Case 1:

JF is a 42-year old previously healthy farmer who presented with sudden onset central chest pain of one hour duration to the ED. The pain is associated with sweating and radiates to the left arm and jaw. The area of discomfort is about the size of the fist.

Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

 

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Question 26 of 39:

This patient should receive lidocaine in the first 24 hours to prevent life-threatening ventricular arrhythmias.

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The use of prophylactic anti-arrhythmic agents in the first 24 hours after MI is not recommended. However, the availability of atropine, lidocaine, pacing paddles or a pacemaker, a defibrillator and epinephrine remains prudent for treating important rhythm disorders.

Lidocaine in a dose of 1.0 to 1.5 mg/kg IV may be used for first-line treatment of sustained ventricular tachycardia (VT) associated with hemodynamic instability.

Epinephrine plays a prominent role in advanced life support following a circulatory arrest associated with ventricular fibrillation, asystole or electromechanical dissociation. Although it is known to have an adverse effect on cardiac rhythm and increases myocardial oxygen demand, it does support the peripheral vascular tree and thus enhances circulation during external chest compression.

 
 
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