Arrhythmia Treatments
SINUS BRADYCARDIA & HEART BLOCK: 2ND DEGREE (BOTH TYPES) & 3RD DEGREE
Symptomatic – First line: Atropine 0.5mg (may repeat up to 3 mg)
Secondary: Pacing, Dopamine 2-10mcg/kg/min, Epinephrine 2-10mcg/min
Cardiac transplant pt: Isoproterenol
Asymptomatic – continue to monitor
SINUS TACHYCARDIA
Symptomatic – Synchronized cardioversion (pain meds before if you have time – Versed, Diprivan)
Asymptomatic – Vagal, Adenosine 6mg, Digoxin, Beta Blockers, Cardizem
SINUS ARRHYTHMIA
Rarely treated, only treat if showing symptomatic bradycardia during expiration
SICK SINUS SYNDROME
Permanent pacemaker (for bradycardia) & Digoxin or Beta Blocker (for tachycardia)
ANY PREMATURE CONTRACTION (PAC, PVC, PJC)
Happens in most people, don’t usually treat. If happening frequently, determine underlying cause
ATRIAL TACHYCARDIA (SVT)
Symptomatic – Synchronized cardioversion, vagal stimulation, Adenosine 6mg, BBs, CCBs, Digoxin,
Cordarone
Paroxismal – reverses on its own, determine underlying cause
ATRIAL FLUTTER & ATRIAL FIBRILLATION
Symptomatic – Need to know how long it has been occurring before treatment!
<48hr: Synchronized cardioversion
>48hr: drug therapy until anticoagulants can take effect (do TEE to check for clots if no
time for anticoags), then cardiovert
Asymptomatic – Cardizem 10-20mg over 2 min, Vagal, Adenosine (6mg x 1, 12mg x 1, 12mg x 1)
VENTRICULAR TACHYCARDIA with PULSE
First line: Synchronized cardioversion
Second line: Amiodarone 150 mg over 10 min
VENTRICULAR TACHYCARDIA without PULSE & VENTRICULAR FIBRILLATION
100%O2, CPR, Defibrillate, Immediately resume CPR x 5 cycles, Check pulse, Defibrillate, CPR x 5
cycles and:
Epinephrine 1mg q 3-5min OR Vasopressin 40 U x 1 dose
Defibrillate, CPR x 5 cycles and:
Amiodarone 300mg (may repeat with 150 mg) OR Lidocaine 1-1.5mg/kg
Hang drip of last drug used once perfusable rhythm returns
TORSADE DE POINTES
Same as V Tach except Magnesium administered also
ASYSTOLE
100%O2, CPR x 5 cycles while putting in IV, Epinephrine 1mg q 3-5min OR Vasopressin 40 U x 1
dose, Atropine 1 mg q 3-5min up to 3 doses, CPR x 5 cycles
1 DEGREE HEART BLOCK - Tell MD, hold Digoxin, Cordarone, etc.
ST
SINUS BRADYCARDIA & HEART BLOCK: 2ND DEGREE (BOTH TYPES) & 3RD DEGREE
Symptomatic – First line: Atropine 0.5mg (may repeat up to 3 mg)
Secondary: Pacing, Dopamine 2-10mcg/kg/min, Epinephrine 2-10mcg/min
Cardiac transplant pt: Isoproterenol
Asymptomatic – continue to monitor
SINUS TACHYCARDIA
Symptomatic – Synchronized cardioversion (pain meds before if you have time – Versed, Diprivan)
Asymptomatic – Vagal, Adenosine 6mg, Digoxin, Beta Blockers, Cardizem
SINUS ARRHYTHMIA
Rarely treated, only treat if showing symptomatic bradycardia during expiration
SICK SINUS SYNDROME
Permanent pacemaker (for bradycardia) & Digoxin or Beta Blocker (for tachycardia)
ANY PREMATURE CONTRACTION (PAC, PVC, PJC)
Happens in most people, don’t usually treat. If happening frequently, determine underlying cause
ATRIAL TACHYCARDIA (SVT)
Symptomatic – Synchronized cardioversion, vagal stimulation, Adenosine 6mg, BBs, CCBs, Digoxin,
Cordarone
Paroxismal – reverses on its own, determine underlying cause
ATRIAL FLUTTER & ATRIAL FIBRILLATION
Symptomatic – Need to know how long it has been occurring before treatment!
<48hr: Synchronized cardioversion
>48hr: drug therapy until anticoagulants can take effect (do TEE to check for clots if no
time for anticoags), then cardiovert
Asymptomatic – Cardizem 10-20mg over 2 min, Vagal, Adenosine (6mg x 1, 12mg x 1, 12mg x 1)
VENTRICULAR TACHYCARDIA with PULSE
First line: Synchronized cardioversion
Second line: Amiodarone 150 mg over 10 min
VENTRICULAR TACHYCARDIA without PULSE & VENTRICULAR FIBRILLATION
100%O2, CPR, Defibrillate, Immediately resume CPR x 5 cycles, Check pulse, Defibrillate, CPR x 5
cycles and:
Epinephrine 1mg q 3-5min OR Vasopressin 40 U x 1 dose
Defibrillate, CPR x 5 cycles and:
Amiodarone 300mg (may repeat with 150 mg) OR Lidocaine 1-1.5mg/kg
Hang drip of last drug used once perfusable rhythm returns
TORSADE DE POINTES
Same as V Tach except Magnesium administered also
ASYSTOLE
100%O2, CPR x 5 cycles while putting in IV, Epinephrine 1mg q 3-5min OR Vasopressin 40 U x 1
dose, Atropine 1 mg q 3-5min up to 3 doses, CPR x 5 cycles
1 DEGREE HEART BLOCK - Tell MD, hold Digoxin, Cordarone, etc.
ST
