Tachycardia cardiopulmonary resuscitation

American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care, part 7.3. Management of symptomatic bradycardia and tachycardia. Circulation 2005 112 IV-67 to IV-177. 

CPR, cardiopulmonary resuscitation D5W, 5% dextrose in water PEA, pulseless electrical activity PVT, pulseless ventricular tachycardia ROSC, return of spontaneous circulation VF, ventricular fibrillation. 

A 38-year-old man was given intravenous adenosine 6 mg for a narrow-complex tachycardia (20). Within about 1 minute his heart rate fell from 230/minute to bradycardia and then asystole. Cardiopulmonary resuscitation was ineffective. At autopsy there was a 75% occlusion of one of the coronary arteries (unspecified). 

The common ventricular arrhythmias include (1) premature ventricular complexes (PVCs), (2) ventricular tachycardia, and (3) ventricular fibrillation. Again, these arrhythmias may result in a wide variety of symptoms. PVCs often cause no symptoms or only mild palpitations. Ventricular tachycardia may be a life-threatening situation associated with hemodynamic collapse or be totally asymptomatic. Ventricular fibrillation, by definition, is an acute medical emergency necessitating cardiopulmonary resuscitation (CPR). 

Lidocaine is used in the therapy of non-life-threatening ventricular arrhythmias, such as non-sustained ventricular tachycardia and frequent premature ventricular beats. It is also used as an adjunct to defibrillation and cardiopulmonary resuscitation (CPR) in patients with ventricular tachycardia and/or fibrillation. 

A 43-year-old man injected a large dose of cocaine in a suicide attempt and had a seizure and cardiopulmonary arrest, from which he was resuscitated. His arterial blood pH was 6.72 and his electrocardiogram showed a wide complex tachycardia. An infusion of sodium bicarbonate maintained the blood pH at 7.50 and the electrocardiogram became normal. The bicarbonate infusion was discontinued after 12 hours. 

Drug overdose Life-threatening flecainide intoxication in a 2-year-old toddler occurred when syringes used for oral administration were accidentally reversed, producing a fivefold flecainide overdose 3 hours after drug administration he developed a bradycardia of 50/minute and had a cardiopulmonary arrest, requiring resuscitation and adrenaline, after which the bradycardia recurred, followed by a wide-complex tachycardia that converted rapidly to a narrow-complex tachycardia after bolus intravenous adrninistration of sodium bicarbonate [60 ]. He then remained hemo-dynamicaUy stable and in sinus rhjflhm. The serum flecainide concentration was 0.7 mg/1. 

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