Rhythms and their Treatments

Quick reference for the deadly rhythms: what to give, what to shock, and when to sync.

The following are supposed to be quick and simple reference points for the deadly rhythms you will encounter. By no means is it comprehensive, but it should serve as a quick simple reference of key treatments. • CPR: Maintains cerebral and coronary perfusion o If you defibrillate, immediately resume CPR for 2 minutes because even if the rhythm converted out of Ventricular Fibrillation or Pulseless Ventricular Tachycardia, it still takes the heart time to start producing adequate contractions. After the 2 minutes, then a pulse/rhythm check should occur. • Defibrillation essentially stops all electrical activity in the heart. We hope by doing so, the hearts normal electrical pathways take over and the patient resumes normal sinus rhythm. o Early defibrillation for ventricular fibrillation and pulseless ventricular tachycardia is key. The longer a patient has been in these rhythms, the less likely they are to respond to being shocked. Therefore, it is ideal to defibrillate as soon as possible. • Cardioversion provides a reset. The heart is vulnerable during repolarization (T wave on an ECG) to energy. If you accidentally deliver the cardioversion shock on the T wave, it could trigger ventricular fibrillation. To avoid this risk, cardioversion should always be synchronized to the R wave (Always sync to the R wave in cardioversion). • Keep in mind: Is the patient stable or unstable? This will determine how aggressive and rapid treatments should be.

Treatment of Ventricular Fibrillation:

• CPR • Early Defibrillation (200 J) • Epinephrine 1mg Q3-5 minutes • Amiodarone 300mg then 150mg • Reversible Causes: H's and T's

Treatment of Ventricular Tachycardia Without a Pulse:

• CPR • Early Defibrillation (200J) • Epinephrine 1mg Q3-5 minutes • Amiodarone 300mg then 150mg • Magnesium 2g if polymorphic • Reversible Causes: H's and T's

Treatment of Ventricular Tachycardia with a Pulse:

• Synchronized Cardioversion (R Wave) • Amiodarone Infusion Protocol (150mg over 10 minutes, followed by 1mg/min for 6 hours, then 0.5mg/min over 18 hours) • Review H's and T's and potential triggers like any abnormal electrolytes

Treatment of PEA and Asystole:

• CPR • Epinephrine 1mg Q3-5 minutes • Reversible Causes: H's and T's (Bicarb, Calcium, Fluids etc)

Treatment of SVT:

• Vagal Maneuvers • Adenosine (6mg,12mg) • Synchronized Cardioversion(Sync to R wave)

Treatment of Symptomatic Bradycardia:

• Atropine 1mg Q3-5 minutes, max 3 mg • Epinephrine Infusion • Transcutaneous Pacing • Identify possible triggers

Treatment of 3rd Degree AV Block:

• Transcutaneous Pacing followed by Transvenous Pacing if available (Pacer will ultimately be inserted by cardiology)

Treatment of Atrial Fibrillation with a Rapid Ventricular Response:

• IV fluids if no contraindication • Metoprolol or Diltiazem IV (Followed by a PO dose for longer effect) • Consider Amiodarone Infusion • Consider synchronized cardioversion if new onset and no contraindications present