Peri-Arrest Arrhythmias


Principles of Management

Assess using ABCDE approach
Note the presence of 'adverse features'
Give oxygen immediately and adjust according to arterial oxygen saturations
Gain IV access
Record 12-lead ECGs where possible
Correct electrolyte abnormalities


Adverse features - the 'unstable' patient

  • Shock: hypotensive, pallor, sweating, cold, clammy extremities, altered mental state
  • Syncope
  • Myocardial ischemia: typical chest pain or ECG evidence
  • Heart failure: pulmonary oedema/raised JVP

The presence of adverse features and the nature of the arrhythmia guides treatment


  1. no treatment
  2. simple interventions (vagal manoeuvres, fist pacing)
  3. pharmacological
  4. electrical (cardioversion for ttachyarrhythmias or pacing for bradyarrhythmias) - electrical treatment is preferred in the unstable patient


After successful treatment of the arrhythmia, patient should be assessed using ABCDE approach and repeat of the 12-lead ECG

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