NUR 308 Basic EKG Interpretation Krueger

supraventricular tachycardia

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?