WikEM - User contributions [en]

Accelerated idioventricular rhythm

2016-05-17T08:43:15Z

Mustafaomar:

===Background===
AIVR results when rate of an ectopic ventricular pacemaker exceeds sinus node.
Usually benign,self limiting
===Causes===
#Reperfusion phase of acute myocardial infarction (= most common cause)
#Beta-sympathomimetics (isoprenaline or adrenaline)
#Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane
#Electrolyte abnormalities
#Cardiomyopathy, congenital heart disease, myocarditis
#Return of spontaneous circulation (ROSC) following cardiac arrest
#Athletic heart
===ECG features===
#Regular rhythm.
#Rate 50-110 bpm.
#Three or more ventricular complexes.
#QRS complexes >120ms.
#Fusion and capture beats.
===Management===
#AIVR is a benign rhythm in most settings and does not usually require treatment.
#Self limiting and resolves when sinus rate exceeds that of the ventricular foci.
#Anti-arrhythmics may cause precipitous haemodynamic deterioration and should be avoided.
#Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion.
#Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction.
===References===
http://lifeinthefastlane.com/ecg-library/aivr/
[[Category:Cardiology]]

Accelerated idioventricular rhythm

2016-05-17T08:42:26Z

Mustafaomar:

Accelerated idioventricular rhythm

2016-05-17T08:40:32Z

Mustafaomar: /* References */

Accelerated idioventricular rhythm

2016-05-17T08:36:13Z

Mustafaomar: Created page with "===Background=== AIVR results when rate of an ectopic ventricular pacemaker exceeds sinus node. Usually benign,self limiting ===Causes=== #Reperfusion phase of acute myocardia..."

===Background===
AIVR results when rate of an ectopic ventricular pacemaker exceeds sinus node.
Usually benign,self limiting
===Causes===
#Reperfusion phase of acute myocardial infarction (= most common cause)
#Beta-sympathomimetics (isoprenaline or adrenaline)
#Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane
#Electrolyte abnormalities
#Cardiomyopathy, congenital heart disease, myocarditis
#Return of spontaneous circulation (ROSC) following cardiac arrest
#Athletic heart
===ECG features===
#Regular rhythm.
#Rate 50-110 bpm.
#Three or more ventricular complexes.
#QRS complexes >120ms.
#Fusion and capture beats.
===Management===
#AIVR is a benign rhythm in most settings and does not usually require treatment.
#Self limiting and resolves when sinus rate exceeds that of the ventricular foci.
#Anti-arrhythmics may cause precipitous haemodynamic deterioration and should be avoided.
#Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion.
#Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction.
===Refereces===
http://lifeinthefastlane.com/ecg-library/aivr/

Sodium bicarbonate

2016-02-15T08:53:04Z

Mustafaomar: Created page with "Hyperosmolar solution. Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial '''Indications:''' -Hyperkalemia -decr pain due to LA '''Toxicological indications-'..."

Hyperosmolar solution.
Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial

'''Indications:'''
-Hyperkalemia
-decr pain due to LA
'''Toxicological indications-'''
Cardiotoxicity secondary to fast sodium channel blockade-TCA,Bupropion,Chloroquine/hydroxychloroquine,Dextropropoxyphene,Propranolol.
Prevent redistribution of drug to CNS-Severe salicylate poisoning.
Profound life-threatening metabolic acidosis-Cyanide,Toxic alcohol poisoning,Isoniazid overdose.
Enhance urinary drug elimination-Salicylate,Phenobarbitone intoxication.
Increase urinary solubility-Methotrexate toxicity.Drug-induced rhabdomyolysis

'''Contraindications:'''
Acute pulmonary oedema
Hypokalaemia
Metabolic or respiratory alkalosis
Poorly controlled congestive cardiac failure
Renal failure
Severe hypernatraemia.

'''Adverse drug reactions:'''
Alkalosis (serum pH >7.6 is detrimental to cardiovascular function)
Hypernatraemia and hyperosmolarity
Fluid overload and acute pulmonary oedema
Hypokalaemia
Local tissue inflammation secondary to extravasation

'''Administration:'''
'''Cardiotoxicity secondary to fast sodium channel blockade:'''
Resuscitation from severe cardiotoxicity (cardiac arrest, ventricular arrhythmias and hypotension)
Give repeated boluses of 2 mmol/kg IV until cardiovascular stability is achieved
'''Maintenance of serum alkalinisation in severe cardiotoxicity:'''
Consider following resuscitation in the presence of ventricular arrhythmias, hypotension, or a markedly wide QRS complex (>140 ms)
Commence an infusion of 100 mmol sodium bicarbonate diluted in 1000 mL normal saline at 250 mL/hour
Hourly ABGs and maintain serum pH 7.50–7.55
Cease following resolution of cardiovascular toxicity as determined by clinical and ECG criteria
'''Prevention of redistribution of salicylate to CNS:'''
Maintain pH above 7.4 at all times
Intubated pt-serum pH may be maintained >7.4 by hyperventilation
Unwell un-intubated patient with salicylate poisoning-Give sodium bicarbonate 2 mmol/kg IV bolus,Then intubate, hyperventilate and recheck ABGs.
Serum alkalinisation is maintained until definitive care with haemodialysis.
'''Urinary alkalinisation:'''
Correct hypokalaemia if present.Give 1–2 mmol/kg sodium bicarbonate IV bolus
Commence infusion of 100 mmol sodium bicarbonate in 1000 mL 5% dextrose at 250 mL/hour
20 mmol of KCl may be added to infusion to maintain normokalaemia
Monitor serum bicarbonate and potassium at least every 4 hours
Regularly dipstick urine and aim for urinary pH >7.5 .Continue until resolving clinical and laboratory evidence of toxicity.

'''Specific considerations:'''
'''Pregnancy:''' No restriction on use
'''Lactation:''' No restriction on use
'''Paediatric:''' Doses are the same as for adults on mmol/kg basis. Reduced fluid volumes should be used in children.