Management of arrhythmias

With all peri-arrest arrhythmias similar initial steps are followed:

  1. Assess the patient with ABCDE approach

  2. Continuous monitoring of ECG, oxygen saturations and blood pressure.

  3. Gain IV access

  4. 12 Lead ECG

  5. Identify and treat any potential reversable causes such as electrolyte abnormalities, infection and hypovolemia

Assess for the presence of ‘adverse features’ which may include:

Legend:

  1. Syncope: Brief loss of consciousness due to reduced cerebral perfusion

  2. Heart failure: Characterised by pulmonary oedema or raised JVP

  3. Cardiac chest pain: ​Typical myocardial ischaemia (MI) chest pain or evidence of MI on ECG

  4. Shock: Evidence of shock or hypoperfusion – such as hypotension, cool and clammy, onset of confusion.

The presence of adverse features will determine what the management will be and the urgency of attempted cardio version.

Stop and think

Expert help should be sought from someone who is trained in Adult Life Support (ALS) if there is presence of adverse features with an arrhythmia. As the patient may need direct current (DC) cardioversion.

Cardiac Monitoring

If your patient requires continuous cardiac monitoring consider:

  • Do they need continuous monitoring such as on ICU or cardiac HDU.

  • Attach patient to 3 lead or 5 lead cardiac monitor.

  • Check monitor alarm settings:

    • Low and high limits should be set

    • Arrhythmia alarm should be on

    • Ensure alarms are on and audible

    • Check connected to power supply