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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Emergency Suprapubic Catheter Placement

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miércoles, 13 de diciembre de 2017

New Arrhythmia Guidelines 2017

EmergencyPedia
EmergencyPedia -  December 13, 2017 - By Andrew Coggins

"Summary from Journal Feed
  1. If in doubt with wide complex tachycardia, assume it’s VT (class I).
  2. For hemodynamically stable VT, procainamide is the preferred pharmacologic agent (class IIa). However, cardioversion remains a class I recommendation.
  3. In hemodynamically unstable ventricular arrhythmias, electricity is undoubtedly first priority. If that fails, amiodarone is the preferred pharmacologic agent (class IIa).
  4. IV beta blockers may be useful (class IIa) for patients with:
    1. VT/VF storm despite DCCV and antiarrhythmics
    2. Polymorphic VT due to MI
  5. Adrenaline 1mg every 3-5 minutes “may be reasonable” in cardiac arrest (class IIb).
  6. Consider emergent PCI in all patients after out-of-hospital cardiac arrest, particularly with initial shockable rhythm. Absence of STEMI does not rule out culprit coronary lesion and may be seen in 30% of patients.
  7. Contrary to common teaching, accelerated idioventricular rhythm (AIVR) is not a marker of reperfusion. Instead it is more strongly associated with infarct size.
  8. Some drugs can worsen or unmask Brugada syndrome. (drugs of concern include procainamide (not available in Australia), flecainide, TCAs, lithium, propofol, cocaine, cannabis and alcohol).
  9. Digoxin isn’t the only cause of bidirectional VT. Catecholaminergic polymorphic VT (exercise or stress induced VT) can also cause it.
  10. Long QT syndrome: males in childhood and postpartum females are at greatest risk for ventricular arrhythmia."