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Medical: 5

Cardiology: 2 ════════════════════════════════════════════════════════════════════════════════════ ══════════════════════════

      • (a)

        When in doubt

        • i)

          Cardioversion when hemodynamic state is compromised or changing

        • ii)

          Never use verapamil

        • iii)

          If hemodynamic state is stable - consider lidocaine

      • (b)

        Pitfalls

        • i)

          Age is not a differential

        • ii)

          Slower rates may present with stable hemodynamic

        • iii)

          Preexisting BBB prior to onset of the tachycardia

      • (c)

        Regularity

        • i)

          Monomorphic V-tach and SVT are usually very regular and SVT frequently is faster

        • ii)

          Polymorphic V-tach is irregular

  • 10.

    Pulseless electrical activity

    • a.

      Electrical mechanical dissociation

    • b.

      Mechanical impairments to pulsations/ cardiac output

    • c.

      Other possible causes

  • 11.

    Other ECG phenomena

    • a.

      Accessory pathways

    • b.

      Preexitation phenomenon

    • c.

      Aberration versus ectopy

  • 12.

    ECG changes due to electrolyte imbalances

    • a.

      Hyperkalemia

    • b.

      Hypokalemia

  • 13.

    ECG changes in hypothermia

  • VI.

    Management of the patient with arrhythmias

    • A.

      Assessment

      • 1.

        Symptomatic

      • 2.

        Hypotensive

      • 3.

        Hypoperfusion

      • 4.

        Mechanical

      • 5.

        Vagal maneuvers - if the heart rate is too fast

      • 6.

        Stimulation - If heart rate is too slow

      • 7.

        Precordial thump

      • 8.

        Cough

    • B.

      Pharmacological

      • 1.

        Gases

        • a.

          Such as oxygen

      • 2.

        Sympathetic

        • a.

          Such as epinephrine

      • 3.

        Anticholinergic

        • a.

          Such as atropine

      • 4.

        Antiarrhythmic

        • a.

          Such as lidocaine

      • 5.

        Beta blocker

        • a.

          Selective

          • (1)

            Such as metoprolol

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────────────────────────── United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

18

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