Lethal Dysrhythmias:
o  Heartbeat disturbances - beat formation, beat conduction, or myocardial response to beat
o  Can life threatening due to decreased cardiac output and ineffective tissue perfusion
P-R interval
0.12-0.20 seconds
QRS segment
0.06-0.10
duration of QT
0.36-0.44
what is defribillation
Asynchronous delivery of energy, such as the shock is delivered randomly during the cardiac cycle
when do u use D-FIB
pulseless vtach
pulseless v fib
what is cardioversion
Delivery of energy that is synchronized to the QRS complex
when do u use cardioversion
Persistent unstable tachyarrhythmia in patients with a pulse
what is asystole?
§ Total absence of ventricular electrical activity
-not shockable
Asystole nursing actions
§ No Pulse â CPR
§ Administer Epi (1:10,000)
§ Identify and treat Hâs and Tâs
hâs
â˘Hypovolemia
â˘Hypoxia
â˘Hydrogen ion (acidosis)
â˘Hyper/hypokalemia
â˘Hypothermia
â˘Hypoglycemia
tâs
â˘Toxins
â˘Tamponade
â˘Tension pneumothorax
â˘Thrombosis (Coronary (MI), Pulmonary (PE)
what is PULSELESS ELECTRICAL ACTIVITY (PEA)?
§ Organized electrical activity WITHOUT mechanical heart activity and pulse.
§ Most commonly seen after defibrillation.
-not shockable
PULSELESS ELECTRICAL ACTIVITY (PEA) nursing actions
§ No pulse â CPR
§ Administer Epi (1:10,000)
§ Identify and treat Hâs and Tâs
VENTRICULAR TACHYCARDIA - with pulse nursing action
¡     Cardioversion
¡     Administer Amiodarone or Lidocaine
¡     VENTRICULAR TACHYCARDIA - with NO pulse nursing action
¡     No pulse â CPR
¡     Defibrillator
¡     Administer Amiodarone or Lidocaine
¡     Administer Epi (1:10,000)
what is VENTRICULAR FIBRILLATION?
§ Ventricle is âquiveringâ and not contracting = NO CARDIAC OUTPUT
VENTRICULAR FIBRILLATION nursing action
§ No Pulse â CPR
§ Defibrillator
§ Administer lidocaine or amiodarone
§ administer Epi (1:10,000)
what is 1st DEGREE HEART BLOCK
§ Prolonged PR interval (> 0.2 seconds)
1st DEGREE HEART BLOCK nursing action
§ Assess symptoms of poor cardiac output
¡     Bradycardia
¡     Decreased HR
¡     Fatigue
¡     SOB
§ Administer Atropine if they are symptomatic
§ Asymptomatic â do nothing
§ If pt is unstable - pacing
¡     Chest pain
¡     Decreased LOC
¡     Unstable vitals
what is 2ND DEGREE TYPE 1 HEART BLOCK
§ PR interval increases with each beat until it drops. Pattern repeats.
2ND DEGREE TYPE 1 HEART BLOCK nursing action
§ Assess patient for symptoms of poor cardiac output
¡     Bradycardia
¡     Decreased HR
¡     Fatigue
¡     SOB
§ Administer Atropine if they are symptomatic
§ if pt is unstable â pacing
¡     Chest pain
¡     Decreased LOC
¡     Unstable vitals
what is 2nd DEGREE TYPE 2 HEART BLOCK
§ PR interval is consistent, but the QRS will drop unexpectantly.
what is 2nd DEGREE TYPE 2 HEART BLOCK nursing action
§ Assess patient for symptoms of poor cardiac output
¡     Bradycardia
¡     Decreased HR
¡     Fatigue
¡     SOB
§ Administer Atropine if they are symptomatic
§ if pt is unstable â pacing
¡     Chest pain
¡     Decreased LOC
¡     Unstable vitals
what is 3rd DEGREE (COMPLETE) HEART BLOCK
§ Dissociation of atria from the ventricles with no impulses conducted through heart. (Atria and Ventricles are divorced).
3rd DEGREE (COMPLETE) HEART BLOCK nursing action
§ ABC
§ Decreased cardiac output
§ Transcutaneous pacing until pacemaker can be placed