rhythm strips

Normal sinus

• 60-100 bpm

• regular rhythm with visible P, R, and T waves

Sinus Tachycardia

• greater than 100 bpm

• regular rhythm with visible p, r, and t waves

sinus bradycardia

• less than 60 bpm

• irregular to regular rhythm with visible p, r, and t waves

atrial flutter

• regular rapid heart rhythm originating in the atria, typically characterized by a "sawtooth" pattern

• More P waves than QRS, T waves present

atrial fibrillation

• irregular rhythm with fluctuating heart rate

• most likely to clot

ventricular tachycardia

• regular fast heart beat with no P waves and wide QRS intervals

• Medical emergency, rapid response, shockable rhythm

ventricular fibrillation

• extremely irregular high heart rate, unable to count bpm

• no P waves, QRS interval not measurable, no perfusion

asystole

• everything absent

• do not defibrillate

supraventricular tachycardia

• regular extremely high heart beat exceeding 140 bpm

• narrow QRS, P waves usually present

ST elevation

• STEMI: tissue death, MI

ST Depression

• previous tissue damage

Peaked T wave

• high potassium

• check baseline t waves to identify

Inverted T wave

• low potassium

  • usually due to diuretic usage

Rhythm strip interpretation

P wave: atrial depolarization

QRS: Ventricular depolarization

R: electrical stimulus, heart beat is considered regular when R waves are equal distance apart

ST: distance between end of QRS and T wave

T wave: Repolarization, heart at rest

PR interval: count number of boxes between start of P wave and start of QRS

SV node

pacemaker of the heart

heart rate will be within normal range 60-100 bpm

AV node

takes over if SV node fails

heart beat will be between 40-60 bpm

Ventricles

takes over if both SV and AV node fail

heart beat will be less than 40 bpm

decreased perfusion which causes cells to die

Rhythm strip boxes

• each small box is 0.04 sec

• 1 large box is 0.20 sec

• strips are 6 sec, multiply by 10 to get bpm

12 lead ekg

shows heart from different angles

defirbillation

• only done on unconscious pt

• EMERGENCY

• higher joules

cardioversion

• conscious pt, then sedated

• can be done outpatient

• lower electrical current than defibrillation

Ablation

uses radiofrequency energy to destroy segment of heart tissue that is causing rapid or irregular heart beats when pt is unresponsive or intolerant to medication therapy

Pulseless electrical activity (PEA)

has rhythm with no pulse

mimics sinus brady

Start CPR

Pacemaker care and teaching (PACER)

P: pulse/pain meds as needed, monitor HR and Bp, teach client to check HR daily and notify HCP if pulse is <5 bpm

A: Assess insertion site for redness, drainage, swelling, hematoma

C: control and minimize shoulder movement initially, may need sling. client instructed to have no heavy lifting

E: Evaluate rhythm strip for pacemaker spike

R: Record insertion time, model #, settings, client response. Recommend client to wear medical alert bracelet and carry pacemaker ID card. Notify HCPs of any diagnostic test (MRI, etc.)

Interventions for symptomatic sinus bradycardia

give atropine ( increases HR) and suplemantal O2 as needed

Interventions for symptomatic sinus Tachycardia

give amiodarone (Most common med), calcium channel blockers, digoxin, beta blockers

may need ablation or cardioversion

Interventions for A-Fib and Atrial flutter

• Supplemental O2, fall precautions

• medications to decrease HR (calcium channel blockers, beta blockers, digoxin) Adenosine for HR >150 bpm

• Anticoagulants, client teaching about safety, monitor INR, PT, PTT, diet

• prepare client for cardioversion or ablation

  A-Fib does not convert to normal sinus, keeps HR below 100 bpm with medication

Interventions for Ventricular tachycardia (w/ & w/o pulse)

CALL RAPID

W/ Pulse:

• give Amiodarone (1st), lidocaine, or procainamide

• prepare for cardiac ablation

W/o Pulse:

• begin CPR until defibrillator is connected

• defibrillate starting at 120 then increasing until reaching 200 joules

• Follow ACLS protcols for med admin

• prevention: client may need ACID device implanted for future episodes

Interventions for Ventricular fibrillation

CALL CODE

• Begin CPR

• Give O2 (May need intubation)

• Follow ACLS protocol for meds. (Amiodarone, Lidocaine, vasopressin)

• Defibrillate

• PT may need AICD

Supraventricular tachycardia interventions

Give adenosine (stops HR then restarts)

vagal manuver

Asystole Interventions

Begin CPR

Give O2/ABG results/O2 sat

Follow ACLS protocols for med admin. (Epinephreine)

Prepare to defibrillate if rhythm returns. DO NOT DEFIBRILLATE IF NO RHYTHM