EKG Rhythms

normal sinus rhythm

P wave: normal

PR interval: 0.12-0.20s

QRS: <0.12

Rate: 60-100

Regularity: Regular

dysrhythmias

electricity not conducting properly

sinus bradycardia

p wave: normal

PR interval: 0.12-0.20

QRS: <0.12

Rate: <60

Regularity: Regular

sinus bradycardia causes

Sleep

Inactivity

Very athletic (low resting HR)

Drugs

MI (muscle damage => impulses slowed down, pumping slowed down)

sinus bradycardia interventions

fix the cause

atropine (Symptomatic)

sinus tachycardia

P-wave: normal

PR interval: 0.12-0.20

QRS: <0.12

Rate: >100

Regular

sinus tachycardia causes

Caffeine

Exercise

Fever

Anxiety

Drugs

Pain

Hypotension

Volume depletion (HR increase to perfuse, increase CO)

sinus tachycardia interventions

tx the cause

heart blocks

Conduction is excessively delayed or stopped at AV node or bundle of His

first degree heart block

P-wave:

Normal

PR Interval: >.20 (prolonged)

QRS: <0.12

Rate: 60-100

Regularity: Regular

first degree heart block causes

often an incidental finding

peds - infection

myocarditis

congenital heart disease

first degree heart block interventions

fix the cause

treatment is generally not required

if extreme - pacing

second degree heart block type 1

P-wave: Not a P for every QRS

PR Interval: longer, longer, longer....drop

QRS: <0.12

Rate: 60-100

Regularity: Regular

dropped beat, P wave but no QRS complex, electricity does not reach ventures from Atria

second degree heart block type 1 causes

Ischemia

Myocarditis

Status post-cardiac surgery

second degree heart block type 1 interventions

fix the cause

asymptomatic: no treatment required

symptomatic: pacing

second degree heart block type 2

P-wave: Not a P for every QRS (happens at random times)

PR Interval: 0.12-0.20

QRS: <0.12

Rate: >100

Regularity: Regular

int. dropped beats, P wave then no QRS, atria is contracting but not the ventricles

second degree heart block type 2 causes

MI, ischemia

second degree heart block type 2 interventions

fix the cause

pacing

third degree heart block

P-wave: Normal

PR Interval: Variable

QRS: <0.12

Rate: <60

Regularity: Irregular

complete dissociation between Atria + ventricles, not sufficient enough CO to support VS

third degree heart block causes

damage to the heart

MI

heart valve disease

rheumatic fever (heart valves damaged by rheumatic fever)

sarcoidosis (inflammation in myocardium)

third degree heart block interventions

fix the cause

pacing (may need permanent), will be symptomatic

if R is far from P

then you have FIRST DEGREE

longer longer drop

Then you have a Wenkebach (2nd degree type 1)

if some P's dont go through

then you have a Mobitz II (2nd degree type 2)

if Ps and Qs disagree

then you have a third degree

pacemaker types

transcutaneous: through skin, pads. usually in ER situation

transvenous: veins (come back from OR), if they are cardiac risk. can easily be paced from machine

permanent: implanted into their body

pt education about permanent pacemaker

-keep pacemaker ID card in wallet

-you can take a bath and showers

-don't apply pressure over the generator, dont wear tight clothing

-operating household appliances are safe

-notify airport security of pacemaker

-for temporary pacemakers: ensure lead wires dont get wet

-contraindx for MRI (MRIS use magnets, do CT scan instead)

atrial flutter

P-wave: saw tooth (lots of pwaves!)

PR Interval: none

QRS <0.12

Atrial Rate: 250-400

Ventricular Rate: varies

Regular or IRregular

a flutter causes

Heart disease

MI

CHF

Pericarditis

a flutter interventions

-fix the cause

-cardioversion

-antiarrhythmics: amiodarone

-beta blockers: metoprolol (slow HR)

-CCB: diltiazem (regulate rhythm)

a fib

P wave: wavy

PR interval: none

QRS 0.12

Atrial Rave >400

Ventricular rate: irregular

atria deterioriate and quiver, not sending blood forward

a fib causes

Heart disease

Pulmonary disease (increases pressure that our RV has to pump)

Stress

Alcohol

Caffeine

a fib interventions

fix cause

cardioversion***

antiarrhythmic: amiodarone

BB - metoprolol

surgery: ablation

ablation

removal of tissue to destroy its function

SVT

P-Wave: hidden

PR interval: immeasurable

QRS: <0.12

Rate: 150-250

REgularity: LOCKED IN REGULARITY

SVT causes

Caffeine

CHF

Fatigue

Hypoxia

Altered pacemaker in the heart (changes in SA node)

SVT interventions

fix causes

cardioversion

adenosine

vagal maneuver

to restart in SVT

adults: bear down, stimulates vagal nerve (CN X), can flip back into normal rhythm

infants: ice to face, blow on pinwheel (kids)

V tach

P-wave: none

PR Interval: none

QRS >0.11 wide and bizzare

Rate 150-250

Regular

ventricles are just contracting to get cardiac output out to body, can be with or without pulse

v tach causes

- MI

- ischemia

- digoxin toxicity

- hypoxia

- acidosis

- hypokalemia (or hyperkalemia)

- hypotension

v tach interventions

pulse: check pulse for 5-10 seconds

cardioversion

no pulse:

CPR

defibriliate

Epinephrine

v fib

p wave: none

pr interval: none

qrs: none

rate: none

regularity: irregular

ventricles are quivering, life threatening

v fib causes

- MI

- Ischemia

- Hypoxia

- acidosis

- hypokalemia

- hypotension

- most common cause of sudden death

= digoxin toxicity

v fib interventions

fix the cause

CPR

defibrillate

epinephrine

cardioversion

synchronized shock - in time with client's own rhythm

NEED PULSE

lower energy

adults: 100-360 J

peds: 2J/kg

defibriliation

asynchronous - does not coordinate with the clients own rhythmn

higher energy

adults: 200-360J

peds: 2J/kg

asystole

p wave none

PR interval none

QRS none

rate none

regularity n/a

asystole causes

Follows VT/VF in cardiac arrest

Acidosis

Hypoxia

Hypokalemia

Hypothermia

Overdose

asystole interventions

fix the cause

CPR

epinephrine

epinephrine in an emergency situation

1mg every 3-5min there is no maximum dose in a code