Guide Intern Survival Guide Tachycardia

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Intern Guide. Page 2. - 2 -. University of Colorado Guide to Internal Medicine you come away from the process of internship a stronger, more confident Adenosine can be used to help differentiate narrow complex tachycardias. .. NO data demonstrating recovery or survival benefit from thyroid hormone.
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Reverse Hs and Ts: Apply pads. Prepare for transcutaneous pacing. Consider cardiology consult. Hypoxia : bag mask ventilation, intubation If hypotensive: Bolus fluids.

Predicting tachycardia as a surrogate for instability in the intensive care unit

Treat as shock. Hydrogen ion acidosis : Bicarb boluses Discontinue all nodal blockers. Attempt to wake patient and see bedside response. Consult SNF.


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If new 2nd or 3rd degree block, consider cardiology consult. Obtain EKG.

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Attach a Zoll monitor. Sync cardioversion: J, increment if needed. Rx underlying cause. Torsades: Magnesium IV. Start on Cardizem gtt. Metoprolol 2. If hypotensive: Amiodarone mg loading IV, then gtt. Treat underlying cause: Volume depletion vs overload eg sepsis vs. If considering septic shock and have central access: Transfer Irregular narrow complex: A.

See stable tachycardias for further management. Page Is the call because patients rate is now uncontrolled or because Acuity: New or old? Whats been tried and what worked? Is there a known cause? Please see section on causes. Did patient miss any medications? Review old EKGs, old cardiology notes. Vitals: Ensure hemodynamic stability. Use of theophylline, caffeine.

Predicting tachycardia as a surrogate for instability in the intensive care unit | SpringerLink

Repeat BMP, magnesium levels in not sent within the last 4 hours. Send a TSH levels if none done recently. Hypokalemia, hypomagnesemia. Alcohol, illicit drugs cocaine, amphetamine, bath salts, etc. Always remember withdrawal states! Open areas? Patient not taking PO? Assess why. Consider IV formulations from same family.

Metoprolol 5 or 10 mg IV and repeat as necessary. Once PE: stat imaging.

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Consider empiric anticoagulation if high controlled, immediately give PO Cardizem 0. May repeat after 15 minutes. Once controlled, can start exercise caution since beta agonists can exacerbate atrial cardizem 30 mg PO q 6 H. If not controlled, start on cardizem fibrillation. Cocaine use: Consider benzodiazepines. May use lower doses of IV metoprolol or cardizem. Alcohol withdrawal: CIWA protocol. Dehydration: IV hydration. Esmolol 0.

Special considerations: unresponsive synchronized cardioversion evaluate risk of If A. Acuity: New or existing issue? Trend the blood pressure to see acute vs. Request a manual reading and in elevation.

Common Urgent Calls: The Intern Survival Bible, Volume 2

Confirm BP with appropriately sized cuff as mentioned 4. Treatment: in 1. Enalaprilat: 1. Carvedilol: 3. Esmolol: 0. Amlodipine: 2. Hemodynamically stable? Known source of GIB? Past GI history? Symptoms: Upper vs.

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Associated symptoms? Known coagulopathy? Check medications. Initial interventions: 3. Examination: Abdominal, oral, rectal.


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    • Consider Assess severity: Rockall score see reference tables. PRBC transfusion see below.

    ICU/Critical Care: How to Present A Patient During Rounds

    Discontinue Delineate source, consider etiology see graphic below anticoagulation, consider reversal.