[...]... arrest: a 3-phase time-sensitive model JAMA 2002; 288: 3035–38 Cardiac arrest Aim 17 Cardiac arrhythmias: general approach 3 Cardiac arrhythmias: general approach Cardiac arrhythmia Yes Cardiac arrest or BP unrecordable? Call resuscitation team ALS algorithm (p 13 ) No Key observations (Table 1. 2) Oxygen, ECG monitor, IV access Focused assessment (Table 3 .1) Patient unstable? Yes No Stabilize airway and... the AV node and back via the accessory pathway) – Fast conduction of atrial fibrillation down the accessory pathway (broad complex, irregular) – Rarely, antidromic tachycardia (broad complex, regular) (conduction forward down the accessory pathway and back via the AV node) Continued Cardiac arrhythmias: general approach 20 C O MMO N P RESENTATI ONS Associated acute or chronic illness? • Atrial fibrillation... pre-excited atrial flutter Yes or antidromic tachycardia? (Table 4 .1) DC or chemical cardioversion (Table 5.3) Refer to cardiologist No Treat as ventricular tachycardia (Table 4 .1, Fig 4 .1) DC or chemical cardioversion (Table 4.2) or antitachycardia pacing Refer to cardiologist 21 22 C O MMO N P RESENTATI ONS T A B L E 4 1 Broad complex regular tachycardia: differential diagnosis and management Broad... s and then release: a capillary refill time of >2 s is abnormal Jugular venous pressure Auscultation: added heart sounds, murmurs or pericardial rub? Major pulses: present and symmetrical? Signs of pulmonary and/or peripheral edema? T A B L E 1 7 Management of circulatory failure: general principles • Stabilize airway and breathing: maintain arterial oxygen saturation >90% • Correct major arrhythmia... management of the airway 2 Respiratory rate Respiratory rate 30/min Give oxygen (initially 60 10 0%) Check arterial oxygen saturation and blood gases (pp 98 10 3, 587) See Table 1. 5; pp 10 4–9 for management of respiratory failure 3 Arterial oxygen saturation Arterial oxygen saturation 220 >13 0 >30 3 A score of 3 or more suggests potential critical illness and requires immediate assessment The score is a guide and has not been fully validated Neurological status Temperature (°C) Systolic blood... pharynx, larynx and trachea with a suction catheter Call for urgent help from an anesthetist Before intubation, ventilate the patient using a bag-mask device with 10 0% oxygen * Respiratory distress is shown by dyspnea, tachypnea, ability to speak only in short sentences or single words, agitation and sweating The critically ill patient: assessment and stabilization T A B L E 1 3 Assessment and stabilization . edition 19 95 Third edition 20 01 Fourth edition 2008 1 2008 Library of Congress Cataloging-in-Publication Data Sprigings, David. Acute medicine : a practical guide to the management of medical emergencies. 3 2 1 0 1 2 3 Respiratory <8 8 11 12 –20 21 25 26–30 >30 rate (/min) Arterial oxygen <85 86–89 90–94 >95 saturation(%) Heart rate (/min) <40 41 50 51 10 0 10 1 11 0 11 1 13 0 > ;13 0 Systolic. disorders and thrombocytopenia, 500 79 Management of anticoagulation, 507 80 Sickle cell crisis, 514 81 Anaphylaxis and anaphylactic shock, 519 82 Complications of cancer, 523 Miscellaneous 83 Acute medical