- A dysrhythmia refers to an abnormality of the heart rhythm.
- Although not all patients will become unstable and show adverse signs, brady-dysrhythmias (<60bpm) and tachy-dysrhythmias (>100bpm) have the potential to severely compromise cardiac output and lead to cardiac arrest.
- Supraventricular tachycardia (SVT) is a common cardiac dysrhythmic disturbance. It is narrow complex and regular, usually of rapid onset and is typically defined as having an absence of P waves.
- Rates can range from +/- 150bpm, can be slower, although are often much faster. Typically, SVT is not usually life threatening and can be self-resolving.
- Patients presenting with cardiac dysrhythmia, demonstrating adverse signs such as distress and fatigue may require urgent transport.
Unstable bradycardia (with pulse and not associated with traumatic cause):
- Poor signs of perfusion, including:
- Hypotension
- Altered conscious state
- Diaphoresis
- Shortness of breath and/or cyanosis
- Syncope
Unstable tachycardia (with pulse)
- Unstable indicates that cardiac output has reduced to produce blood pressure changes, altered mental status, ischaemic chest pain, hypotension, syncope or other signs of shock.
Supraventricular tachycardia (SVT):
- Pulse > approx 150 bpm, rapid onset, regular, with diaphoresis and signs or symptoms of reduced cardiac output.
- Nil
- Primary Survey
- Reassurance (continuous)
- Limit patients exertion as much as is practically possible
- Vital Sign Survey (monitor regularly including pre-and-post intervention pain scores)
- Consider Oxygen if indicated as per CPG
- Consider Secondary Survey
- Apply cardiac monitor including a 12 Lead if available, trained and authorised
- Pain relief: If pain >3/10 post 1x spray of GTN, administer Methoxyflurane
- Consider ondansetron if required
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- 12 lead ECG; transmit telemetry to receiving hospital as indicated
- Vascular access; obtain pre-hospital blood sample
- Address reversible cause:
- If inferior/right ventricular MI associated with bradycardia and hypotension, consider IV saline to address cardiogenic shock and follow STEMI protocol.
- Hypovolaemia, hypoxia and some toxins that can be addressed in the field.
- Consider Atropine Sulphate, if likely to have effect. Atropine would not be effective in 3rd degree Heart Blocks or in wide complex bradycardias.
- Consider ASMA consult for advice.
- Early recognition.
- 12 Lead ECG should not delay transport.
- Consider proximity to ED; consider ASMA consult if delivery to ED will be delayed.
- Consider patient in peri-arrest state.
- Consider Modified Valsalva Manoeuvre
- Consider pain relief
- Consider anti-emetic
- Monitor patient continuously, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- If atrial fibrillation, consider Amiodarone (if onset <48 hours)
- Transport for rate control
- Early recognition
- 12 Lead ECG should not delay transport
- Synchronised cardioversion
- Consider Amiodarone if cardioversion unsuccessful
- Resuscitation equipment should be at hand
- Consider unstable patient as being time-critical and in a peri-arrest state.
- Resuscitation equipment should be at hand.
- Consider unstable patient as being time-critical, possible peri-arrest.
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