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!Tachyarrhythmia!

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Question!1!

A!40%year%old!woman!presents!to!ED!with!palpitations.!She!has!a!history!of!recurrent!SVT.!She!is!awake!and!haemodynamically!stable.!She!has!no!other!medical!problems!and!no!allergies.!Her!ECG!is!attached!(ECG!1)!

1. What!is!your!approach!to!this!patient?!2. !Discuss!the!use!of!Adenosine!vs!Verapamil!in!this!patient!

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Question!2!

A!65%year%old!man!present!to!the!ED!with!palpitations,!which!he!has!never!before.!He!has!no!chest!pain.!He!is!awake!and!oriented.!He!has!a!history!of!hyperlipidaemia!and!hypertension!(but!has!left!his!medications!at!home).!!

His!vital!signs!are:!HR!130!irreg,!BP!95/65,!RR!18,!O2!sats!96%!RA,!afebrile.!

His!ECG!is!attached!(ECG!2).!

1. What!is!your!approach!to!this!patient?!2. Discuss!the!concept!of!‘Rhythm!Control!vs!Rate!Control’!3. When!would!you!consider!anticoagulation!for!this!patient?!

Despite!treatment,!the!patient!remains!in!AF,!with!a!rate!of!105!

4. What!factors!will!determine!whether!this!patient!is!safe!for!Discharge?!!!!!!!

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Question!3!

A!75!year!old!man!is!brought!to!ED!after!a!conscious!collapse!whilst!shopping.!He!describes!feeling!lightheaded!prior!to!his!collapse!but!no!pain.!He!has!a!history!of!CABG,!diabetes!and!hypertension.!

His!ECG!is!attached!(ECG3).!The!patient!is!awake!and!talking,!has!a!BP!80/50!and!cool!peripheries.!

1. Describe!your!management!

You!elect!to!DC!cardiovert!this!patient!

2. Discuss!your!options!for!sedation!for!this!procedure!

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Author:!Monash!Emergency!Education!group,!2015!