All Cardiac Arrhythmais Flashcards
What are the rules for a wandering pacemaker?
Regularity: slightly irregular
Rate: 60-100
P wave: morphology changes from one complex to the next
PRI: less than .20 second
QRS: less than .12 second
What are the rules for ectopic PAC’s?
Regularity: depends on the underlying rhythm; regularity will be interrupted by the PAC
Rate: depends on underlying rhythm
P wave: p wave of early beat differs from the sinus p waves; can be flattened or notched. May be lost in preceding t wave
PRI: 0.12-0.20 seconds
QRS: less than 0.12 second
What are the rules for atrial tachycardia?
Regularity: regular Rate: 150-250 bpm P wave: atrial p wave, can be lost in T wave PRI: 0.12-0.20 QRS: less than 0.12
What are the rules for atrial flutter?
Regularity: atrial rhythm is regular, ventricular rhythm is usually regular but can be irregular if there is a variable block
Rate: atrial rate 250-350, ventricular varies
P wave: sawtooth pattern
PRI: Unable to determine
QRS: less than 0.12 second
What are the rules for atrial fibrillation?
Regularity: grossly irregular
Rate: atrial rate greater than 350, ventricular varies
P wave: no discernible p waves; atrial activity is referred to as fibrillatory waves
PRI: unable to measure
QRS: less than 0.12 second
What do you do for stable vtach with a pulse (wide QRS)
Drug therapy, amiodarone or lidocaine
What do you do for unstable vtach with a pulse?
Synchronized cardiovert - 100 joules
What do you do for witnessed v-fib?
Chest compressions then defibrillate at 360 joules when ready
What do you do for unwitnessed vfib?
Chest compressions for 2 min before defibrillating
What do you do for stable sinus bradycardia?
Drug therapy - atropine 0.5 mg every 3-5 min
What do you do for unstable sinus bradycardia?
Pace on monitor at 70 bpm and increase milliamps until shows QRS, then check for pulse
What is a normal sinus rhythm with no pulse?
PEA
What do you do for stable SVT?
Attempt vagual maneuver (have patient blow on their thumb like they are trying to blow up a ballon) drug therapy = adenosine
What do you do for unstable SVT?
Cardiovert
What are the characteristics of SVT?
Over 160 bpm, tight QRS complex
What is the first drug you give for clinical death?
Epi 1:10,000 @ 1mg every 3-5 min
What are the rules for atrial tachycardia?
Regularity: regular Rate: 150-250 bpm P wave: atrial p wave, can be lost in T wave PRI: 0.12-0.20 QRS: less than 0.12
What are the rules for atrial flutter?
Regularity: atrial rhythm is regular, ventricular rhythm is usually regular but can be irregular if there is a variable block
Rate: atrial rate 250-350, ventricular varies
P wave: sawtooth pattern
PRI: Unable to determine
QRS: less than 0.12 second
What are the rules for atrial fibrillation?
Regularity: grossly irregular
Rate: atrial rate greater than 350, ventricular varies
P wave: no discernible p waves; atrial activity is referred to as fibrillatory waves
PRI: unable to measure
QRS: less than 0.12 second
What do you do for stable vtach with a pulse (wide QRS)
Drug therapy, amiodarone or lidocaine
What do you do for unstable vtach with a pulse?
Synchronized cardiovert - 100 joules
What do you do for witnessed v-fib?
Chest compressions then defibrillate at 360 joules when ready
What do you do for unwitnessed vfib?
Chest compressions for 2 min before defibrillating
What do you do for stable sinus bradycardia?
Drug therapy - atropine 0.5 mg every 3-5 min
What do you do for unstable sinus bradycardia?
Pace on monitor at 70 bpm and increase milliamps until shows QRS, then check for pulse
What is a normal sinus rhythm with no pulse?
PEA
What do you do for stable SVT?
Attempt vagual maneuver (have patient blow on their thumb like they are trying to blow up a ballon) drug therapy = adenosine
What do you do for unstable SVT?
Cardiovert
What are the characteristics of SVT?
Over 160 bpm, tight QRS complex
What is the first drug you give for clinical death?
Epi 1:10,000 @ 1mg every 3-5 min
What do leads 2,3, and AVF look at?
Left ventricle (inferior wall MI)
What do leads v-1 and v-2 look at?
Septum
What do leads v-3 and v-4 look at?
Anterior
What do leads v-5 and v-6 look at?
Lateral
What does ST elevation indicate?
Heart injury
What does ST depression indicate?
Heart ischemia
What is your treatment for a right sided MI?
Fluid
What is your treatment for a left sided MI?
Nitro
What does the right coronary artery feed?
SA node (60-100)
Why do heart blocks occur?
Result of conduction disturbances in the av node
What is a first degree heart block?
Not a true block, delay at the AV node but each impulse is eventually conducted through to the ventricles. Characterized by a PRI longer than .20 and constant. This will be the only abnormality in the arrhythmia.
What is a key feature of second degree heart blocks?
Not every P wave is followed by a QRS complex
What is the difference between wenckebach and type II second degree block?
The pattern in which the P waves are blocked, concentrate on the PR intervals
What rate is a type II second degree heart block usually?
Bradycardia
What is a key characteristic of type II second degree heart blocks?
Will always have more P waves than QRS complexes. It will be regular or irregular depending on the conduction ratio.
What is a key characteristic of wenckebach second degree heart block?
Increasing long PRI’s followed by a blocked p wave
