Acute Medical Presentations — Flashcards

Flashcard 81: What are the typical ECG findings in Supraventricular Tachycardia (SVT)?

Answer: Narrow complex tachycardia with a regular rhythm and absent P waves.

Flashcard 82: What is the Medical Management for Supraventricular Tachycardia (SVT) ?

Answer: 1. Vagal maneuvers\n2. Adenosine (IV 6mg rapid bolus; follow with 12mg if needed)\n3. AV nodal blockers (Beta-blockers or Calcium channel blockers) if adenosine fails/is contraindicated.

Extra: In hemodynamically unstable patients, the immediate treatment of choice for SVT is synchronized DC cardioversion. Adenosine is the first-line medical therapy for stable SVT. Flashcard updated to reflect the full sequence of management.

Flashcard 83: If the 12mg adenosine is unsuccessful, what is the next step in SVT management?

Answer: DC Cardioversion (if unstable) OR alternative AV nodal blockers (e.g., Verapamil, Diltiazem, Beta-blockers) (if stable)

Extra: The standard adenosine dosing for SVT is 6mg, then 12mg. In some guidelines (like older ACLS or specific European protocols), a third dose of 12mg or 18mg was mentioned, but current ACLS guidelines typically stop at 12mg and transition to DC cardioversion (if unstable) or other drugs (if stable). 18mg is not a standard recommended dose in current ACLS protocols.

Flashcard 84: In the management of stable SVT, if the first bolus (6 mg) of Adenosine is unsuccessful, what is the next step?

Answer: Give a second dose of 12 mg IV adenosine.

Extra: The standard ACLS protocol for stable SVT is: 1. Vagal maneuvers. 2. Adenosine 6 mg rapid IV push (with saline flush). 3. If unsuccessful, Adenosine 12 mg rapid IV push. 4. A second 12 mg dose can be given if needed.

Flashcard 85: What presents as narrow complex tachycardia?

Answer: • Supraventricular Tachycardia

Flashcard 86: What is the immediate management of brain metastases with significant peritumoral oedema? _____

Answer: Dexamethasone

Flashcard 87: Which artery infarction is most commonly associated with arrhythmias (like bradycardia or heart block) due to its supply to the conduction system?

Answer: Right Coronary Artery (RCA) - it supplies the SA and AV nodes in most individuals.

Flashcard 88: What is the appropriate treatment for symptomatic bradycardia if atropine is ineffective or contraindicated (e.g., atropine allergy)?

Answer: Adrenaline infusion or Transcutaneous Pacing (TCP)

Flashcard 89: In ALS what should be given in patients who are in VF/pulseless VT after 5 shocks have been administered?

Answer: • Amiodarone 150mg

Flashcard 90: What ECG signs are suggestive of previous myocardial infarction?

Answer: Pathological Q waves (signifying transmural scar/necrosis)

Extra: Pathological Q waves are defined as: • Width > 0.04 sec (1 small box) • Depth > 25% of the following R wave height • Seen in contiguous leads (except aVR) Other signs of old MI include persistent T-wave inversion or loss of R-wave height (poor R-wave progression).