Cardiac arrhythmia.ppt

Cardiac arrhythmia Primary quinidine–like drugs, sympathomimetic drugs, calcium channel blockers, β–blockers, digitalis, chloroquine Secondary to metabolic/electrolyte abnormalities salicylates, methanol, ethylene glycol Cardiotoxic drugs All patients should have oxygenation and protection of airway decontamination of the GIT atropine pre–medication correction of electrolyte abnormalities acid base balance cardioversion when appropriate consultation Cardiac arrest Successful resuscitation has been well documented after 8 hours of CPR Overdose patients usually have a reversible cause for their arrest good general health novel treatments for arrhythmias cerebral protection Antidotes: asystole bradycardia Atropine everything Bicarbonate tricyclic antidepressants Calcium calcium channel blockers Diazepam chloroquine, organochlorines Epinephrine everything, β–blockers Fab fragments digoxin Glucagon β–blockers, CCBs Cardiac case 1 18 yo female admitted 3 hours after self–poisoning with 3.5 g of slow release verapamil (Isoptin SR) 6 g of paracetamol 4.5 g of tetracycline 1 g of pseudoephedrine On arrival in casualty pr 120, BP 110/80, RR 20, afebrile drowsy but oriented and cooperative Cardiac case 1 GI decontamination emesis before arrival lavaged with return of green tablets 50 g of charcoal with sorbitol repeated 4 h later Investigations ECG sinus tachycardia with normal QRS width serum paracetamol at 4 h was 38 μmol/l hepatotoxicity 1300 μmol/l at 4 hours Cardiac case 1 In intensive care unit 16 hours post overdose BP fell to 70/40 and then 50/30 PR 50 oxygen saturation dropped to 75 % ECG absent p waves prominent u waves normal QRS duration and QT interval Cardiac case 1 Treatment IV atropine 0.6 mgs – no response IV calcium gluconate 6 g over 20 minutes further 6 g over the next hour pr 60, sinus rhythm, BP 100/80 oxygen saturation 95 % infusion of 10% calcium gluconate at 2 G/h for 10 hours she was also given 2.5 L IV