AH3 Exam 1: Dysrhythmias

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Last updated 6:56 PM on 9/26/26
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24 Terms

1
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What to look for when interpreting ECG

  1. is it regular?

  2. whats the rate?

  3. is there a P wave for every QRS?

  4. is there a QRS for every P wave?


2
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Electrical conduction of the heart pathway:

  1. Atrial Depolarization at P wave (contracts)

  2. Ventricular Depolarization @ QRS

  3. Ventricular Repolarization @ T wave


<ol><li><p><span style="color: rgb(208, 99, 99);"><strong>Atrial </strong>Depolarization</span> at P wave (contracts)</p></li><li><p><span style="color: rgb(85, 81, 211);"><strong>Ventricular </strong></span>Depolarization @ QRS</p></li><li><p><span style="color: rgb(92, 73, 223);"><strong>Ventricular </strong></span>Repolarization @ T wave</p></li></ol><p></p>
3
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treatment for Sinus Bradycardia:

  • what med is given?

    • if it doesnt work?


Atropine IV!!

  1. 1st dose: 1mg bolus

  2. repeat q3-5 mins

  3. max dose: 3mg


→ Move onto Transcutaneous Pacing

<p><span style="color: rgb(71, 75, 202);"><strong>Atropine </strong></span>IV!!</p><ol><li><p><span style="color: rgb(38, 129, 145);"><strong>1st dose</strong>: <strong>1mg bolus</strong></span></p></li><li><p><span style="color: rgb(183, 151, 36);">repeat<strong> q3-5 mins</strong></span></p></li><li><p><span style="color: rgb(38, 129, 145);"><strong>max dose</strong>: <strong>3mg</strong></span></p></li></ol><p></p><p>→ Move onto <span style="color: rgb(192, 29, 29);"><strong>Transcutaneous </strong></span>Pacing</p>
4
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What are PACs?


Premature Atrial Contractions

  • atrial contracts early in a sinus rhythm…not worrisome

    • caffeine


<p><span style="color: rgb(65, 102, 239);"><strong>Premature </strong></span>Atrial Contractions</p><ul><li><p>atrial contracts early in a sinus rhythm…not worrisome</p><ul><li><p>caffeine </p></li></ul></li></ul><p></p>
5
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Whats Atrial Fibrillation and Atrial Flutter?

  • tx?


Multiple impulses in atria with NO P wave and narrowed QRS

  • can turn into LETHAL rhythm!!

→ Cardioversion

<p><span style="color: rgb(70, 64, 196);"><strong>Multiple </strong></span>impulses in atria with <span style="color: rgb(230, 34, 34);"><strong>NO P wave</strong> and <strong>narrowed QRS</strong></span></p><ul><li><p>can turn into LETHAL rhythm!!</p></li></ul><p>→ Cardioversion</p>
6
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  • Major complications of A. Fib/ Flutter (2)


complications

  1. loss of Cardiac output (blood just sits in atria, not moving)

  2. stationary blood in atria → clots → stroke

  • put on blood thinners




<p>complications</p><ol><li><p>loss of <span style="color: rgb(35, 158, 134);"><strong>Cardiac output</strong></span> (blood just sits in atria, not moving)</p></li><li><p>stationary blood in atria → <span style="color: rgb(149, 109, 38);"><strong>clots → stroke</strong></span></p></li></ol><ul><li><p>put on blood thinners</p></li></ul><p></p><p></p><p></p>
7
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Whats the difference b/w A.Fib rhythm and A.Flutter rhythm?

A. Fib (quiver)

  • irregular (chaotic)

    • Random electrical activity

A. Flutter (sawtooth waves)

  • more regular/patterned

    • Organized rapid electrical activity


<p><span style="color: rgb(215, 57, 57);">A. <strong>Fib</strong> (quiver)</span></p><ul><li><p><span style="color: rgb(215, 57, 57);"><strong>irregular</strong></span><strong> </strong>(chaotic)</p><ul><li><p>Random electrical activity</p></li></ul></li></ul><p>A. <span style="color: rgb(30, 145, 87);"><strong>Flutter</strong> (sawtooth </span><span style="color: rgb(23, 38, 31);">waves)</span></p><ul><li><p><span style="color: rgb(30, 145, 87);">more <strong>regular/patterned</strong></span></p><ul><li><p>Organized rapid electrical activity</p></li></ul></li></ul><p></p>
8
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Whats SVT? (3)

Supra Ventricular Tachycardia (happens in the atria = NO P wave)


  1. > 150-250 BPM

  2. regular rhythm w/ narrowed QRS

  3. NO P wave


<p>Supra Ventricular Tachycardia (happens in the atria = <span style="color: rgb(199, 38, 38);"><strong>NO P wave</strong></span>)</p><p></p><ol><li><p><span style="color: rgb(66, 132, 194);"><strong>&gt; 150-250</strong></span> BPM</p></li><li><p><span style="color: rgb(202, 33, 153);"><strong>regular rhythm w/ narrowed QRS</strong></span></p></li><li><p><span style="color: rgb(199, 38, 38);"><strong>NO P wave</strong></span></p></li></ol><p></p>
9
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tx for SVT: (2)

1) adenosine!!

  1. 1st dose: 6mg via RAPID IVP

  2. 2nd dose: 12 mg rapid IVP if needed

  3. Follow each dose w/ RAPID 10-20 mL NS flush!!

*has extremely short ½ life and needs to reach heart quick!!—IV site closest to heart


2) Vagal Maneuvers

  • bearing down

  • blow into syringe

  • put face in ice water



<p><strong><mark data-color="#effce1" style="background-color: rgb(239, 252, 225); color: inherit;">1) adenosine!!</mark></strong></p><ol><li><p><span style="color: rgb(217, 132, 45);"><strong>1st dose: 6mg</strong></span> via RAPID IVP</p></li><li><p><span style="color: rgb(103, 166, 34);"><strong>2nd dose: 12 mg</strong></span> rapid IVP if needed</p></li><li><p>Follow each dose w/ RAPID <span style="color: rgb(69, 161, 212);"><strong>10-20 mL NS flush!</strong></span>!</p></li></ol><p>*has extremely <strong>short ½ life</strong> and needs to reach heart quick!!—IV site closest to heart</p><p></p><p><strong><mark data-color="#e1f9dc" style="background-color: rgb(225, 249, 220); color: inherit;">2) Vagal Maneuvers</mark></strong></p><ul><li><p>bearing down</p></li><li><p>blow into syringe</p></li><li><p>put face in ice water</p></li></ul><p></p><p></p>
10
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What are PVCs: (2)

Premature Ventricular Contractions

  1. has a wide, abnormal QRS complex

  2. person may feel skipped beat


<p><strong>Premature </strong>Ventricular Contractions</p><ol><li><p>has a <strong>wide, </strong><span style="color: rgb(189, 23, 209);"><strong>abnormal QRS </strong></span><strong>complex</strong></p></li><li><p>person may feel <strong>skipped </strong>beat</p></li></ol><p></p>
11
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What is V-Tach? (3)

  1. ventricles beat rapidly (3+ PVCs in a row)

  2. organized QRS

  3. Pulse OR no pulse


<ol><li><p><span style="color: rgb(215, 62, 62);">ventricles beat <strong>rapidly</strong></span><strong> </strong>(3+ PVCs in a row)</p></li><li><p><span style="color: rgb(39, 134, 80);"><strong>organized QRS</strong></span></p></li><li><p><span style="color: rgb(27, 148, 177);">Pulse <strong>OR </strong>no pulse</span></p></li></ol><p></p>
12
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monomorphic v-tach vs polymorphic v-tach:

*important note

mono: QRS have similar appearances

poly (aka Torsades de Pointes): QRS vary in appearance

**give Magnesium!!!* for Torsades


<p><span style="color: rgb(110, 65, 196);"><strong>mono</strong>: QRS have <strong>similar </strong>appearances</span></p><p><span style="color: rgb(173, 114, 42);"><strong>poly</strong> (aka <em>Torsades de Pointes)</em>: </span><span style="color: rgb(178, 116, 41);">QRS <strong>vary </strong>in appearance</span></p><p><span style="color: rgb(178, 116, 41);"><mark data-color="#ece7d0" style="background-color: rgb(236, 231, 208); color: inherit;">**give </mark><strong><mark data-color="#ece7d0" style="background-color: rgb(236, 231, 208); color: inherit;">Magnesium</mark></strong><mark data-color="#ece7d0" style="background-color: rgb(236, 231, 208); color: inherit;">!!!* for Torsades </mark></span></p><p></p>
13
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V-tach treatment

  • with pulse (3)

  • NO pulse: (2)


  • with pulse

  1. antiarrhythmic med (Procainamide, Amiodarone, Sotalol)

  2. electrolyte replacement (K+)

  3. cardioversion (shocks)

  • NO pulse:

  1. CPR

  2. defibrillate


14
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What is V.Fib? (3)

  1. Ventricles quiver chaotically

  2. Chaotic, no organized QRS

  3. NO PULSE!!

worst one**


<ol><li><p>Ventricles <span style="color: rgb(207, 79, 79);"><strong>quiver chaotically</strong></span></p></li><li><p><span style="color: rgb(59, 134, 162);"><strong>Chaotic</strong></span>, no organized <strong>QRS</strong></p></li><li><p><span style="color: rgb(160, 29, 29);"><strong>NO PULSE!! </strong></span></p></li></ol><p>worst one**</p><p></p>
15
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Tx V. Fib: (5)

  1. CPR

  2. Defibrillate

  3. EPI

  4. Amiodarone

  5. Lidocaine


<ol><li><p><span style="color: rgb(16, 197, 33);"><strong>CPR</strong></span></p></li><li><p><span style="color: rgb(16, 197, 33);"><strong>Defibrillate</strong></span></p></li><li><p><span style="color: rgb(84, 84, 251);"><strong>EPI</strong></span></p></li><li><p><span style="color: rgb(84, 84, 251);"><strong>Amiodarone</strong></span></p></li><li><p><span style="color: rgb(84, 84, 251);"><strong>Lidocaine</strong></span></p></li></ol><p></p>
16
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Asystole protocol: (3)

No electrical activity!!

  1. Call Code!!

  2. Start CPR!

  3. Give Epi

  • 1mg IV bolus q 3-5 mins!



<p>No electrical activity!!</p><ol><li><p>Call <span style="color: rgb(250, 120, 120);"><strong>Code</strong></span>!!</p></li><li><p>Start <span style="color: rgb(57, 101, 189);"><strong>CPR</strong></span>!</p></li><li><p><span style="color: rgb(45, 173, 110);"><strong>Give Epi</strong></span></p></li></ol><ul><li><p><span style="color: rgb(45, 173, 110);"><strong>1mg IV bolus q 3-5 mins!</strong></span></p></li></ul><p></p><p></p>
17
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What is PEA? (3)

  • treat?


Pulselessness Electrical Activity

  1. electrical activity present but NO pulse

  2. NOT shockable rhythm!! (pt dead x_x)

  3. can give 1mg IV bolus Epi q3-5 mins and CPR



<p><strong>Pulselessness </strong>Electrical Activity</p><ol><li><p>electrical activity present but <span style="color: rgb(229, 37, 37);"><strong>NO pulse</strong></span></p></li><li><p><span style="color: rgb(42, 152, 117);"><strong>NOT shockable</strong></span> rhythm!! (pt dead x_x)</p></li><li><p>can give 1mg IV bolus <span style="color: rgb(175, 93, 239);"><strong>Epi q3-5 mins and CPR</strong></span></p></li></ol><p></p><p></p>
18
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What are NON-shockable rhythms??

Asystole!!

PEA!! (pulseless electrical activity)

  • continue CPR


19
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  1. Which rhythm has NO P waves and is irregularly irregular?

  2. Which rhythm is associated with sawtooth waves?


  1. atrial fibrillation (quivering)

  2. a.flutter


<ol><li><p><span style="color: rgb(68, 107, 199);"><strong>atrial fibrillation</strong></span> (quivering)</p></li><li><p><span style="color: rgb(37, 151, 43);"><strong>a.flutter</strong></span></p></li></ol><p></p>
20
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  1. Which rhythm is usually 150–250 bpm with a narrow, regular QRS?

  2. which rhythm has premature wide beats originating in the ventricles?

  1. V-tach + NO pulse =?

  2. Which rhythm is especially associated with magnesium?


  1. SVT

  2. PVC

  3. CPR and Defibrillator

  4. Torsades de Pointes


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  1. What is the difference between PEA and asystole?

  2. What is the biggest complication of A-fib?



  1. PEA has activity but no pulse; asystole has no activity and no pulse

  2. ⬇CO & blood clots


22
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Whats adenosine used for?

SVT

  1. 1st dose: 6mg rapid IVP

  2. 2nd dose: 12 mg rapid IVP

  3. flush 10-20 mL NS after each dose


23
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What is the epinephrine dose for asystole and PEA?

1mg IV bolus q3-5 mins

  • no limit to this


24
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What cardiac rhythm do u give atropine for? (3)

Sinus Brady

  1. 1st IV dose: 1mg bolus

  2. repeat q3-5 mins

  3. max 3 mg