Administering antidysrhythmics

Using an antidysrhythmic medication to treat dysrhythmia seems like a no-brainer. But it's not quite that simple, and getting it wrong can be catastrophic. In this video, from our Resuscitation Essentials course, you'll learn about the different medication options available to treat various dysrhythmias and when you should consider other options instead.

Find out how to differentiate between different dysrythmias–including perfusing and non-perfusing rhythms–and discover treatment options based on etiology, in our Resuscitation Essentials (Advanced Life Support) course. By the end of this course, you'll master a step-by-step approach for managing patients in or near cardiac arrest in any environment. Get a free trial account and access the course today!

[00:00:00] An abnormal tachydysrhythmia may cause cardiogenic shock or cardiac arrest. Antidysrhythmic medications may have a role in treating shock or arrest caused by these dysrhythmias but first, an alternative cause should be excluded. This is especially important with a narrow complex tachycardia, which is more likely to be the result of severe hypotension rather than a true cardiogenic cause. For ventricular

[00:00:30] dysrhythmias like ventricular tachycardia and ventricular fibrillation, common antidysrhythmic options include amiodarone and lidocaine. Neither agent has shown superiority over the other but lidocaine has a much shorter half-life and smaller volume of distribution, which may give it a theoretical advantage. More recently, beta-blockers, specifically esmolol and metoprolol have gained notoriety for treating persistent ventricular dysrhythmias. These are good secondary options if initial resuscitation

[00:01:00] is unsuccessful. They likely work through mitigating the beta agonism of very large doses of epinephrine, which are commonly given in cardiac arrest, so using smaller or less frequent doses of epinephrine may be another consideration. Occasionally, a supraventricular tachycardia with aberrant conduction may be confused with a ventricular tachycardia. Several algorithms have been proposed to make this distinction but in an unstable patient, a wide complex tachycardia should generally be treated

[00:01:30] as ventricular tachycardia, with cardioversion or defibrillation and consideration for adjunctive antidysrhythmics. It's important with any dysrhythmia to ensure that electrolytes are normal. Hypokalemia and hypomagnesemia are factors commonly contributing to ventricular dysrhythmias. Empiric supplementation may be considered if this is a suspected concern, for example, in a patient with poor nutrition or taking diuretics. Torsades de pointes is a special case of

[00:02:00] polymorphic ventricular tachycardia that's particularly amenable to treatment with magnesium. And of course, defibrillation is appropriate as this is a wide complex unstable rhythm.