Acute Management of Arrhythmia

1. Tachyarrhythmia in a stable patient
   1. Run continuous Rhythm strip (preferably a three-lead or 12 lead ) ECG

During the conversion attempt

1. Vagal maneuvers

Valsalva/Gag/Ice to face

(Avoid carotid & ocular massage and hypertension-producing drugs)

1. Adenosine (Adenocard, 2 mg/vial x 3mg/ml= 6mg/vial) DRUG OF CHOICE
   • Start dose 50 μg/kg IV push(fastest bolus possible, follow immediately with saline flush)
   • Increase by 100 μg/kg/dose to maximum 500 μg/kg (Theophylline is antagonist; may need >> maximum dose)
2. Verapamil is absolutely contraindicated in < age 12 months and relatively contraindicated in WPW syndrome.
3. Obtain 12-lead ECG after conversion

2. Tachyarrhythmia in an unstable patient
   1. Cardioversion
3. Bradyarrhythmia in an unstable patient
   1. Isoprenaline 0.1 – 0.5 μg/kg/min
   2. Pacemaker