By David C. Sprigings, John B. Chambers
This highly regarded name has develop into the definitive pocket advisor to the administration of clinical emergencies for front-line sanatorium medical professionals. It presents designated tips at the analysis and therapy of all universal stipulations and encompasses a step by step advisor to the 9 most crucial functional strategies in acute medication.
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Extra resources for Acute Medicine: A Practical Guide to the Management of Medical Emergencies
Lancet 2002; 359: 593–603. Wellens HHJ. Contemporary management of atrial ﬂutter. Circulation 2002; 106: 649–52. 8 Bradycardia and atrioventricular block See p. 1) Bradycardia and atrioventricular block Patient unstable? 4) Poor response to drug therapy or bradycardia likely to recur? 5; p. 4) Refer to cardiologist 47 48 COMMON PR ESENTATIONS T AB L E 8 . 3 for causes) • Junctional bradycardia (Fig. 1) • Slow atrial ﬁbrillation (distinguished from atrial ﬁbrillation with complete AV block by variability in RR interval) • Atrial ﬂutter/atrial tachycardia with 4 : 1 AV block • Complete AV block with junctional or ventricular escape rhythm (Fig.
Relationship of P wave to QRS varies randomly, and P waves are absent if there is atrial ﬁbrillation. Escape rhythm may be junctional (narrow complex) or ventricular (broad complex). Even in asymptomatic patients, this carries a risk of sudden death due to ventricular standstill or polymorphic ventricular tachycardia/ventricular ﬁbrillation. F IG U R E 8 . 3 Second degree atrioventricular (AV) block, Mobitz type 2. Constant PR interval with dropped beats. Usually due to disorder of His–Purkinje system and often progresses to complete AV block.
Weisfeldt ML, Becker LB. Resuscitation after cardiac 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. 1) Patient unstable? g. 1 Focused assessment of the patient with an arrhythmia Cardiac arrhythmias: general approach Symptoms? • Of arrhythmia (palpitation, presyncope, syncope) • Of underlying cardiac disease (chest pain, breathlessness) Hemodynamically stable?
Acute Medicine: A Practical Guide to the Management of Medical Emergencies by David C. Sprigings, John B. Chambers