Isoprenaline Tachycardia
Report:
Sinus tachycardia 108/min
2:1 AV block (top)
Sinus tachycardia 150/min
2:1 & 3:2 Wenckebach AV block (middle)
Sinus tachycardia 165/min (bottom)
First degree AV block
1:1 conduction
Comment:
Isoprenaline helped the bradycardia, but at a price (which could have been higher still). It would have been wiser to start with an infusion rather than give a 200 µg bolus.
Some evidence favours aminophylline as the drug of choice in this setting46.
The patient was eventually put on dobutamine, which produced stable sinus rhythm 82/min (not shown) and was uneventfully withdrawn two days later. What was the âstronger stuffâ I would have reached for at the time of the original asystole in the previous Case 67? A small bolus (50 - 100 μg) of adrenaline. One could argue for a long time over this one.
Fig 69. Unconscious 20 year old girl with closed head injury.
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