Konzept der ?5A“ für die Intensiv- und Notfallmedizin

Bradycardia (heart rate <50/min) (BR) and tachycardia rhythm disturbances (heart rate >100/min) (TR) require rapid and targeted therapeutic strategies. Supraventricular tachycardias (SVT) are paroxysmal forms of tachycardia, such as sinus tachycardia, atrial tachycardia, AV-nodal re-entry tachycardia and tachycardia due to accessory pathways. All SVTs are characterized by a ventricular heart rate >100/min and small QRS complexes (QRS width <0.12 s) during tachycardia. It is essential to evaluate the arrhythmia history and to perform a careful physical examination with exact analysis of the 12-lead electrocardiogram. An exact diagnosis of SVT is then possible in >90% of cases. Ventricular tachycardia (VT) has a broad QRS complex (QRS width ≥0.12 s), while ventricular flutter (VFlut) and ventricular fibrillation (VF) are associated with chaotic electrophysiologic findings. For acute therapy the new “5As” concept consisting of adenosine, adrenaline, ajmaline, amiodarone and atropine is presented. Additional “B, C and D strategies” are beta blocking agents, cardioversion and defibrillation. The 5As concept allows a safe and effective treatment of BR, TR, SVT, VT, VFlut, VF and asystole and together with the B, C and D strategies provides an effective treatment of all emergency situations due to arrhythmia.