Life-threatening cardiac arrhythmia

Life-threatening arrhythmias are a frequent indication for mobile intensive care unit (MICU) missions. In part these are for patients requiring cardiopulmonary resuscitation but other patients are still conscious and need careful evaluation before treatment. Symptoms such as severe angina pectoris and clinical signs such as low blood pressure < 90 mmHg, dizziness and left ventricular failure as well as a history of structural heart disease are valuable criteria for distinguishing stable from unstable patients. Generally an unstable patient with bradycardia needs immediate pacing or pharmacological support. An unstable patient with tachycardia needs immediate electrical cardioversion, whereas stable patients require targeted out-of-hospital treatment or in many cases, while being monitored, may be transported to a nearby qualified hospital for definitive evaluation and treatment. A 12-lead ECG should be registered at the scene wherever possible: this is the mainstay for targeted treatment and also after hospital admission helps the specialist in the diagnostic process. If a pharmacological strategy is chosen, treatment with multiple anti-arrhythmic agents should be avoided because of potentially uncontrollable reactions.