NBME Shelf Review (Part 6) – Common Arrhythmias
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 4 November 2018
⏱️ 15 minutes
🧾️ Download transcript
Summary
“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)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
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| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.a.i. Hey guys, what's going on? This is Mike Estefan from the University of |
| 0:49.3 | Rochester School of Medicine, bringing you episode six in the Emergency Medicine shelf exam review series. |
| 0:56.6 | This week's episode is going to focus on the management of the arrhythmias that you are likely to |
| 1:01.8 | see on your shelf exam. In addition to knowing how to manage these arrhythmias, you are also going to |
| 1:08.1 | need to be able to identify them on EKG. |
| 1:14.7 | So if you don't know how to recognize any of these arrhythmias on EKG, |
| 1:17.1 | I would recommend looking them up online. |
| 1:22.8 | There are tons of resources out there that do a way better job at teaching how to identify these arrhythmias on EKG than I ever could on a podcast. Let's start out by talking |
| 1:29.3 | about the management of some of the arrhythmias that you may see on your exam. Before we dive into |
| 1:34.9 | the specific arrhythmias, I just want to quickly touch on what defines a stable or an unstable |
| 1:41.2 | patient in this context. Now, in the clinical setting, deciding whether a patient |
| 1:46.2 | is stable or unstable is a little more difficult because these patients exist on a spectrum. It is |
| 1:52.2 | not black and white. There are significant amounts of gray when making this decision. However, |
| 1:57.1 | for your exam, this is a black and white decision. The patient is either stable or unstable. |
| 2:03.9 | Factors that would make you decide that the patient is unstable includes hypotension, pulmonary edema, chest pain, or altered mental status. |
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