for more than 48 hours or for an unknown duration, cardioversion should not be performed acutely because of the risk of thromboembolism. These patients should be therapeutically anticoagulated.
Category: Fundamentals If a patient has hemodynamically unstable AFib or AFlutter (hypotension, syncope), immediate DCC is first-line therapy. If the patient is hemodynamically stable and has a rapid ventricular rate, the first priority is to control the ventricular rate.
Category: Fundamentals Initial vagal maneuvers may serve as both diagnostic and therapeutic purposes for certain arrhythmias. For example, carotid sinus massage may make the flutter waves in AF investigations more apparent.
Category: Fundamentals Atropine is a parasympatholytic drug that enhances both sinus nodal automaticity and AV nodal conduction through direct vagolytic action. Atropine blocks acetylcholine at parasympathetic neuroeffector sites.
