Write a 50 marks answer for Postgraduate Anaesthesia exam on the topic of Management of Tachydysrrhythmia including Cardioversion and Defibrillation and its anaesthetic considerations (Shoe with the flowchart ) and convert it to pdf
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Tachydysrhythmia Management PG Anaesthesia
PDF Document · PDF
Here is a full outline of everything covered in the answer (50 marks):
PG Anaesthesia – Management of Tachydysrhythmia (50 Marks)
Structure of the Answer
| Section | Topic | Marks |
|---|---|---|
| 1 | Introduction & Definition | 2 |
| 2 | Classification (narrow/wide, regular/irregular) | 4 |
| 3 | Pathophysiology (reentry, automaticity, triggered activity) | 3 |
| 4 | ACLS Algorithm Flowchart (2020 AHA) | 6 |
| 5 | Cardioversion – definition, indications, contraindications, procedure, energy levels table | 8 |
| 6 | Defibrillation – definition, indications, step-by-step procedure (4Hs & 4Ts, epinephrine, amiodarone) | 6 |
| 7 | Pharmacological management table (13 drugs with doses, indications, cautions) | 6 |
| 8 | Anaesthetic considerations – pre-assessment, sedation agents table, monitoring, intraoperative, post-procedure | 8 |
| 9 | Special scenarios – WPW+AF, Torsades de Pointes, Pregnancy, Paediatrics | 4 |
| 10 | Complications of cardioversion/defibrillation | 2 |
| 11 | Anaesthetic agents and cardiac rhythm interactions | 3 |
| 12 | Summary key points (14 bullet points) | 3 |
| Refs | 8 authoritative references | 1 |
Key Anaesthetic Points Highlighted
- Sedation agents for cardioversion: Propofol (preferred), Etomidate (poor LV function), Ketamine (haemodynamic compromise), Midazolam + Fentanyl (less haemodynamic effect)
- Synchronise mode ON - must be confirmed before every cardioversion shock
- WPW + AF = AV nodal blockers CONTRAINDICATED (adenosine, verapamil, diltiazem, amiodarone IV all forbidden)
- Torsades de Pointes = Magnesium sulphate 2 g IV first line
- ICD patients: disable ATP before cardioversion, pads ≥8 cm from device, re-interrogate post-procedure
- Intraoperative tachycardia: rule out light anaesthesia, hypoxia, hypovolaemia, hypercapnia before treating pharmacologically
Sources: Miller's Anaesthesia 10e (Ch.82), Braunwald's Heart Disease (Ch. 67 & 69), Fuster & Hurst's The Heart 15e (Ch. 36), 2020 AHA ACLS Guidelines.
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