NUR 308 Basic EKG Interpretation Krueger

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
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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 (

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?