Acute Medical Presentations — Flashcards

Flashcard 81: What is the first-line drug treatment for symptomatic Sinus bradycardia?

Answer: Atropine (0.5 - 1 mg IV) ⟗ repeat every 3-5 mins (Max 3mg)

Extra: If Atropine is ineffective, second-line treatments include: • Transcutaneous pacing • Dopamine infusion (5-20 mcg/kg/min) • Epinephrine infusion (2-10 mcg/min) Note: ACLS 2020 updates increased the initial dose of Atropine to 1 mg for bradycardia, though 0.5 mg is still commonly cited in many guidelines (like ALS UK). The previous dose was 0.5 mg.

Flashcard 82: Which patient group can present without Chest Pain during an MI ?

Answer: • Elderly • Diabetics • Women

Flashcard 83: What presents as narrow complex tachycardia?

Answer: • Supraventricular Tachycardia

Flashcard 84: What is the Medical Management for Supraventricular Tachycardia (SVT) ?

Answer: 1. Vagal maneuvers\n2. Adenosine (IV 6mg rapid bolus; follow with 12mg if needed)\n3. AV nodal blockers (Beta-blockers or Calcium channel blockers) if adenosine fails/is contraindicated.

Extra: In hemodynamically unstable patients, the immediate treatment of choice for SVT is synchronized DC cardioversion. Adenosine is the first-line medical therapy for stable SVT. Flashcard updated to reflect the full sequence of management.

Flashcard 85: What are the ECG features of Torsades de Pointes?

Answer: • Ventricular tachycardia (polymorphic) • Prolonged QT interval (preceding the arrhythmia) • Rapid polymorphic QRS complexes that appears to "twist" around the isoelectric line

Flashcard 86: What are the typical ECG findings in Supraventricular Tachycardia (SVT)?

Answer: Narrow complex tachycardia with a regular rhythm and absent P waves.

Flashcard 87: If the 12mg adenosine is unsuccessful, what is the next step in SVT management?

Answer: DC Cardioversion (if unstable) OR alternative AV nodal blockers (e.g., Verapamil, Diltiazem, Beta-blockers) (if stable)

Extra: The standard adenosine dosing for SVT is 6mg, then 12mg. In some guidelines (like older ACLS or specific European protocols), a third dose of 12mg or 18mg was mentioned, but current ACLS guidelines typically stop at 12mg and transition to DC cardioversion (if unstable) or other drugs (if stable). 18mg is not a standard recommended dose in current ACLS protocols.

Flashcard 88: In the management of stable SVT, if the first bolus (6 mg) of Adenosine is unsuccessful, what is the next step?

Answer: Give a second dose of 12 mg IV adenosine.

Extra: The standard ACLS protocol for stable SVT is: 1. Vagal maneuvers. 2. Adenosine 6 mg rapid IV push (with saline flush). 3. If unsuccessful, Adenosine 12 mg rapid IV push. 4. A second 12 mg dose can be given if needed.

Flashcard 89: 8892364799924d4aa95741d3852db59a-ao-2

Answer:

Flashcard 90: What is the immediate management of brain metastases with significant peritumoral oedema? _____

Answer: Dexamethasone