Editing Circulation (section)

== '''Management of arrhythmias:''' ==

* Most important thing is haemodynamics initially.
** Assess:
*** Vitals
*** Peripheral perfusion
*** Cardiac ischaemia/CHF
*** Level of consciousness
*** Management:
*** For all arrhythmias:
**** '''Check and correct electrolytes'''
**** '''Oxygen if needed'''
**** '''Optimise fluid'''
* ECG
* ?telemetry
* Tachyarrhythmia:
** Unstable - cardioversion
** Stable:
*** Supraventricular - may respond transiently to valsalva. beta blockers/digoxin/amiodarone. Adenosine 6mg or 12mg can be given to block the AV node (avoid in asthmatics and the presence of dipyridamole, but otherwise relatively safe in inexperienced hands).
*** Paroxysmal SVT: vagal stimulation or adenosine
*** VT: lidocaine/procainamide/amiodarone can be given. Cardioversion generally required. Especially urgently if there is compromised cardiac output.
* Bradyarrhythmia:
** Sustained - atropine or beta adrenergic agonist
** Transient - nothing
* Heart block: 
** Persistent high-grade second degree or third degree: insertion of PPM