MyCpdZw - Protocols Details

HEART BLOCKS

Heart block is an abnormal heart rhythm where the heart beats too slowly (bradycardia ). In this condition, the electrical signals that tell the heart to contract are partially or totally blocked between the upper chambers (atria) and the lower chambers (ventricles).

Diagnosis

· First degree: P-R interval > 0.2 secs.

· Second degree, Mobitz Type 1 –Wenckebach: P-R interval progressively increases until a beat is dropped.

· Second degree, Mobitz Type 2: P-R interval is constant with frequent regular dropped beats, in a 1:2 or 3 ratio commonly.

· Third degree, complete: No P to QRS relationship.

· Bundle Branch Blocks:

o Left Bundle Branch Block-

-QRS >120milliseconds, broad notched or slurred R wave in lead I, aVL,V5 and V6.

-absent Q waves in lead I, V5 and V6, narrrow Q wave

-ST and T waves opposite direction to QRS

-depressed ST segment and/ or negative T wave in leads with negative QRS

o Right Bundle Branch Block

-QRS prolonged

-wide S wave in leads I and V6

-inverted T wave in V1 and V2

o Left Anterior Fascicular with Left Axis Deviation (Q1R1S3) with normal width QRS,

Left Posterior Fascicular (rare) with Right Axis Deviation (S1R3) and normal width QRS.

Management

1. First degree: Observe,

2. Second degree/ Mobitz type 2: Usually indicates more significant conduction defect. May progress to Third degree block. Usually pacing. Consider Isoprenaline 20-40 mcg bolus IV followed by infusion (6 mg made up to 100 mLs with 55 Dextrose) at 0.5-10 mcg/min.

Third degree: May be well tolerated. Usually resolves after Acute Myocardial Infarction. With slow QRS rates or wide complexes, pacing generally required. Consider use of Isoprenaline infusion.

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

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SPINAL CORD INJURY

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