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1. Drugs classification:
1. Class 1: use for VT
1. procainamide
2. Lidocaine
2. Class 2: B-blockers
3. Class 3: Amiodarone ⇒ for VT and SVT and AF
4. Class 4: Calcium channel blockers
2. Bradycardia: <50-60 bpm
1. Amp atropine 0.5 mg IV, repeat q5min, max 3 mg
2. if no response, Amp dopamine 5-10 ugr/min IV infusion
3. 1st degree heart block: no Tx
4. 2nd and 3rd degree heart block:
1. Amp dopamine 10-10 ugr/kg/min
2. or Amp epinephrine 2-10 ugr/kg/min
5. 2nd degree due to BB or CCB:
1. Amp glucagon 5-10 mg stat then 2-5 mg/hr infusion
6. Sinus tachycardia:
1. look for underlying cause rather than treating the mere tachycardia
7. Atrial flutter: 250-350 HR, sawtooth appearance
1. if unstable: 50-100 j cardioversion
2. if stable: Echo for clot formation if >48 hrs is passed
1. Amp heparin 5,000 u IV stat then 1000 u/hr IV infusion
2. Amp Diltiazem 20 mg IV over 2 mins then 5-15 mg/hr, repeat with 25 mg if no response seen
3. if HF +: Amp Digoxin 0.25 mg IV in 5 mins repeat q2hr (max 1.5 mg)
4. if no response: Amp MgSO4 4 gr in 4 mins
8. PSVT: regular, 200-180 HR, AVNRT
1. Vagus massage, cold water, gag reflex
2. Amp adenosine 6,g IV push then 12 mg IV (Amp 3mg/ml)
9. AF: 400 HR + 120-170 ventricular response
1. instable: synchronized cardioversion 120-200j
2. stable:
1. Amp digoxin 1/2 amp stat slowly
2. start anticoagulants using CHA2DS2 Vacs scoring system
10. VT: wide complex, regular, 15-200 HR
1. unstable: unsynchronized or synchronized cardioversion 100-200j
2. stable:
1. Amp procainamide 100mg + 10cc D/W (25-50 mg/min) then 3mg/min infusion
2. or Amp Amiodarone 150 mg + 50 cc D/W in 10 mins then 1 mg/hr infusion for 6 hrs
3. or Amp lidocaine 1.5 mg/kg IV then 2-4 mg/kg IV infusion
3. if polymorphic VT:
1. Amp MgSO4 2 gr + 50 cc D/W in 15 mins infusion then 1-2 gr/hr infusion
11. PVSs:
1. Tab metoprolol 50 mg bid
2. Tab propranolol 20 mg tds
3. Tab Concor (bisoprolol) 5 mg qd
4. Tab verapamil 40 mg tds
5. tab diltiazem 60 mg tds
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