Dr. Jetty Sedyawan, SpJP.K

Abstract:

Arrhythmia are some of the most alarming and exciting medical conditions facing both experienced front-line emergency room physicians. The major cardiac emergency cases is Acute Coronary Syndrome and it’s complications such as Acute Pulmonary Edema, Heart Failure, Cardiogenic Shock, and Life threatening arrhythmia.

Tachycardia with a heart rate greater than 150 beats per minute in an unstable patient who is not in cardiac arrest may require immediate cardioversion with a defibrillator. Stable tachycardias should be addressed in the hospital whenever possible because any intervention has the potential to trigger a life-threatening arrhythmia.

The ACLS protocol recommends pharmacologic measures for treatment of most stable tachycardias, but a defibrillator and equipment for endotracheal intubation should be on hand before any medication is administered. Amiodarone, 150 mg diluted to 100 mL with normal saline administered IV over 10 min, is recommended today as front line therapy. At a minimum, you should be trained in BLS and the use of an AED, and so should at least 2 other members of your office staff. It is not uncommon for more than one life-threatening cardiac condition to occur simultaneously: Myocardial Infarction (MI) may occur with arrhythmia or acute pulmonary edema.

Cardiac arrest rhythms include Ventricular Febrillation (VF), Ventricular Tachycardia (VT), asystole, and Pulseless Electrical Activity (PEA). Urgency is compounded when the arrhythmia is accompanied by shortness of breath, chest pain, reduced consciousness, low BP, shock, pulmonary congestion, heart failure, or MI. Whenever possible, compare the stable patient’s current ECG with those obtained at previous visits. If you have been unable to document an arrhythmia with an ECG in a patient who complains of palpitations, the history can sometimes tell you whether there is a high risk of a serious disorder. Palpitations are often completely benign. On occasion, though, they can signal a life-threatening arrhythmia, especially if the patient also reports dizziness and fainting. Any underlying structural heart disease increases the likelihood that symptoms may represent a hazardous condition. Some 65% of cardiac arrests are caused by VF, and another 3% by its precursor rhythm, VT.

VF is universally fatal without defibrillation. Immediate defibrillation is the treatment of choice for a short episode of VF; the success of defibrillation decreases dramatically with the passage of time. Cardiopulmonary resuscitation (CPR) remains essential for treating patients in cardiac arrest. Chest compressions should be applied until the defibrillator is attached because mechanical support of circulation increases the chance of successful defibrillation. CPR is also critical for treating patients with asystole and PEA. Patients i

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