Periarrest Arrhythmias

Peri-arrest rhythms are those that may present as emergency situations. Many of these adverse arrhythmias occur following a myocardial infarction, resuscitation or other factors. In such instances, if standard measures to manage or prevent arrhythmias are ineffective, expert help should be sought promptly (ERC 2001).

Adverse arrhythmias can manifest with the following signs and symptoms.

• Evidence of a low cardiac output - for example, hypotension, cool peripheries, clamminess, pallor, confusion.

• Excessive tachycardias - a narrow or broad complex tachycardia can significantly decrease diastolic time, resulting in impaired coronary blood flow and myocardial ischaemia.

• Excessive bradycardias - usually defined as a rate less than 40bpm, although some patients may become symptomatic at higher rates.

• Cardiac failure - includes the triad of pulmonary oedema, a raised jugular venous pressure and hepatic engorgement (ERC 2001).

Fig. 8.6 Bradycardia.

The major peri-arrest rhythms include:

• bradycardia

• atrial fibrillation

• other narrow complex tachycardia

• broad complex tachycardia.

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