By David C. Sprigings, John B. Chambers
This very hot name has turn into the definitive pocket consultant to the administration of clinical emergencies for front-line clinic medical professionals. It presents targeted counsel at the prognosis and therapy of all universal stipulations and features a step by step consultant to the 9 most crucial useful approaches in acute drugs.
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Extra info for Acute Medicine: A Practical Guide to the Management of Medical Emergencies
Rare symptomatic sinus pauses, or complete heart block with a stable escape rhythm and no hemodynamic compromise • Discuss management with a cardiologist. Consider using standby external pacing system instead of transvenous pacing • Prosthetic tricuspid valve Complications • Complications of central vein cannulation (p. 590), especially bleeding in patients with acute coronary syndromes treated with thrombolytic therapy (reduced with ultrasound-guided approach, p. 591) • Cardiac perforation by pacing lead (may rarely result in cardiac tamponade) • Arrhythmias (including ventricular ﬁbrillation) during placement of pacing lead • Infection of pacing lead AV, atrioventricular.
Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart 2003; 1363–72. Broad complex irregular tachycardia Drug F IG U R E 5 . 1 Pre-excited atrial ﬁbrillation in Wolff–Parkinson–White syndrome. g. V1–6 ) look regular. By contrast, in atrial ﬂutter the tachycardia is usually regular and in antidromic tachycardia, it is reproducibly regular. Broad complex irregular tachycardia 32 COMMON PR ESENTATIONS 6 Narrow complex tachycardia See p. 1) Yes No Narrow complex tachycardia Stabilize airway and breathing Patient unstable?
2 Atrial ﬂutter with 2 : 1 block. 4 Intravenous therapy for rate control in atrial ﬁbrillation, atrial ﬂutter and atrial tachycardia Comment Dose (IV) Esmolol Short-acting (half-life 8 min) beta-1 selective beta-blocker 500 μg/kg over 1 min, followed by 200 μg/kg over 4 min Metoprolol May cause hypotension 5 mg over 5 min, to maximum dose of 15 mg Solatol May cause hypotension 1 mg/kg over 10 min Verapamil May cause hypotension Contraindicated in patients taking beta-blockers or in heart failure 5 mg over 5 min, to maximum dose of 15 mg Digoxin Use if there is heart failure 500–1000 μg in 50 ml saline over 1 h Amiodarone May be combined with digoxin for rate control in hemodynamically unstable patients Loading: 300 mg, diluted in 5% glucose to a volume of 20–50 ml, infused over 20 min via a central vein Maintenance: 900–1200 mg over 24 h Further reading American College of Cardiology, American Heart Association and European Society of Cardiology.
Acute Medicine: A Practical Guide to the Management of Medical Emergencies by David C. Sprigings, John B. Chambers