Transcript QUIZ OF THE WEEK

QUIZ OF THE WEEK
PRESENTED BY :ABDULAZIZ
ALRAQTAN
• 30 Y/O Saudi male medically free, presented
with nausea and vomiting for 10 hours and
here is his ECG
• Digoxin toxicity may cause almost any dysrhythmia
• Classically, dysrhythmias associated with increased
automaticity and decreased AV conduction occur
• Sinus bradycardia and AV conduction blocks are the
most common ECG changes in the pediatric
population, while ventricular ectopy is more common
in adults
• Nonparoxysmal atrial tachycardia with heart block and
bidirectional ventricular tachycardia are particularly
characteristic of severe digitalis toxicity
Management
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Supportive care of digitalis toxicity includes the following:
Hydration with IV fluids
Oxygenation
Activated charcoal is indicated for acute overdose or
accidental ingestion
Binding resins (eg, cholestyramine) may bind
enterohepatically-recycled digoxin
Treatment of electrolyte imbalance
Treatment with digoxin Fab fragments is indicated for a
K+ level greater than 5 mEq/L
Hemodialysis may be necessary for uncontrolled
hyperkalemia
• Digoxin immune Fab
• Digoxin immune Fab is considered the first-line treatment
for significant dysarrhythmias from digitalis toxicity. Other
indications for its use include the following:
• Ingestion of massive quantities of digitalis (in children, 4 mg
or 0.1 mg/kg; in adults, 10 mg)
• Serum digoxin level greater than 10 ng/mL in adults at
steady state (ie, 6-8 hours after acute ingestion or at
baseline in chronic toxicity)
• Hyperkalemia (serum potassium level greater than 5
mEq/L)
• Altered mental status attributed to digoxin toxicity
• Rapidly progressive signs and symptoms of toxicity
• Management of dysrhythmias
• In hemodynamically stable patients, bradyarrhythmias and
supraventricular arrhythmias may be treated with
supportive care
• Short-acting beta blockers (eg, esmolol) may be helpful for
supraventricular tachyarrhythmias with rapid ventricular
rates, but may precipitate advanced or complete AV block
in patients with sinoatrial or AV node depression
• Atropine has proved helpful in reversing severe sinus
bradycardia
• Magnesium sulfate may terminate dysarrhythmias, but is
contraindicated in the setting of bradycardia or AV block
and should be used cautiously in patients with renal failure
• Cardioversion may be used if the patient is
hemodynamically unstable and has a wide, complex
tachycardia and if fascicular tachycardia has been ruled out