ADH II wk 2 pt 1 Cardiac Rhythms

SALI stands for in EKG

Septal

Anterior

Lateral

Inferior

Septal EKG for what

V1, V2

Anterior EKG for what

V3, V4

Lateral EKG for what

V5, V6, VL

Inferior EKG for what

II, III, AVF

P wave purpose

Atria depolarization (SA node)

QRS wave purpose

ventricular depolaraziton

T wave purpose

Ventricular repolarization

Small box time

0.04

9 steps for ECG analysis (H, R, P, P, Q, S, T, Q, I)

calculate heart rate

Determine if heart rhythm is regular

assess P waves

Measure PR interval

Measure duration of QRS complex

Assess ST segment

Observe for change in T wave

Measure length of QT interval

Interpret the rhythm

How to calculate test strip

count QRS (heartbeat) x 10 = bpm

How to measure is heart rhythm is regular or not

measure the distance of the R - R (peak) intervals

How to assess for P waves

determine if P way is present before each QRS

(see if the P’s are the same)

How to measure PR interval

Normal Duration

start of P wave to start of QRS complex

0.12-0.20

(see if PR intervals are consistent)

How to measure QRS complex

normal duration

how many boxes should normal height be

start of QRS complex to start if ST segment (start and end of hump)

0.06-0.10

less than 3 t

Where is ST segment located

After QRS right before T wave

How to assess ST segment

what does elevated or depressed isoelectric line indicate

see if it went back to isoelectric line

some myocardial or cardiac ischemia (ST elevation)

How to assess for changed in T wave

What are 2 irregular shapes for T wave

look for shape and height

inverted and peaked

Inverted T wave can indicate what

Electrolyte issues like hypokalemia

Cardiac Perfusion problems like ischemia, PE

Peaked T wave can indicate what

Electrolyte issues like hyperkalemia

How to measure QT interval

what should max time of QT interval be

start of QRS to end of T wave

0.45 seconds

can lead to lethal dysrhythmias

Sinus Rhythm

Sinus Brady

Sinus Tachy

premature ventricular contraction PVC
(no p wave before it, can be "Benign" until has patterns)

What is bigeminy

consistent irregular heart rhythm that hits every other complex (1 gap)

2nd in the biz bigeminy

What is Trigenimy

consistent irregular heart rhythm that hits every 3rd complex (2 gap)

3rd in the biz = trigenimy

sinus rhythm with premature atrial contraction (PAC)

Benign can’t feel

How are PAC and PVC different

PVC dont derive from atrium (no atrial depolarization P wave, wide and bizzar)
PAC dont derive from ventricles

sinus rhythm w/ first degree atrial ventricular (AV block)

pt are asymp (wait and watch)

Atrial fibrillation (A- Fib)

Quiver in isoelectric line = p waves

if more than 100 bpm = a fib w/ rapid ventricular response

may need anticoaglate or anti platelet

Atrial flutter

Saw tooth like P waves

Asymp (can lead to A fib)

Mostly regular

How to manage a fib and a flutter

Anti arrythmics Meds
Ca channel blockers
Beta Blockers

Synchronized cardioversion if less than 24 hours (shock w/ electrcity) when they are conscious

What can A fib lead to

blood statsis can lead to clothes

supra ventricular tachycardia (SVT)

no P wave

rate greater than 150

supra ventricular tachycardia (SVT) management least invase to mose

first see if stable or unstable

check vagal maneuver

Meds adenosine: temp stops heart has fast half life

Synchronized Cardioversion (electricity) when they are conscious

Ventricular tachycardia (V-Tach)
Emergency

V tach management if pulse is present

synchronized cardioversion

ventricular antiarrhythmics medications (amiodarone, lidocaine)

V tach management if pulse is not present

defibrillate

ACLS protocal (CPR, epi, amiodarone, lidocaine)

Ventricular Fibrillation (V Fib)

Ventricular Fibrillation (V Fib) management

(pt is most likley unconsciousness)

defibrillate

ACLS protocal (CPR, epi, amiodarone, lidocaine)

Pulseless electrical activity PEA

heart shows organized electrical signals on an ECG, but the heart muscle doesn't contract effectively to pump blood

Pulseless electrical activity PEA management

CPR and epi q 3-5 min

(not a stackable rhythm

Only shockable rhythm in a code

V tach

V Fib

Pulseless electrical activity PEA 5 H’s

Hypovolemia

Hpoxia

Hydrogen ion

Hypokalemia/ Hyperkaelmia

Hypothermia

Pulseless electrical activity PEA 5 T’s

Tension peumonthroax

Trauma

Tamponade

Thrombosis (pulomonary)

Thromobosis (coronary)

What will code rhythm turn into if we do nothing

asystole (flat line)

When your PR interval gets long and long and drops

now you have a winky block

Pr get longer and longer

(2nd degree AV [heart] block type 1)

How to determine the severity of any rhythm

if pt is symptomatic or not

If some P’s dont get thorugh (no QRS)

then you have a mobitz 2

Pr are constant

(second degree heart block type 2)

How to manage block

identify underlying cause to prevent from becoming higher degree block

check if pt is symptom

If pt is bradycardic (low HR) and hypotensive (low BP) give meds
atropine
dopamine
pace (electricity)

if R and P disagree then you have a

3rd degree and you need electricity

3rd degree heart block (complete heart block)

3rd degree heart block management

need a permeant pacemaker (electricity) to support