Studied by 5 people
supraventricular tachycardia
Intervention for ___: -vagal maneuver: "bear down as if youre going to have bowel movement and cough" -If the patient is still in ___, Adenosine -will need HR monitor and oxygen due to poor perfusion -have cardiovert ready -have crash cart and be ready for CPR ​
atrial fibrillation
intervention for ___: (note: Rapid Ventricular Response (HR: 150s, RVR is more symptomatic) control heart rate by: -BB (ie -lol) -Ca Channel (ie ditiazem) -digoxin -blood thinners (ie warfarin (coumadin), dabigatran, heparin) -control rhythm by : -amiodarone -TEE (check for clots bf cardiovert) -cardiovert if hypotensive and no clots -ablation (burn where impulse or pathways for irreg rhythm)
left ventricle (big muscle equals big waveform)
Anatomy: part of heart that dominates EKG
60-100
Conduction system:
rate of sinus node (aka pacemaker)
40-60
Conduction system:
rate of AV node (note: delays impulse to allow for atrial and ventricular filling)
20-40
Conduction system:
ventricular tissue can generate...
electrical activity
EKG captures...
0.04 seconds
I small box=___ (note: see red box in pic)
0.20 seconds
5 small boxes or 1 large block=___ (note: see red box in pic)
1 second
5 large blocks=___ (note: see red box in pic)
3 seconds
15 large boxes=___
30 blocks
A 6 second strip on EKG is ___ (large) blocks
QRS complexes
To calculate heart rate on a 6 second strip, you count the ___ and multiply by 10.
0.12-0.20 seconds
normal PR interval
less than 0.12 seconds
normal QRS complex is ___
cardiac ischemia (STEMI aka ST elevation Myocardial infarction)
when the ST segment is elevated, it is indicative of...
350-450 msec (0.35-0.45)
normal QT interval is ____
torsades (aka lethal ventricular tachycardia rhythm...note: alot of meds can cause QT interval to lengthen)
What happens if the QT interval lengthens
normal sinus
Patho of ____: -Rate 60-100 -Regular rhythm: P wave precedes each QRS. -PR is constant and 0.12-0.20 -QRS is constant and less than 0.12
nothing
Intervention for normal sinus: ___
sinus tachycardia
patho of ___: -SA is controlling, but faster than 100 -Regular -P wave before every QRS -PR interval is constant and within normal range (0.12-0.20). -QRS is less than 0.12 and constant.
sinus tachycardia
___'s Effect on patient: This is the scariest rhythm bc something is driving tachycardia and eventually compensatory method will die
sinus tachycardia
Intervention for ___: What Do I Do? -Treat the underlying cause... (IF Hypoxia-give O2, Fever-give Tylenol , Hypovolemia-give fluids, Infection-figure out source & treat it, Lyte Imbalance-correct lyte, Stimulants- remove stim, Anemia-treat hypoxic state) -may give BB (-lol) or CCB (diltiazem) to regulate HR
sinus bradycardia
Patho: -SA node controlling but slower than 60. -P wave precedes each QRS, and the -PR interval is normal (0.12-0.20). -QRS is normal (<0.12).
sinus bradycardia
What are causes of ____: hypoxia, vagal simulation, sleep, hypothermia, medications (CCB, BBlockers)
athletes
Population in which sinus bradycardia is normal: ___
sinus bradycardia
Intervention for ___: -BP, HR, O2 monitor -atropine (to increase HR) -pacing/pacemaker (externally/internally give electrical impulse for SA/ AV node), --dopamine, epinephrine (inc HR) --remove cause (EX if patient overdose BB, remove BB
0.5ml IV
How much atropine should sinus bradycardic patient receive? Route?
atrial fibrillation
patho for ___: •No P wave (multiple pacer cells generating independent impulses). •Chaotic baseline (P waves); No PR interval; typically normal QRS •Irregularly Irregular. •RVR, SVR, NVR
atrial fibrillation
____'s effect on patient? -If you see hr bouncing 82,74,92—good clue it's ____ -In ___, atrial are quivering -How long in rhythm? IF long blood pools in atria so anticoagulated. Shorter time, less likely to have clots
atrial flutter
Patho of ___: •Regular, but not from Sinus •AV node will conduct every 2nd, 3rd, or 4th impulse giving it sawtooth appearance. •No PR; normal QRS (sometimes ___ has rate of 350 bpm) -atrial blood is spinning
atrial flutter
Intervention of ___:
CCB, BB, digoxin
antidysrhythmic (if rate <100 to convert NSR) -TEE before cardiovert (severe symptoms) *anticoagulates (ie warfarin (coumadin), dabigatran, heparin)
supraventricular tachycardia
patho of ___: Rapid rhythm from above ventricles (Umbrella term): Sinus Tachycardia, Atrial Tachycardia (not sinus node), AFib RVR, Aflutter, Junctional Tachycardia). Regular, Narrow QRS complex tachycardia (greater than 100).
-6-12mg -preferably, central access. (Half of dose if administer central access) -push hard and fast and flush hard and fast
For a patient in supraventricular tachycardia, what is the dose of adenosine? Route? How to push med?
pacing, cardioversion, defibrilllation
Difference among ____ -pads hook to joules -for bradycardia EX sinus bradycardia, Second degree type 1 HB, Second Degree type 2 HB, Third Degree HB -heart rate goes up ____ -for afib, aflutter, SVT, VT (pulse)
for tachycardia and symptomatic -need to get out of tachycardia ____ -higher joules than cardiovert -patient has no pulse -for VT, VF, torsades -purpose: reset SA node
no pulse
Intervention for patient with ___(pulse/ no pulse) in ventricular tachycardia: defibrillate (priority) , CPR, epi, amiodarone (THIS ORDER)
pulse
Intervention for patient with ___ (pulse/ no pulse) in ventricular tachycardia:____ -check how symptomatic? (like if eyeballs rolled in back of head) -admin antidysrhythmic (ie amiodarone) -electrolytes -cardiovert
torsades
Intervention for ___: magnesium IVP primary concerns: defibrillate, CPR, magnesium
torsades
patho of __: -Type of VT -If prolonged QT interval (normal is 350-450), it puts patients at risk for ___ bc of R on T phenomena
ventricular fibrillation
patho of ___: always pulseless
ventricular fibrillation
Intervention of ___: -CPR (start STAT) -defibrillate -epi -2nd choice: amiodarone
-1mg -IVPush -every 3-5 minutes
how much epi do you administer for a ventricular fibrillation patient after CPR and defibrillation? Route? Time?
150-300
how much amiodarone do you give a ventricular fibrillation after you have already administered epi?
PACs and PVCs
Types of Ectopy: ___ ___
PACs
Ectopy-- cause of ____: -irritable atria
hypoxia -impulses come from the top down
PACs (premature atrial contractions)
patho of ___: -PR interval is narrow -not as concerning as PVCs -wide and defined p waves -irregular heart rate
PVCs, PACs
Intervention for ___:??? -monitor frequently, eliminate cause
PVCs (premature ventricular contractions)
Patho for ___: contractions: -impulses from bottom up -worry more bc lose CO -3 ___ in row is VT -wide and round QRS complex
PEA
patho for ___: -Can be any rhythm without a pulse -heart muscle is not squeezing but there is electrical activity -lethal rhythm
asystole
Intervention for ___: -check pads -chest compressions ASAP: stop only long enough to verify rhythm with a second monitor to rule out a fine v fib -fine v fib: defibrillate
asystole: compressions -epi -treat cause
PEA
Intervention for ___: -CPR (chest compressions) and EPI -fix cause H and T: Hypovolemia, Hypoxia, Hypokalemia, Hypoglycemia, Hypothermia; acidosis; Toxins; Tamponade; MI; PE Can't shock!!
agonal
patho for ___: Heart is dead, no pulse guaranteed, pulse is thready. Some impulse and patters out, no maintain CO
CPR, epi, treat cause
intervention for agonal:___
first degree heart block
patho for ___: Normal PR: 0.12-.20 A ____is simply a prolonged PR. Atrial depolarization is delayed in AV node. (something is delaying the AV node)
Monitor
what is the intervention for first degree heart block?
second degree type 1 heart block
patho for ___: -Also called Wenckebach or Mobitz I -Not all Atrial impulses get through AV node -PR gets long, longer, longer and drops...Resets
If symptomatic, administer atropine and pace.
what is the intervention for second degree type 1 heart block?
0.5ml IVP
how much atropine do you administer to second degree heart block type 1? Route?
second degree type 2 heart block
patho for ___: -Mobitz II -No change in PR intervals but dropped QRS. (for no reason) -Life threatening as it can quickly progress to 3rd Degree. -You are more concerned with ___________than Second Degree type 1
If symptomatic, pace or need pacemaker
what is the intervention for second degree type 2?
third degree heart block
patho for ___: -AV node is completely blocked and no impulses are getting through. -Atrial rate usually 60-100 Ventricular rate usually 40 or less.
-there is complete lost of association and complete dissociation bw the top of the heart and the bottom of the heart. -Pwaves and QRS will march out independently -Pwaves can be hidden in QRS complex
-march out independently -treat symptoms ( hypotension & dyspnea) -pace then pacemaker
intervention for third degree heart block?
Note 
Flashcard (44)