14. Fast AF with CP and hypotension
Is there anything driving the AF?
Sepsis, CCF, dehydration
How long has she been in AF?
Chronic AF unlikely to cardiovert and may throw of a clot if
does cardiovert
15. Fast AF with CP and hypotension
New onset ( < 48 hours): fluid load, phenylephrine,
analgese (fentanyl) sedate and cardiovert
Chronic AF: fluid load, phenylephrine, analgese (fentanyl)
+/- treat for ACS
21. Sinus tachy or SVT?
Sinus tachy
P waves
Rate varies – watch the monitor
Will slow with reassurance, analgesia
Usually caused by something eg pain, illness
Not usually the presenting complaint
Gradual onset and offset
SVT
Fast onset
Constant rate – watch the monitor
Usually presenting complaint
24. SVT
Vagal manoeuvres
Valsalva
Carotid sinus massage (age < 60)
Face in ice water
Adenosine
Big IV line
Can mix with big flush
12, 18mg
Verapamil
5mg IV
27. Hyper K
Salbutamol 10mg neb
Calcium gluconate 1 amp = 10mmol
Arrange urgent dialysis
Then think about glucose + insulin, HCO3
Resonium probably does more harm than good
33. 70M, CP, hypotensive
Inferior MI
Do a R sided ECG – may well have a R ventricular infarct
Try atropine – unlikely to work
Avoid GTN, avoid morphine (use fentanyl for pain)
FLUID LOAD (may need litres of fluid) before trying pacing
/ inotropes
Reperfuse ASAP – PCI preferred