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patient was eventually put on dobutamine, which produced stable sinus rhythm 82/min (not shown) and was uneventfully withdrawn two days later.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 “stronger stuff” 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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