Treatment and monitoring of emergency arrhythmias

The article was professionally consulted by Master, Doctor Ngo Dac Thanh Huy - Cardiologist - Department of Medical Examination & Internal Medicine, Vinmec Danang International General Hospital

Emergency cardiac arrhythmias appearing suddenly can cause dangerous complications such as cardiac arrest, myocardial infarction, stroke, etc., threatening the patient's life if not handled promptly. Therefore, the emergency arrhythmia monitoring is one of the very important procedures.

Arrhythmia is a very common condition in cardiovascular diseases. Arrhythmia has many forms such as bradycardia, tachycardia, supraventricular tachycardia, extrasystoles, sinus tachycardia, sinus bradycardia,... Mechanism of arrhythmia is nerve conduction disturbance automatically in cardiac structures.
Conduction disturbances reverse the refractory period, causing tachycardia episodes due to the inward loop or conversely causing obstruction, creating bradycardia. Another mechanism of arrhythmias is disturbance of impulse formation due to altered autonomic availability of the cardiac autonomic nervous system.
Arrhythmias sometimes cause no symptoms. However, in case the heart rate is too slow, the patient may feel dizzy, short of breath, faint, swollen ankles, etc. When the heart rate is too fast, the above symptoms may also appear. The ventricles do not have enough time to dilate to fill with blood. Some other common symptoms of arrhythmia are palpitations, chest pain, heart palpitations,...
Severe and prolonged arrhythmia can cause heart failure. Cardiac arrhythmias appearing suddenly can cause cardiac arrest, myocardial infarction, stroke, ... if not handled promptly. In clinical practice, emergency cardiac arrhythmia is one of the common causes of sudden death. Therefore, arrhythmias need to be diagnosed and treated early to avoid circulatory failure.

The emergency arrhythmia treatment and monitoring team includes 1 doctor and 2 nurses. The required equipment includes:
Monitors to monitor electrocardiograms and vital signs Electrical shocks Medicines (adrenalin, amiodarone, propranolol, atropine, sedation, analgesia...) Means of respiratory resuscitation respiration, other circulation. 2.1. Assess the patient's condition The doctor evaluates the airway status, circulatory factors (such as heart rate, pulse, blood pressure, capillary refill time, skin temperature) and the patient's neurological status.
2.2. Carry out resuscitation Steps to resuscitate patients with arrhythmia emergency include:
Clearing the airway: Give the patient an oxygen mask, pass the balloon through the mask or intubate if necessary. Install a monitor to monitor SpO2, the patient's heart rate. Take the patient's blood for tests including: complete blood count, kidney function, blood sugar. Assess arrhythmia on 12-lead electrocardiogram: tachycardia or slow, regular or irregular, wide or narrow QRS. Rapid infusion of 20ml/kg of crystalloid fluid if the patient has bradycardia and shock.

2.2.1. Treatment when the patient is in shock If the emergency arrhythmia patient is in shock, manage the shock according to the following steps:
Perform chest compressions if the patient is in shock and the heart rate is < 60 beats/min. Electroconvulsive shock is 1-2 J/kg if the patient is in shock and has ventricular tachycardia. If no electric shock machine is available, insert intravenous or intra-osseous line, then intravenous adenosine 0.1-0.5mg/kg. 2.2.2. Emergency treatment of bradyarrhythmias Treat hypoxia and shock if any, ensure adequate ventilation for the patient. Intravenous atropine at a dose of 20 mcg/kg (100 to 600 mcg). Atropin can be repeated after 5 minutes (1mg total dose in young children, 2mg in older children). Atropine can be intubated 0.04 mg/kg through the endotracheal tube. Consult a poison control specialist if the patient is intoxicated. 2.2.3. Emergency management of supraventricular tachycardia Perform parasympathetic stimulation with ECG monitoring on monitor, do not apply ocular pressure in children. If that does not work, inject the patient with adenosine or use one of the drugs including amiodarone, flecainide, digoxin, verapamil, propranolol. 2.2.4. Emergency management of ventricular tachycardia Manage according to the ventricular fibrillation protocol if the patient has pulseless ventricular tachycardia. If the patient is hemodynamically stable, a cardiologist should be consulted immediately. The drug amiodarone (5 mcg/kg intravenously over 20 minutes, neonates over 30 minutes) or procainamide (15 mg/kg intravenously over 30-60 minutes). If the patient is in shock, perform a copper electric shock at 1 J/kg. If not effective increase to 2 J/kg and switch to non-copper shock. An injection of amiodarone 5 mg/kg can be given if the patient is in severe shock. The ECG and vital signs on the monitor should be continuously monitored until stable. In summary, an emergency cardiac arrhythmia that appears suddenly can cause life-threatening complications if not treated promptly. Therefore, the emergency arrhythmia monitoring is one of the very important procedures.
Currently, Cardiovascular Center - Vinmec International General Hospital is one of the leading centers in the country for examination, diagnosis, screening and treatment of cardiovascular diseases. Vinmec not only has the convergence of a team of experienced and reputable leading experts in the field of surgical treatment, internal medicine, interventional cardiac catheterization, but also has a system of modern equipment, on par with The most prestigious hospitals in the world such as: MRI 3 Tesla (Siemens), CT 640 (Toshiba), high-end endoscopy equipment EVIS EXERA III (Olympus Japan), high anesthesia system Avace level, Hybrid operating room according to international standards... Especially, with the space designed according to 5-star hotel standards, Vinmec ensures to bring patients the most comfort, friendliness and peace of mind. .

Reference source: Ministry of Health