UPDATED 9/3/17 – See Dr Neil Long’s additional notes regarding the stations below
On the 14th December ED Consultant Dr David Alexander and simulation registrar Dr Neil Long staged the annual simulation olympics with this year’s event – “the Pentathlon” – featuring resuscitation stations such as “the swimmer”, “the runner”, “the fencer”, “the shooter” and “the rider”.
Congratulations to registrars Gordon Carter and Mark Daley representing “the Republic of Ireland” who stormed home for the gold medal.
Thanks to all the registrars who came and participated.
[L-R: Sze-Chi + Jess, Son + Kiri, Sheri + Jamie, Rob + Annie, Emily + Maddy, Heather + Ben]
Thanks to Dr Luigi Marino, Dr Raj Patel, Dr Sam Robertson and the simulation centre staff for their help running the morning.
Wolff-Parkinson-White Syndrome with Atrial Fibrillation
• Very rapid irregularly irregular tachycardia (rates may approach 300 beats/min) with wide QRS complexes that vary in morphology
• Often misdiagnosed as SVT, VT or atrial fibrillation with BBB
• Misdiagnosis and treatment with AVN blockers can be deadly!
• Treat with procainamide, flecainide (?), or preferably electrical cardioversion
• Key Point: Avoid all AV Nodal blockers
• Calcium channel blockers
Pitfall: Treatment with Amiodarone results in patient decompensation (see references)
Take Home Points:
WPW + Atrial Fibrillation
• Irregularly irregular tachycardia
• Complexes vary in shape and width
• May approach 250-300 bpm or higher
• Avoid all AV nodal blockers…including Amiodarone!
• Use Procainamide, Flecainide (?),or electrical cardioversion
Traumatic Cardiac Arrest Algorithm from the European Resuscitation Council
- don’t do CPR
- control catastrophic haemorrhage
- control the airway
- bilateral chest decompressions
- relieve cardiac tamponade
- consider prox aortic compression
- CPR can commence once the chest procedures have been completed but in the context of trauma and hemorrhagic loss your CPR will be useless if you don’t correct the underlying cause.
Video coming soon