Advanced Cardiac Flashcards
For patients with symptomatic A Fib who are hemodynamically unstable, what interventions are performed?
- Cardioversion
- Transesohageal Echocardiogram (TEE)
- Looking at tricuspid valve
- Looking for plaque or clot
- Radiofrequency catheter ablation
- Permanent Pacemaker
Causes of V Fib
- Myocardial infarction
- Myocardial ischemia
- Untreated V-Tach
- Acid-base imbalance (metabolic or resp.)
- Electric shock
- Electrolyte imbalance
- Hypokalemia
- Hypomagnesaemia
- Severe hypothermia
- Underlying heart disease
- Trauma
- Surgery
- Hemorrhage
- Antidysrhythmic therapy
- Cardioversion
- Rapid supraventricular tachycardia (SVTs)
- Shock
What should the nurse do after valsalva maneuvers?
Re-assess V/S & EKG rhythm
Normal Mg++ Level
1.3 - 2.1
Causes of V Tach
-
Electrolyte imbalances
- Hypokalemia
- Hypomagnesaemia
- Myocardial irritability
- Ischemic heart disease
- Acute MI
- CAD
- Cardiac arrest
- Drug toxicity
- Digitalis
- Heart Failure
- Hypothermia
- Hypovolemic Shock
- caused by…Hemorrhage
- which leades to…Hypotension
- Electrical shock
- Trauma
- Surgery
With Noninvasive Temporary Pacing (NTP), the QRS is ____________.
wide & bizarre
What interventions beyond medication are performed for Junctional Dysrhythmias?
Transcutaneous Pacing
Pacemaker
therapy used for V Tach, V Fib and asystole in which cooling blankets or hypothermia pads are used to decrease a patient’s temperature to 89.6-93.2 ºF for 24 hours before slowly re-warming at a rate of 0.5-1 ºC/ hour
Therapeutic Hypothermia
Dysrythmias defined as repetitive firing of an irritable ventricular ectopic focus resulting in a HR of 140-180 bpm
…or 3 or more PVC’s in a row or runs
Ventricular Tachycardia (V Tach)
Medication given for symptomatic Junction Dysrhythmia is:
Atropine 0.5 -1.0 mg IV bolus FAST q 3-5 min
Dopamine (if hemodynamically compromised)
V Tach HR is _____ to ____ bpm.
140 -180 bpm
PSVT patient may be prescribed ________ or ________ for maintenance
Cardizem or amirodione
What is used to hear the pulse during V Tach?
dopper or echo
Supraventricular Tachycardia (SVT) HR = ___ to ___ bpm
150 - 280
Rhythm in which the entire heart is no longer contracting, only quivering without organized contraction with random depolarization of many cells
Ventricular Fibrillation
Complications of Transvenous Pacing
- PVC
- V Tach
- V Fib
- Cardiac tamponade
In Cardioversion, delivering a synchronized shock prevents ___________.
R on T Phenomenon
In Atrial Flutter, P waves are _______.
absent
In monophasic defibrillation, the monitor is set to a rate of _____ Joules.
360
In biphasic defibrillation, the monitor is set to a rate of _____ to _____ Joules.
120 - 200
Causes of Premature Atrial Complexes (PAC)
- Myocardial ischemia
- CHF
- Valvular disease
- Pulmonary HTN
- Hypermetabolic states
- Electrolyte imbalance
- Atrial stretch
- Hyperthyroidism
- Stress
- Fatigue
- Anxiety
- Inflammation
- Infection
- Caffeine, nicotine, or alcohol
- Drugs
- epinephrine
- catecholamines
- sympathomimetics
- amphetamines
- digitalis
- anesthetic agents
For A Fib patient with normal heart function, what beta blocker can be given and at what dose?
Brevibloc
Initially, 500 mcg/kg/min for 1 min
Then, 50 mcg/kg/min for 4 min
Then, titrate up as necessary
occurs when the R wave of the PVC falls on the T wave of the previous complex which may lead to lethal dysrhythmia, such as V Tach because the PVC occurs during the vulnerable period of ventricular repolarization
R on T Phenomonon
For Biphasic Cardioversion, the monitor is set in __________ mode.
synchornized
What does the nurse do when the metal external ends of the lead wires in Transvenous Pacing are not attached to the pulse generator?
insulate the wires with gloves, loop and cover with non-conductive tape
If PVCs are caused by MI or ischemia, what medication is given?
Amiodarone PO or IV
Will Sustained V Tach have a pulse?
may or may not
Signs & Symptoms of Atrial Flutter
- Angina
- Palpitations
- Weakness
- SOB
- Hypotension
- Irregular HR
- Syncope
- Anxiety
- Heart failure
- Shock
What are the only two rhythms that can be shocked?
V Fib and V Tach
Bradydysrhythmia is defined as a HR less than ______ bpm.
60 bpm
antidysrhythmic drug that may cause asystole
Adenosine
Premature Complexes are generated by ________, _________, or __________ tissue.
atrial, junctional or ventricular
Dysrhythmia in which impulses are excessively delayed or totally blocked in the AV node while the SA node continues to function normally, and atrial depolarizations and P waves occur regularly but because of the conduction dysfunction, ventricular depolarizations and QRS complexes are either delayed or blocked
Atrioventricular Blocks
Where are the electrodes placed during Noninvasive Temporary Pacing (NTP)?
one to the right of the sternum and one placed over the heart apex
Symptoms of SVT
- Palpitations
- Light-headedness
- Dizziness
- Anxiety
- Shortness of breath
- Rapid breathing
- Chest pain
- Hypotension
- Syncope
- Loss of consciousness
- Numbness of various body parts
Normal K+ Level
3.5 - 5.0
Symptoms of Sustained V Tach
- Non-responsiveness
- Loss of pulse
Symptoms of Junctional Dysrythmias
- Fatigue
- Fluttering in chest
- Chest pain
In ______-degree heart block, none of the sinus impulses reach the ventricles. The ventricles are therefore depolarized by a second, independent pacemaker.
third (complete heart block)
Junctional Dysrhythmias are most commonly _________.
temporary
Treatment for Idioventricular Rhythm, PEA & Ventricular Asystole
- Oxygenate
- CPR
- Intubate
4. Epinephrine
1 mg IV bolus followed by 20 ml saline flush
Repeat q 3-5 min
- If rhythm becomes shockable,defibrillate
Or if you have a pulse, try to pace
- Treat reversible causes (H’s & T’s)
In __________-degree heart block, some sinus impulses reach the ventricles but others do not because they are blocked.
second
During Radiofrequency catheter ablation, check for _________ pulses.
peripheral
Tachydysrhythmias cause _______ and ______ to decrease.
cardiac output and BP
Causes of Sinus Tachycardia
- Sympathetic nervous system impulse imbalance
- Hypovolemic shock
- MI
- Infection
- Heart failure
- Pain
- Anxiety
- Fever
- Hypoxemia
- Stress
- Fear
- Anemia
- Hyperthyroidism
- PE
- Alcohol
- Nicotine
- Caffeine
- Drugs
- Thyroid medications
- Epinephrine
- Atropine
- Aminophylline
Tachydysrythmias are considered HR greater than _____ bpm.
100 bpm
Rhythm called the “rhythm of last resort” or “rhythm of the dying heart” acting as safety mechanism to prevent ventricular standstill when no impulses are conducted to the ventricles from above the bundle of His…rate usually less than 40 bpm
Idioventricular Rhythm
MD may perform these procedures before giving meds for A Fib?
vagal maneuvers or carotid massage
Symptoms of Sinus Bradycardia:
- Syncope
- Dizziness and weakness
- Confusion
- Hypotension
- Diaphoresis
- Shortness of breath
- Angina pain
- T-wave inversion
- ST-segment elevation or depression
What does the valsalva maneuver and raising the hands above the head do in the heart?
slows SA to AV node conduction which slows the heart rate
Sinus Rhythm with Premature Atrial Complexes (PAC)
Dysrhythmias are treated based on what?
their effect on cardiac output and the risk to the patient
What does the nurse do if a patient is having non-sustained V Tach runs?
Give Amiodarone PO
Give O2
Call the physician
MD may perform these procedures before giving meds for SVT?
valsalva maneuver or carotid massage
cardioversion electrode placement in which the electrodes are on the right and left of the chest
Monophasic
Causes of Ventricular Asystole
- MI
- Severe electrolyte disturbances
- Hyperkalemia
- Severe uncorrected acidosis
- Massive PE
- Prolonged hypoxemia
- Electric shock
- Drug overdose
What should the nurse do during valsalva maneuvers?
- Assess HR
- Asess Rhythm
- Assess BP
- Record rhythm strip
Medications given for Unstable V Tach are:
Epinephrine
1 mg IV bolus followed by 20 ml saline flush
Repeat q 3-5 min
Amiodarone
1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)
2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)
Maintenance Infusion: 540 mg IV over 18 hrs
Then, 720 mg/24 hrs
Lidocaine (Xylocaine)
1 -1 .5 mg/kg IV bolus
0.5-0.75 mg/kg bolus q 5-10 min up to 3 mg/kg (loading dose)
Followed by infusion of 2-4 mg/min
(1 - 2 doses then start drip)
Magnesium Sulfate
1 - 2 gm in 100ml/D5W IV over 1-2 min
(normally give over 1 hr)
(Then start drip)
What does this EKG strip show?
It shows pacing attempted but not acheiving capture. The arrow shows the pacing stimulus indicator which is below threshold.
In Third-Degree (Complete) Heart Block, there about 2x as many P waves as ____________.
QRS complexes
Supraventricular Tachycardia (SVT) is defined as a heart rate higher than ______.
150 bpm
For Biphasic Cardioversion, the monitor is set at a rate of
_______ Joules.
120
Signs & Symptoms of V Fib
- Loss of consciousness
- Pulselessness
- Syncope
- Apneic
- No BP
- No heart sounds
- Respiratory and metabolic acidosis
- Seizures
- Pupils become fixed and dilated
- Cold and Mottled Skin
For A Fib patient with normal heart function, it is controlled by administering what type of drug?
Beta Blocker
MD may perform these procedures before giving meds for A Flutter?
vagal maneuvers and carotid massage
Before we treat the rhythm, we must ________ the rhythm.
identify
A Fib
Causes of AV Heart Blocks
- Drug therapy
- digoxin
- beta-adrenergic blockers
- calcium channel blockers
- antiarrhythmic drugs such as amiodarone
- MI
- Chronic degenerative disease of the atrial conduction system (seen with aging)
- CHF
- Hypo- or Hyperkalemia
- Increased vagal tone
Sinus Tachycardia QRS Width
< 0.12 seconds
What are the potential complications of valsalva maneuvers?
- rebound tachycardia
- severe bradycardia
Radiofrequency catheter ablation could lead to _________ requiring insertion of a ____________.
heart blocks; permanent pacemaker
Digoxin Level is toxic above _____.
2.4
PACs could lead to these dysrhythmias:
A Fib, A Flutter or PSVT
What electrolytes do you always check on a patient with a Run of V Tach?
K+ and Mg++
Causes of V Fib, V Tach, PEA & Asystole
(H’s & T’s!!!)
- Hypovolemia
- Hypoxia
- Hydrogen ions (Acidosis)
- Hyperkalemia or Hypokalemia
- Hypoglycemia
- Hypothermia
- Tablets or Toxins (Drug overdose)
- Tension pneumothorax
- Chest Tube
- Thrombosis
- Anti-Thrombolytics
- Cardiac Tamponade
- Trauma
Dysrhythmias are classified according to __________.
site of origin
What does carotid massage do in the heart?
slows SA to AV node conduction which slows the heart rate
What should the nurse do during carotid sinus massage?
Observe rhythm strip
The degrees of block of the heart are differentiated by their ______________.
PR intervals
For an elective cardioversion, digoxin is held for _____ hours.
48
Treatment for V Fib
- CPR (if no code cart)
- Immediate Defibrillation
- ACLS Protocol
- Oxygen
- Intubation
- Epinephrine
- Amiodarone
- Lidocaine
- Magnesium sulfate
- Alternating CPR with Defibrillation
Beta Blocker used as an antidysrhythmic drug
Propanolol
If V Fib results after cardioversion, then switch to ___________.
asynchronized defibrillation
intermittent Supraventricular Tachycardia (SVT)
Paroxysmal Supraventricular Tachycardia (PSVT)
Most common dysrhythmia in which the atria fibrillate or quiver without organized contraction
Atril Fibrillation (A Fib)
decrease in the rate of atrial depolarization due to slowing of the SA node
Sinus Bradycardia
type of pacing usually done in temporary pacing situations in which the pacemaker’s sensitivity is set to sense the patient’s own heart beats and if patients heartbeat goes above the rate set on the pulse generator, the pacemaker does not fire and if it goes under, the pacemaker provides the electrical impulses
synchronous or demand pacing
Causes/ Risk Factors for Atrial Flutter are:
- Acute or chronic cardiac disorder
- Rheumatic or ischemic heart disease
- Heart failure
- Mitral or tricuspid valve disorder
- Septial defects
- Pericarditis
- Post MI complication
- PE
- Hyperthyroidism (speeds up HR)
- Alcoholism
For patients with PVCs, be on alert for _____________.
R on T phenomenon
a synchronized countershock that may be performed in emergencies for hemodynamically unstable A Flutter, A Fib or SVT and electively for stable tachydysrythmias that are resistant to medical therapies. The shock depolarizes a critical mass of myocardium simultaneously during intrinsic depolarization and is intended to stop the re-entry circuit and allow the sinus node to regain control of the heart.
Cardioversion
Atrial Flutter HR is _____ to _____ bpm
220 - 350 bpm
Medication given for digoxin toxicity:
Digibind
Normal PR Interval
0.12 - 0.20 seconds
Calcium Channel Blockers used as antidysrhythmic drugs
Cardizem and verapamil
Risk Factors/ Causes of A Fib
- Hypertension
- Diabetes mellitus
- Male gender
- Congestive heart failure
- Valvular disease
- Alcohol
- Rheumatic heart disease
- Coronary artery disease
- Caffeine
- Cardiac surgery
- Electrocution
- MI
- Pericarditis
- Myocarditis
- Pulmonary embolism
- Digoxin toxicity
- COPD
Normal Ca+ Level
9.0 - 10.5
If Idioventricular Rhythm is accompanied by NO pulse its is called ________________.
Pulseless Electrical Activity (PEA)
In V Fib, there is no cardiac output or pulse and therefore no cerebral, myocardial, or systemic perfusion. This rhythm is rapidly fatal if not successfully ended within ___ to _____ minutes.
3 - 5
P waves in Junctional Dysrythmias may be _______ or may occur _________, _________, or _______ the QRS.
absent; before; during; after
Causes of Sinus Bradycardia:
- Increased vagal tone
- Hyperkalemia
- Increased intracranial pressures
- Possible result of inferior MI
- Drugs
- Beta-adrenergic blockers
- Calcium channel blockers
- Digoxin
- Morphine
“R on T leads to __________”
asystole
What medication is given for patients with more than 5000 PVCs in 24 hours?
Beta Blockers
The components of ACLS are:
CPR
Manual Resuscitation Bag with O2 @ 10-15 L/min
Intubation
2 Large-Bore IV lines (NS)
Suction Equipment
External Pacing
Therapeutic Hypothermia
Sustained V Tach is defined as lasting longer than ___ to ___ seconds.
15 - 30
4 ºC = ____ ºF
39.2
What is done for PVCs in a patient with no underlying heart condition?
no treatment except for eliminating contributing cause
What are the 6 steps of analyzing an EKG?
- Heart Rate
- Determine the Rhythm
- Analyze the P Waves
- Measure the PR Interval
- Measure the QRS Duration
- Interpret the Rhythm
cardiac treatment that is used to depolarize cells followed by a contraction and increase cardiac output and provides timed electrical stimulus to the heart (used in bradycardia)
temporary pacing
Symptoms of PAC
usually asymptomatic except for heart palpitations
In Supraventricular Tachycardia (PSVT), the ______ may not be visible on the EKG.
P waves
What are the potential complications of carotid sinus massage?
- Bradydysrhtyhmias
- Asystole
- V Fib
- Cerebral damage
Causes of PVC
- Myocardial ischemia
- Myocardial infarction
- CHF
- Chronic hypoxemia
- Anemia
- Hypokalemia
- Hypomagnesaemia
- Catecholamine
- Digitalis
- Acidosis
- Anesthesia
- Stress
- Nicotine
- Caffeine
- Alcohol
- Infection
- Trauma
- Surgery
Medication Given for Stable V Tach (Run of V Tach)
Amiodarone
1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)
2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)
Maintenance Infusion: 540 mg IV over 18 hrs
Then, 720 mg/24 hrs
Lidocaine (Xylocaine)
1 -1 .5 mg/kg IV bolus
0.5-0.75 mg/kg bolus q 5-10 min up to 3 mg/kg (loading dose)
Followed by infusion of 2-4 mg/min
Magnesium Sulfate
1 - 2 gm in 100ml/D5W IV over 1-2 min
(normally give over 1 hr)
Mexitil
200 - 300 mg PO q 8 hrs
Betapace
80 mg PO BID
Increase q 2-3 days to 240 - 320 mg/day
If strip shows R on T that leads to asystole, always __________ to see if V Fib can be picked up.
change the lead
Never give _______ to a Second-Degree Mobitz II, because it can cause Third-Degree AV Block.
atropine
Which 2 electrolyte imbalances contribute to PVCs?
Hypomagnesemia & Hypokalemia
Causes/ Risk Factors of Junctional Dysrhythmias
- Most common causes:
- Hypokalemia
-
Drug induced
- Beta blockers
- Calcium channel blockers
- Cardiac glycoside
- Digoxin toxicity
- Younger/athletic individuals during periods of increased vagal tone
- Structural heart disease
- Sick Sinus syndrome
- Oxygen deficiency
- Inferior wall MI
- Ischemia of the AV node
- Cardiac surgery
- Sepsis
Medications given for A. Flutter are:
Cardizem (hung as a drip)
1st dose: 0.25 mg/kg IV over 1-2 min
2nd dose 15 min later: 0.35 mg/kg IV over 2 min
Then, 5-15 mg/hr infusion
Amiodarone
1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)
2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)
Maintenance Infusion: 540 mg IV over 18 hrs
Then, 720 mg/24 hrs
Corvert
1 mg IV over 10 min for weight > 60 kg
0.01 mg IV over 10 min for weight < 60 kg
May repeat 10 min later, if necessary
Symptoms of Sustained Tachydysrhythmias and Bradydysrhythmias
- Chest discomfort, pressure, or pain, which may radiate to the jaw, the back, or arm
- Restlessness, anxiety, nervousness, confusion
- Dizziness, syncope
- Palpitations (in tachydysrhythmias)
- Change in pulse strength, rate, and rhythm
- Pulse deficit
- Orthopnea
- S3 or S4 heart sounds
- Jugular venous distention
- Weakness, fatigue
- Pale, cool, skin; diaphoresis
- Nausea, vomiting
- Decreased urine output
- Delayed capillary refill
- Hypotension
- Shortness of breath
- Dyspnea
- Tachypnea
- Pulmonary crackles
An asynchronous countershock that depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit, allowing the sinus node to regain control of the heart used only for V Fib and V Tach
Defibrillation
Treatment of Second-Degree Mobitz I (Wenkebach)
and Mobitz II AV Block
For concomitant acute myocardial ischemia or myocardial infarction (MI)…
- Telemetry monitoring
- Treat underlying cause (change or hold drugs)
- Oxygen
- Atropine (ONLY FOR MOBITZ TYPE I WENKEBACH!!)
- Transcutaneous pacing
- Permanent pacemaker if unresolved
Sinus Tachycardia is defined as a heart rate of _______.
100-140 bpm
The treatment for Unstable V Tach (the same as for V Fib) is:
- Check ABC’s
- Defibrillate if code cart is bedside or start CPR if no cart
- After 2 minutes of CPR, check rhythm
- Treat accordingly
- V Tach= defibrillate
- Asystole = CPR
type of pacing pacing used in the patient with extreme bradycardia which may occur after heart surgery…it does not sense heart beats but fires at a fixed rate
asynchronous or fixed-rate pacing
In Noninvasive Temporary Pacing (NTP), set the current milliamperes (mA) output ________ above the dose at which consistent capture is observed.
2 mA
For more than 6 PVCs in a row, put the patient on a __________
Holter Monitor
In Sinus Bradycardia, coronary perfusion time ________ while coronary perfusion pressure may ___________.
increase; decrease
Dysrhytmia caused by irritability of ventricular cells that result in early ventricular complexes followed by a pause
Premature Ventricular Complexes (PVC)
Treatment for Torsade is the same as _______.
V Tach
occurs when three or more PVCs occur in a row
Run of Ventricular Tachycardia (Run of VT) or Nonsustained Ventricular Tachycardia
type of pacing in which the pacemaker is inserted through a vein such as a subclavian or internal jugular vein at the bedside or in other nonsurgical environments
Transvenous Pacing or Invasive Temporary Pacing
Sites of origin for dysrhythmias include:
SA node
AV node
Junctional Tissue
Ventricular Tissue
How do you check to see if the heart beat is being perfused through the body?
Assess apical pulse while feeling radial pulse and looking at the monitor for ONE MINUTE
a disturbance in the relationship between electrical conductivity and the mecDhanical response of the myocardium
Dysrhytmias
Normal QRS Duration
0.04 - 0.10 second
Cardiac dysrhythmia that is initiated in the AV node (AV junctional area) when the SA node and atrial sites fail to initiate an electrical impulse that causes loss of ventricular filling during the last part of diastole, loss of atria kick, and loss of cardiac output by 20-25 %
Junctional Dysrythmias
For patients with symptomatic A Flutter who are hemodynamically unstable, what interventions are performed?
- Cardioversion
- Transesohageal Echocardiogram (TEE)
- Radiofrequency catheter ablation
- Permanent Pacemaker
Sinus Tachycardia HR _____ to ____ bpm.
100 - 160
During Noninvasive Temporary Pacing (NTP), the nurse should palpate the ________ or the ________ pulse.
right radial or carotid pulse
equipment used for patients that have experienced one or more episodes of spontaneous sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) not caused by an MI
Implantable Cardioverter/Defibrillator (ICD)
A Fib patients are given _______ to prevent blood clots.
anticoagulants such as heparin, lovenox, or coumadin
If the HR in a Junctional Rhythm is above 60 bpm, it is referred to as ___________ junctional rhythm.
accelerated
Occurs when:
- HR increases slightly during inspiration and decreases slightly during exhalation
- Atrial and ventricular rates are 60 - 100 bpm
- Atrial and ventricular rhythms irregular with the shortest PP or RR interval varying at least 0.12 second from the longest PP or RR interval
Sinus Arrythmia
an invasive procedure that uses radiofrequency waves to abolish an irritable focus that is causing a supraventricular or ventricular tachydysrhythmia
Radiofrequency Catheter Ablation
Full cardiac arrest with the absence of any ventricular rhythm or electrical impulses in the ventricles and therefore, no ventricular depolarization, no QRS complex, no contraction, no cardiac output, and no pulse
Ventricular Asystole
The most dangerous PVCs
multifocal PVCs
Signs & Symptoms of Mobitz I (Wenckebach)
and Mobitz II AV Block
- Asymptomatic
- Light-headedness, dizziness, or syncope
- Chest pain (with myocarditis or ischemia)
- Regularly irregular heartbeat
- Bradycardia
- Decreased cardiac output
- Hypoperfusion
- Hypotension
Causes of SVT
- Myocardial Infarction
- Cardiomyopathy
- Congenital anomalies
- Hyperthyroidism
- Systemic hypertension
- Digoxin Toxicity
- Excessive caffeine
- Electrolyte Imbalances
- Hypoxia
- Physical or psychological stress
- PE
- Cocaine abuse
- Alcohol
- Smoking
Antidysrhythmic drug that slows conduction and shortens repolarization
Sodium Channel Blockers 1B
Prior to a cardioversion, the patient will be placed on ________ for 4-6 weeks.
anticoagulants
Causes of Torsade
-
Electrolyte imbalances, particularly
- Hypokalemia
- Hypomagnesaemia
- Drugs which lengthen the QT interval such as quinidine
- Myocardial ischemia
Normal Digoxin Level
0.8 - 2.0
What medications are given for Torsades?
_*Magnesium IV*_
_*Potassium IV*_
Amiodarone
1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)
2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)
Maintenance Infusion: 540 mg IV over 18 hrs
Then, 720 mg/24 hrs
What should the nurse do after carotid sinus massage?
Assess V/S & LOC
On a biphasic monitor, one electrode is on the _______ and one is on the _________.
chest; back
Frequent PACs are treated by correcting __________.
the underlying cause such as stress, stimulants, CHF, electrolyte imbalances.
Medications given for A Fib with normal heart function:
Cardizem (hung as a drip)
1st dose: 0.25 mg/kg IV over 1-2 min
2nd dose 15 min later: 0.35 mg/kg IV over 2 min
Then, 5-15 mg/hr infusion
Verapamil
1st dose: 2.5 - 5 mg IV over 1-2 min
2nd dose 15-30 min later: 5 -1 0 mg IV over 1-2 min
Repeat up to a max of 20 mg
PO: 80 - 120 mg q6-8 hrs
cardioversion electrode placement in which the they are on the patient’s back and chest
Biphasic
In A Fib, there is a decrease in cardiac output by ____ to ____ %
25 -30%
Rate of Idioventricular Rhythm
20 - 40 bpm
In _______-degree AV block, all sinus impulses eventually reach the ventricles.
first
Supraventricular Tachycardia (SVT)
Antidysrhythmic drug that slows conduction and prolongs repolarization
Sodium Channel Blockers 1A
Interventions for SVT
Cardioversion
Radiofrequency Catheter Ablation (if rhythm as decreased)
If PAC is symptomatic, what is the treatment drug?
Beta Blockers
Medications given for A Fib with impaired heart function:
Digoxin
0.5 - 1.0 mg PO or IV
O.125 - 0.5 mg PO or IV q 6h until total of 1 - 1.15 mg is reached
Cardizem (hung as a drip)
1st dose: 0.25 mg/kg IV over 1-2 min
2nd dose 15 min later: 0.35 mg/kg IV over 2 min
Then, 5-15 mg/hr infusion
Amiodarone
1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)
2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)
Maintenance Infusion: 540 mg IV over 18 hrs
Then, 720 mg/24 hrs
Dysrhythmia in which the P waves are notched, peaked or buried in the preceding T wave
Premature Atrial Complexes (PAC)
For Sinus Bradycardia, what drug is given IV?
Atropine 0.5 -1.0 mg IV bolus FAST
Mobitz I and Mobitz II can cause ________.
Third-Degree (Complete) Heart Block
Torsade HR is ____ to _____ bpm.
150 - 220 bpm
In Third-Degree (Complete) Heart Block, the atrial HR is ___ to ____ bpm but the ventricular HR (electrical impulse) is ____ to ____.
60 - 100; 20 - 40
Antidysrhythmic drug that prolongs conduction with little to no effect on repolarization
Sodium Channel Blockers 1C
Tachydysrhythmias shorten _________.
diastolic time and therefore the coronary perfusion time (the amount of time available for blood to flow through the coronary arteries to the myocardium)
In Sinus Bradycardia, myocardial oxygen demand is __________.
decreased
Class III Antidysrhythmic drug that prolongs repolarization and decreases irritability in the heart
Lidocaine
PSVT may be treated with _________ before it becomes SVT
radiofrequency catheter ablasion
Symptoms of Run of V Tach
- Slight weakness
- Palpitations
In PVCs, QRS complexes are _______ & ________.
wide & bizarre
Complications of CPR
Rib fractures
Fracture of the sternum
Costochondral separation
Lacerations of the liver and spleen
Pneumothorax
Hemothorax
Cardiac tamponade
Lung contusions
Fat emboli
What does CAB stand for?
Chest Compressions
Maintain Patent Airway
Ventilate (Breathing)
First Degree AV Block
A Fib HR = ______ bpm
350 - 600 bpm
type of pacing that uses two large external electrodes to transcutaneously stimulate ventricular depolarization that should be followed by a contraction and cardiac output…used as an emergency measure to provide ventricular pacing until invasive pacing or the heart rate returns back to normal (profound bradycardia or PEA)
Noninvasive Temporary Pacing (NTP)
Which arm does the nurse use for BP during Noninvasive Temporary Pacing (NTP)? And why?
right arm because in the left arm, the pacer might get the wrong reading
Normal HR for Junction Dysrythmias
40 - 60 bpm
type of pacing used for disorders that are not temporary, including complete heart block ,in which the pulse generator is surgically implanted in a subcutaneous pocket…introduced transvenously via the cephalic or the subclavian vein to the endocardium on the right side of the heart.
Permanent Pacemaker
Type of Ventricular Tachycardia that demonstrates a polymorphic ventricular tachycardia with a characteristic illusion of a twisting of the QRS complex around the isoelectric baseline
Torsades
Medications given for SVT:
Cardizem (hung as a drip)
- 1st dose*: 0.25 mg/kg IV over 1-2 min
- 2nd dose 15 min later*: 0.35 mg/kg IV over 2 min
Then, 5-15 mg/hr infusion
Adenosine (closest IV to the heart)
- 1st dose*: 6 mg rapid bolus followed by NS
- 2nd dose 1-2 min later*: 12 mg rapid bolus followed by NS
P waves in Junctional Dysrhythmias are referred to as “_________” P waves.
inverted
Patients with A Fib are at risk for:
Pulmonary Emboli (PE)
Septic Emboli (black fingers/toes)
Embolic Stroke
Symptoms of A Fib
- SOB
- Dizziness, weakness, faintness
- Hypotension
- Dyspnea
- Diaphoresis
- Mild to severe chest pain
- Confusion or disorientation
- Cyanosis
- Decreased urinary output
- Unresponsiveness
For Monophasic Cardioversion, the monitor is set at a rate of
_____ to ___ Joules.
150 - 200
Reccomendation for CPR is _____ compressions/ minute.
120
Dose for Atropine
(used for bradydysrhythmias & Mobitz I AV Block)
0.5 -1.0 mg IV bolus FAST q 3-5 min
Epinephrine Dose
(used for asystole, PEA, idioventricular rhythms, V Tach, V Fib)
1 mg IV bolus followed by 20 ml saline flush
Repeat q 3-5 min
Amiodarone Dose
(used for tachydysrhythmias)
1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)
2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)
Maintenance Infusion:
540 mg IV over 18 hrs
Then, 720 mg/24 hrs
Lidocaine Dose
1 -1 .5 mg/kg IV bolus
0.5-0.75 mg/kg bolus q 5-10 min up to 3 mg/kg (loading dose)
Followed by infusion of 2-4 mg/min
(1 - 2 doses then start drip)
Magnesium Sulfate Dose
1 - 2 gm in 100ml/D5W IV over 1-2 min (normally give over 1 hr)
Then start drip
Corvert Dose
(used for A Flutter)
1 mg IV over 10 min for weight > 60 kg
0.01 mg IV over 10 min for weight < 60 kg
May repeat 10 min later, if necessary
Cardizem Dose
1st dose: 0.25 mg/kg IV over 1-2 min
2nd dose 15 min later: 0.35 mg/kg IV over 2 min
Then, 5-15 mg/hr infusion
