Dysrhythmias, MCSD (mechanical circulatory support devices) ch. 38 & 39

Short or long-term MCS device:

Intraaortic balloon pumps (IABP)

Short

Short or long-term MCS device:

LVAD, BiVAD, PVAD

Long

Short or long-term MCS device:

Extracorporeal membrane oxygenation (ECMO)

Short

Short or long-term MCS device:

Continual flow pumps

Short

Provides temporary circulatory support by reducing afterload, increasing aortic diastolic pressure, & increasing coronary blood flow

IABP

__________ Contraindications:

• irreversible brain damage

• Mod. to Severe aortic insufficiency

• Abdominal aortic and thoracic aneurysms

• Terminal or untreated diseases of any major organ system

• Generalized peripheral vascular disease (e.g, aortoiliac disease)

• Major coagulopathy (e.g, disseminated intravascular coagulation [DIC])

IABP

IABP contraindication:

Generalized peripheral vascular disease (e.g, aortoiliac disease) may inhibit balloon placement & a relative contra.; ____________ insertion may be used

Sheathless

IABP placement:

Inserted percutaneously or surgically into the ______________ artery

Balloon is moved toward the heart & placed in the descending thoracic aorta, just below the ______________ artery

Placement is confirmed by an _________

Femoral, L. Subclavian, X-ray

Arterial trauma caused by insertion or displacement of balloon:

Assess & mark ____________ before inserting balloon to use as a baseline after insertion

Peripheral pulses

Arterial trauma caused by insertion or displacement of balloon

Assess perfusion to both upper & lower extremities at least every ________

Hour

Arterial trauma caused by insertion or displacement of balloon

Measure urine output at least every __________ (occlusion of renal arteries causes severe decrease in urine output)

Hour

Arterial trauma caused by insertion or displacement of balloon

Observe ____________ waveforms for sudden changes

Arterial

Arterial trauma caused by insertion or displacement of balloon

• keep HOB no higher than _______ degrees

• DO NOT _____________ at the hip

45, flex cannulated leg

Arterial trauma caused by insertion or displacement of balloon

Immobilize cannulated leg to prevent ______ using a draw sheet tucked under the mattress, soft ankle restraint, or knee immobilizer

Flexion

IABP: balloon leak or rupture

Priority action: ______________

• prepare for emergent removal & possible reinsertion

Call HCP

IABP: hematologic problems d/t platelet aggregation along the balloon (e.g., thrombocytopenia)

• monitor _________ profiles, _____, & ____________

Coagulation, hct, platelet count

IABP: hemorrhage from insertion site

• Check site for bleeding at least every _______

• Monitor VS for s/sx of ___________ with each check

Hour, hypovolemia

IABP: infection at site

• Use ___________ technique for insertion and dressing changes for all lines

• Cover all insertion sites with occlusive dressings

• Give prescribed _____________ for entire course of therapy

Strict aseptic, prophylactic antibiotic

IABP: issues r/t immobilization (e.g., pressure injuries)

• Reposition the pt at least every _________, maintaining proper positioning

• Use appropriate pressure-relieving devices

2 hrs

IABP: VTE caused by trauma, balloon obstruction of blood flow distal to catheter

• give prophylactic _______ therapy (if ordered)

• Assess pulses, urine output, & level of consciousness at least every __________

• Check circulation, sensation, & movement in both legs at least every _________

Heparin, hour, hour

Most important MSC device complications

Cardiac tamponade, dysrhythmias

Sinus rhythm

Bradycardia treatment (symptomatic):

• Address the cause

• IV __________

• Transcutaneous ________

• IV _________ or ____________ infusion

Atropine, pacemaker, dopamine, epinephrine

Sinus tachycardia: treatment

• Address the cause

• ___________

• IV _________ or ____________

Vagal maneuvers, beta blockers, calcium channel blockers

Premature atrial contractions

Premature Atrial Contractions (PACs)

True of false?

In healthy hearts, not a problem

T

Premature Atrial Contractions (PACs): treatment

• Address the cause

• ____________

Beta blockers

Premature ventricular contractions

Premature Ventricular Contractions (PVCs)- treatment

• Address the cause

• If symptomatic: ____________, ___________, or ____________

Beta blockers, lidocaine, amiodarone

T or F?

Premature Ventricular Contractions (PVCs): Usually not harmful in healthy hearts

T

PVCs: may decrease CO in patients with

Heart disease

AF

loss of atrial kick & high ventricular rate = decreased CO

Atrial flutter, a fib

Biggest Atrial Flutter risk

stroke risk

Atrial Flutter- treatment

• Beta blockers or CCB

• ___________

• _______________

• ____________

Amiodarone, catheter ablation, anticoagulants

If AFlutter unstable:

Synchronized cardioversion

A. fib

Atrial Fibrillation: treatment

Same as a. flutter

Atrial flutter

A fib

Supraventricular tachycardia- hr

150-220

PSVT

Supraventricular Tachycardia (aka PSVT, atrial tachycardia)

If prolonged, will cause decreased CO d/t decreased ____

SV

Supraventricular Tachycardia (aka PSVT, atrial tachycardia) : treatment

• ______________

• Drug of choice; _____________

• ___________ or _____________

Vagal maneuvers, adenosine, IV beta blockers or ccb

Supraventricular Tachycardia (aka PSVT, atrial tachycardia)

If unstable: ___________

Synchronized cardioversion

Adenosine:

• Explain that the pt may feel ________ after receiving

• Injection site should be as close to the heart as possible

• Give IV dose ______ & follow with a rapid __________. Use a ________ setup to make sure adenosine gets to the heart quickly

Chest pressure, rapidly, 20ml NS flush, stopcock

Adenosine:

Monitor ECG continuously, brief period of ________ is common

Assess pt for flushing, dizziness, chest pain, or palpitations

Asystole

VT

VT

VT torsade de pointes

VT, unstable means pt

Pulseless

Ventricular Tachycardia (VT): medications

__________, _________, or ___________

Lidocaine, amiodarone, procainamide

Ventricular Tachycardia (VT): Device

Implantable cardioverter-defibrillator (ICD)

Ventricular Tachycardia (VT): Stable action

Cardioversion

Ventricular Tachycardia (VT): Unstable action (no pulse)

Defibrillation, CPR, epinephrine

Ventricular Tachycardia (VT): Medication for Torsades de pointes: __________

IV magnesium

If VT untreated can lead to

VF

Cardioversion:

Synch: _____

• client awake and sedated

• LOWER JOULES THAN DFIB

• Consent form, EKG monitor

On

V. Fib/ V. Tach without pulse:

EMEGENCY → ________

Defibrillation

VF

VF

VF

Ventricular Fibrillation (VF): treatment

• _________ (ASAP** stop compressions/breaths) & CPR

• _________

• __________ or ___________

Defibrillation, epinephrine, amiodarone, lidocaine

Asystole

Asystole

Asystole: unresponsive, pulseless, & apneic

Treatment:

________ & _____________

• NO DEFIBRILLATION (NO SHOCKS - flat line, no activity to fix)

CPR, epinephrine

Pulseless Electrical activity (PEA):

Organized electrical activity WITHOUT a pulse

• Always check pt first, not monitor

• Treatment: _____ & ______

CPR, epinephrine

R far from P

First degree

Longer, longer, longer, drop

Wenkebach

If some Ps don’t get through, then u have

Mobitz II

Ps and Qs don’t agree, you have

Third degree

NSR w/ 1st degree AV block

The only difference between NSR and NSR w/ a First Degree AV Block is a lengthened PR interval (greater than __ small squares or 1 big box)

5

1st degree AV block

First degree AV Block:

Usually not ________

• asymptomatic

Serious

First-degree AV Block: treatment

Monitor ecg changes

Wenckebach

2nd degree AV Block Type I (Wenkeback):

• Usually transient & well-tolerated

• May be a warning sign of a more serious _________

• dsyrhythmia

2nd degree AV Block Type I (Wenkebach):

If symptomatic- __________, ______________

Atropine, pacemaker

Mobitz II

2nd degree AV Block Type II (Mobitz II)

• Often progresses to 3rd degree AV block

• Treatment: ________________

• Symptomatic treatment: ________________

Permanent pacemaker, temporary transcutaneous pacemaker

3rd degree AV Block

3rd Degree AV Block (complete heart block)

Treatment:

• Requires permanent pacemaker

• If symptomatic: _______________

• Drugs: ________, ____________

Temporary transcutaneous pacemaker, dopamine, epinephrine

Not effective against third degree AV block

Atropine

Pacemakers: _______ device inhibits the pacemaker when the HR is adequate

Sensing

Pacemakers: ______ device triggers the pacemaker when noQRS complexes occur within a preset time

Pacing

Failure to sense

Failure to Capture

Pacemaker

Failure to Pace

Pacemaker Troubleshooting:

• Monitor continuous ECG & pt.s vital signs while troubleshooting problems

• Make sure all connections are hooked up correctly & tight

• Check that generator has power (plug in the equipment or use a new battery each time)

• Place the patient on _________ to promote contact of the trans venous pacing wire with the epicardium

• Adjust settings (sensitivity, electrical charge) as indicated

• ___________ immediately if basic troubleshooting does not work, as pt could have a lead wire displaced or a defective lead wire

Left side, contact HCP