By David C. Sprigings, John B. Chambers

This very hot name has develop into the definitive pocket consultant to the administration of clinical emergencies for front-line health center medical professionals. It offers designated information at the prognosis and therapy of all universal stipulations and incorporates a step by step advisor to the 9 most crucial functional tactics in acute medication.

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Additional info for Acute Medicine: A Practical Guide to the Management of Medical Emergencies

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N Engl J Med 2000; 342: 703–9.

Call resuscitation team DC cardioversion Refer to cardiologist 12-lead ECG and rhythm strip: regular or irregular tachycardia? 2 Vagotonic maneuvers Sinus rhythm restored? 3) Sinus rhythm restored? Yes Likely diagnosis is AVNRT or AVRT (Fig. 1) Refer to cardiologist if: • ECG in sinus rhythm shows Wolff–Parkinson– White syndrome • Episodes of supraventricular tachycardia (SVT) are frequent/severe • Associated cardiac disease Yes No Likely diagnosis is atrial flutter (Fig. 3) may be appropriate to exclude other causes of narrowcomplex regular tachycardia if in doubt AV nodal re-entrant tachycardia (AVNRT) The commonest cause of paroxysmal SVT Typically presents in teenagers or young adults with no underlying cardiac disease Retrograde P wave usually hidden within or inscribed at the end of the QRS complex (simulating S wave in inferior leads, partial RBBB in V1) Heart rate usually 140–200 bpm DC cardioversion (p.

Yes No • Stop drugs which may prolong QT interval • Correct hypokalemia (p. 447) • Temporary pacing (p. 2) • If evidence of myocardial ischemia, manage as acute coronary syndrome (pp. 1 Broad complex irregular tachycardia: differential diagnosis and management Arrhythmia Comment Management Atrial fibrillation with bundle branch block (Fig. 1) Difference between maximum and minimum instantaneous heart rates, calculated from the shortest and longest RR intervals is usually >30 bpm, with QRS showing typical LBBB or RBBB morphology DC cardioversion (p.

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