1. -1st step in ALL palpable ventricular arrythmia is Synchronized Defibrillation - Epinephrin(IV) in 1:10,000 is for Rx. of heart rate and blood pressure. - Epinephrin(SC) in 1:1000 of inhaled is used to Rx. Anaphylaxis respiratory distress.
2. Tachycardia>100
   1. "QRS" complex MORE than 0.12 sec.= VENTRIVCULAR pathology
      1. No palpable Pulse, No breathing=Dead Pt.!
         1. Hx. of lightning or electrical injury
            1. Asystole = flat line EKG
            2. Rx. I.Epinephrine, II.Atropine, III.transcutaneous pacing
         2. Pulseless Electrical activity=normal EKG
         3. Ventricular fibrilation
            1. Rx. 1st: unsynchronized defibrillation(x3)
            2. 2nd: II.Epinephrine OR vasopressin , III.Defibrilate. IV.intubate, V.Defibrilate, VI.Amioderone or lidocain, VII. Procainamide
            3. Ejection fraction less then 35% OR positive arrhythmia induction on electro-physiology study
            4. Rx. Automated Implantable Cardiac Defibrillator
         4. Ventricular tachycardia can present dead or Alive with a palpable pulse= HR is 120 or more & 3 ventricular beats or more
            1. Dead Pt.
            2. Alive w/ palpable pulse
            3. UNStable
            4. Rx. 1st: Synchronized defibrillation
            5. stable
            6. Rx. I. Amioderon, II.Lidocain, III.Procainamide
            7. Long term Rx. for V.Tach is I. Beta-Blocker,II.AICD
      2. Palpable pulse = pt. is alive and breathing
         1. Hx. Heart Block, lithium, TCA, Porcainamide, a/w sudden audiatory of visual sti(eg : phone ringing)
            1. Torsade de Pontes=EKG with elevation of "QT"
            2. Stable
            3. Rx.MgSo4
            4. Unstable
            5. Rx.Unsynchronized defibrillation
         2. Hx. Atrial Arrhythmia (Epstein anomaly), trans-position of the great vessels, S/S: loud S1
            1. WPW=Wolff-Parkenson White Synd. = EKG deflection "Delta"-waves & short "PR'
            2. Rx.Short term: Procainamide; Long term: Ablation
   2. any "QRS" complex LESS than 0.12 sec. is a/w ATRIAL pathology
      1. IRREGULAR PULSE
         1. Hx. Respiratory Disease
            1. EKG= "P' wave has varying forms, a/w COPD & Resp. Failure
            2. Dx. Multi-focal Atrial Tachycardia
            3. Rx. the Respiratory disease will Rx. the arrhythmia
         2. EKG= 350 to 500 ATRIAL beats, May have some "QRS" that are more than 0.12s
            1. Dx. Atrial Fibrilation
            2. both atrial Fibrillation & Flutter have the same Rx.
            3. Acute
            4. Unstable
            5. Rx. Synchronized shock
            6. Stable
            7. Hx. Migraine, or CVS, or thyroid disease,
            8. Rx. Beta-Blocker= Propanolol (PO)
            9. Hx. depression, COPD, or asthma
            10. Rx. Ca-Channel Blocker
            11. Hx. low or boarder line blood pressure
            12. Rx. Digoxin
            13. Chronic is atrial arrhythmia for 2 or more days
            14. less than 60 y. of age
            15. Rx. Asprin
            16. more than 60 y of age
            17. Rx. Warfarin
      2. REGULAR PULSE
         1. EKG=240 to 300 Atrial beat, "P" wave is saw tooth- shaped, 2:1 Atrio-Ventricular block
            1. Dx. Atrial Flutter
3. Bradycardia<60
   1. EKG=constant "R-R" w/ SUDDEN dropped "QRS"
   2. S/S Canon "a" wave on JVP
      1. Rx. 1st: Atropin 2nd Pacemaker(IV)
   3. ANY type of bradycardia S/S on P/E (eg palpable bradycardia with SOB or pain) = Must be treated