EKG rhythms & TX

sinus bradycardia and how to treat

less than 60 bpm

treat with atropine; if atropine is ineffective, transcutanoues pacemaker

possible dopamine or epi

what causes bradycardia

vagal stimulation

CCB like nifedipine and amioradone

-lols

hypoxia

sinus tachycardia and how to treat

greater than 100bpm, reduced CO and low BP

-vagal maneuvers

-adenosine

- Bb and CCB

-cardioversion if drugs dont work

-treat cause of tachy

types of negative inotropes

beta-blockers, calcium channel blockers, and antiarrhythmic medicines

atrial flutter and how to treat

regular rhythm

treat with

-cardioversion

-antiarrhythmic

-anticoags

atrial fibrillation

rapid, irregular, ineffective contractions of the atrium

no P wave, PR cant be measured

treat with cardioversion, arrhythmic and anti coags, digoxin

how does someone with Afib present

SOB

HYPOTN

clots

what causes Afib

age

Htn

diabetes

obesity

heart disease

smoking

MI

heart fx

heart diseases

how to treat Afib in ot who are hemodynamically unstable

BB THEN CARDIOVERSION

SVT / Afib with RVR

heart is beating so fast, you cant see a rhythm

treat with vagal maneuvers, amiodarone, adenosine then cardioversion

what happens in a SVT

p waves are not identifiable

pt is unstable

signs in pt with SVT

SOB

hypoxic

change in VS

PAC/PVC

Premature atrial/ventricular contraction

seen with tachy

-usually regular with caffeine

- treat if symptoms are present or >6 a minute

-can turn into vtach

what happens in a PAC/PVC

hidden P wave

-atrias and ventricles contract at the same time

ways to treat PVC/PAC

-reduce alcohol and caffeine

-reduce stress

-stop smoking

- correct hypokalemia

beta blocker may be prescribed

Vtach

tombstones, 3 PVC in a row

-can be pulseless or pulse

-asses for pulse first

what to do if theres a pulse/ not in VTach

pulse: slow HR or cardiovert, ECG, amiorodone, lidocaine

no pulse: CPR and defib

Vfib

-lethal arrhythmia where there is uncoordinated quivering of the ventricles

start CPR and defib

amioradine and epi

cause of Vfib

CAD

MI

what you need in pt with VFIB

-continuous VS monitoring

-2 IV access

PEA rhythm

lethal rhythm with no pulse

CPR and epi

Asystole

flat line that is lethal

CPR and Epi

Atrial Problems

A flutter

A fib

SVT

PAC

RVR

ventricular problems

Vtach

Vfib

PEA

Asystole

PVC

RVR

what rhythms dont you defib for

PEA and Asystole

which ones do you defib for

Vtach and Vfib

what is the electrical cardiac function

SA & AV nodes

what is the mechanical cardiac function

heart moving

what is the P wave

atrial depolarization (contraction)

a P wave longer than 0.2 indicates

heart block

What happens in the QRS complex/ R wave?

ventricular depolarization and atrial repolarization

what happens in T wave?

ventricular repolarization

what interval needs to short

QT; long means poor perfusion

QRS interval should be how long

less than 0.12

PR interval should be how long

0.12-0.20

QT interval should be how long

less than 0.40

anything more means ventricle cant relax

electrode placement

cloud over grass, smoke over fire

What is a 12 lead ECG?

Ten electrodes are placed on the chest and extremities.

Provides 12 different perspectives of electrical activity in the heart

what are arrhythmias

irregular heart rhythms that can sometimes produce symptoms

what does arrhytmias do to the heart

increase the risk of clots

what to assess in those with arrhythmias/dysrhytmias

-otc medications

-s/s of decreased CO

-s/s of fluid retention

-V/S and auscultation

interventions for arrhythmias

stabilize

manage symptoms

manage anxiety

what characterizes a regular rhythm

equal distance between each R wave

p wave

Tall tented T waves

hyperkalemia

types of rhythm tx

ACLS algorithm

cardioversion

defib

pacemaker

ICD

what is the ACLS algorithm

CPR and oxygen

epi

shock

what is a ZOLL

..

what is cardioversion for

used for Vtach with pulse

-SVT

-torsades

-Afib

A flutter

when do you use cardioversion

when amiordadone for Afib, flutter and RVR

or adenosine dont work for SVT

how does cardioversion work

shocks on R wave at 120-200J to reset rhythm

elective procedure that needs consent

sedation

emergency supply for cardioversion

cardiac monitor

ambu bag

suction

intubation

meds and elective cardioversion

no digoxin fir 48 hours

anticoagulants few weeks before

what is Defib used for

when pt has no pulse and are in vtach or vfib; emergency

360J

what to know about Defib

uses ZOLL to shock back into any rhythm

does not need to sync with electrical activity

shcok done every 2 minutes between CPR cycle

what is given after unsuccessful defib

Epi

what does a pacemaker do

Maintains a normal heart beat rhythm in bradycardia and heart blocks; needs to sense and send

atrial paced

spike before P wave

ventricular paced

spike before QRS

first letter on pacemaker

location of pacing

- atria, ventricular or dual

second letter on pacemaker

chamber being sensed; atria,ventricular or dual

third letter on pacemaker

mode of pacing

-inhibited meaning when heart dont work , triggered meaning when there is an intrinsic heart avtivity or both

transcutaneous pacing

temporary pacing that is accomplished through the application of two large external electrodes

considerations for transcutaneous pacing

erythema and burns

consent

monitor RR

what is an ICD

monitors rhythm continuously, shocks heart when it is in vtach or vfib

sends multiple shocks and if unsuccesful, device performs cardioversion and defb

nurse post op for ICD

check settings to make sure it is set to what is ordered

bleeding or infection

xray to rule out pneumo

ICD precautions

-wear ID bracelet

-manufacturer ID card

-dont use metal detector

-avoid large stereos

-chain saws

-car engines

- old cellphones

-MRI

-no battery pacls

tx for sinus bradycardia

Atropine, pacemaker

tx for SVT

vagal maneuvers --> adenosine--> cardioversion

Adenosine

Antiarrhythmic with short life; needs to be a psuh med

what rhythms do you give epi for

asystole

PEA

pulseless Vtach

V fib

complications for pacemaker

Infection

Hematoma formation

Hemothorax

Vtach

dislocation of lead placed

hiccuping

rare: cardiac tamponade

how is malfunction of pacemaker signified

ECG

brasycardia

cardiac conduction surgery

procedure done when Vtach is unresponsive to meds and cannot be cardioverted or paced

types of cardiac condcution surgery

ablation

endocardial resection

endocardial isolation

types of unstable rhythms

svt and rvr with hypotension

lack of QRS complex

asystole