45.2 📚 國考版醫垫國考 / PGY OSCE

45.2.0.1 📌 Cram Sheet

45.2.0.1.1 🔥 高 yield 8
  1. 4 病因cardiac / non-cardiac / drugs / other
  2. 5 殺手VT / AF rapid / WPW+AF / Long QT TdP / Brugada
  3. 必做 ECG
  4. CHA2DS2-VASc for AF anticoagulation
  5. WPW + AF避 AVN block (BB, CCB, digoxin) → 加速 → VT/VF
  6. Long QT TdP → MgSO4
  7. PSVT 急性vagal → adenosine
  8. VT sustained → ICD
45.2.0.1.2 🔢 必背
項目 æ•žå­—
Sustained VT > 30 sec
QTc Long > 460 (女) / 450 (男); > 500 high risk
HR PSVT 150-220
HR VT 100-220
CHA2DS2-VASc anticoagulation ≥ 2 (men) / ≥ 3 (women)
Adenosine 6 mg → 12 mg → 12 mg PSVT
45.2.0.1.3 易錯
  • WPW + AF 絊 AVN block
  • Long QT 絊 QT 藥
  • 䞍做 ECG
  • 結構心病心悞 党當 benign

45.2.0.2 ⭐ 高 yield

45.2.0.2.1 CHA2DS2-VASc Score
  • CHF 1
  • HTN 1
  • Age ≥ 75 2
  • DM 1
  • Stroke / TIA / TE history 2
  • Vascular disease 1
  • Age 65-74 1
  • Sex (Female) 1
45.2.0.2.2 HAS-BLED for bleeding risk
  • HTN, abnormal liver/renal, stroke, bleeding history, labile INR, elderly, drug/alcohol
45.2.0.2.3 Vagal Maneuver
  • Carotid sinus massage單偎、< 60 yo without bruit
  • Valsalva (modified — REVERT trial 匷化 leg raise)
  • Cold water / ice
45.2.0.2.4 Adenosine
  • 6 mg rapid IV push → 12 mg → 12 mg
  • Brief AV block → 終 AVNRT/AVRT
  • Caveat: avoid in WPW + AF (delivery via AP)
  • Interaction: theophylline, dipyridamole
45.2.0.2.5 AF Acute
  • Stable: rate control (BB, CCB, digoxin) ± rhythm
  • Unstable: cardioversion
  • Anticoagulation per CHA2DS2-VASc + HAS-BLED
45.2.0.2.6 VT Acute
  • Stable: amiodarone / procainamide / lidocaine
  • Unstable: cardioversion
  • Pulseless VT/VF: defibrillation
45.2.0.2.7 Long QT
  • Drugs: macrolide, fluoroquinolone, antiarrhythmic Ia/III, antipsychotic, methadone
  • Electrolyte: low K, low Mg, low Ca
  • Genetic: KCNQ1, KCNH2, SCN5A
  • TdP → MgSO4 + isoproterenol / pacing
  • ICD for high-risk
45.2.0.2.8 Brugada
  • V1-V3 ST elevation + RBBB
  • Asia 高
  • ICD for symptoms / FHx SCD
  • Avoid: BB, sodium channel blocker, fever (can unmask)

45.2.0.3 🎯 自我檢枬

  1. WPW + AF 甚什麌? → Procainamide (avoid AVN block)
  2. PSVT 急救 first? → Vagal
  3. Adenosine 劑量? → 6→12→12
  4. Long QT TdP? → MgSO4
  5. Brugada ECG? → V1-V3 ST elevation + RBBB
  6. CHA2DS2-VASc 起 anticoag? → ≥ 2 (M) / ≥ 3 (F)

⚠ AI 草皿。