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Module 1 > Arrhythmia Treatment > Flashcards

Arrhythmia Treatment Flashcards

1
Q

Assorted Arrhythmias

A

Bradycardia
Tachycardia
SVT
Atrial fib
Atrial flutter
Heart Blocks
Junctional Rhythms
Vtach
Vfib
PEA
Asystole

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2
Q

AV node saves lives!

A

Delays signal – “atrial kick”

Back-up pacemaker

Filters in presence of excessive rate

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3
Q

The “gatekeeper”
What represents the delay in the AV node? What is the significance of that delay?

A

PR interval. Allows for atrial kick (extra 25 % of blood)

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4
Q

Bradycardia

A

Rate below 60

Treat if symptomatic (altered mental status, cool/clammy, SHOB, ect.)

Discontinue offending medications (beta blockers, CCB, Digoxen)

Atropine- affects SA node increases rate-ventricular rate

Pacing

Dopamine- vasopressor, increases BP

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5
Q

Tachycardia

A

Rate over 100

Treat if symptomatic

Underlying cause (wide range of these)

Beta blockers

Treat if symptomatic– treat cause- pain meds for pain, fluids for volume depletion, ect.
Try vagal first!!!! Cough

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6
Q

If they are unstable tachycardia:

A

synchronized cardioversion!

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7
Q

Umbrella term often used for any tachycardia above the ventricles
How to treat?

A

SVTSupraventricular tachycardia

Vagal maneuvers -cough, bear down, cool water, gag reflex, ect.
Adenosine- 6mg then 12 mg fast
Ca channel blockers or beta blockers
Cardioversion if hemodynamically unstable and refactory to meds

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8
Q

What does hemodynamically unstable mean?

A

not adequate BP or HR

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9
Q

_____ Administration for SVT

____ cardiac conduction through the AV node and interrupts reentry pathways

Given by ____ IV bolus

6 mg over 1-3 seconds followed by a 20 mL NS bolus; followed by 12 mg dose

A

Adenosine

Slows

RAPID

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10
Q

Pharmacological or “chemical” conversion for SVT

What is a common initial side effect after the bolus?

A

Adenosine

Flat line.

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11
Q

Atrial fibrillation & atrial flutter

A

Rate control- beta blockers, digioxen, CCB (digoxin)

Anticoagulation- Heparin (PTT), Warfarin (PT INR). To prevent PE of strokes.

Rhythm conversion
-Meds - amniodarone
-Cardioversion- if unstable they will be cardioverted. If not, and greater then 48 hours- they will perform TEE before cardioverting.
-Ablation

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12
Q

What is the difference between paroxysmal, persistent, and permanent a. fib?

A

paroxysmal AF (PAF: episodes of arrhythmia that terminate spontaneously),

persistent AF (episodes that continue for >7 days and are not self-terminating),

permanent AF (ongoing long-term episodes

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13
Q

Why is time of onset an important consideration for treatment of afib or aflutter? For example, what should happen if the time of onset of a fib is >48 hrs?

A
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14
Q

What does RVR mean? What does it mean for the patient clinically?

A

Rapid ventricular rate (above 100). This is the same as Uncontrolled A. Fib.

Rate control- beta blockers, digioxen, CCB (digoxin)

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15
Q

Antiarrhythmics

A

diltiazem
digoxin
amiodarone
sotalol
metoprolol
atropine

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16
Q

What is the concern of a prolonged QT interval which may occur with sotalol?

Best practice, document QT q shift for meds that potentially prolong the QT.

Remember, QT:

A

the depolarization and repolarization of ventricles.

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17
Q

Diltiazem-

A

antiarrhythmic, calcium channel blocker. Vasodilators.

Watch blood pressure.

SVTs, A. fib, A. flutter with RVR.

Main side effect- hypotension, bradycardia. Take blood pressure an pulse before using. Contriindicated for hypotension.

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18
Q

Digoxin-

A

cardiac glycoside. Increases force of contraction. A. Fib, A. flutter, PAT. Digitalis- N/V, blurred vision, anorexia. Use cautiously with hypokalemia. Apical pulse before giving. Check Digoxin level.

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19
Q

Amiodarone-

Can cause:

A

antiarrhythmic. Used for A. fib, A. flutter, V. Tach, V. Fib.

Can cause pulmonary toxicity.

May make arrhythmia worse (proarrhythmic)

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20
Q

Sotalol-

A

Measure QT interval

beta blocker/antiarrhythmic. Suppresses arrythmia. Side effect- bradycardia. Proarrhythmic (measure QT interval). Used for Ventricular arrythmias.

21
Q

Atropine-

A

anticholinergic, antiarrhythmic.

Increases HR. Blocks parasympathetic.

Not used for second degree type II or 3rd degree Heart block. Used for Sinus brady and second degree type I.

22
Q

First degree heart block treatment

A

No treatment

23
Q

2nd Degree Type I

Commonly temporary, may resolve on own.

Less severe of the 2nd degrees.

Discontinue _______

Treat symptomatic bradycardia with __________

A

offending medications.- metoprolol

atropine and/or pacing.

24
Q

2nd Degree Type II

Serious business » CHB or asystole

Often 2° MI

-
_____ for symptomatic hypotension

_____ ineffective

A

External pacing
Transvenous pacing
Permanent pacer

Dopamine

Atropine

25
Q

3rd Degree Heart Block

May lead to _____, especially with wide QRS’s.

_____, permanently if not resolved.

A

asystole

Pace it

26
Q

Junctional arrhythmias

Often bradycardic

Treatment?

A

Atropine
Dopamine
Pacing
Underlying cause (dig toxicity, hypoxia, inferior MI)

27
Q

What is the rate difference with:
1. junctional rhythm =
2. accelerated junctional tachycardia =
3. junctional tachycardia =

A

40-60

60-100

> 100

28
Q

Ventricular Tachycardia (Stable)

VT=

A

Amiodarone bolus and drip

Cardioversion

three or more PVCs in a row

29
Q

Ventricular Tachycardia (Unstable)
unstable with a pulse

A

Cardiovert
Amiodarone drip
AICD - automated implantable defibrillator
Ablation
Underlying cause

30
Q

Note the treatment difference between stable and unstable vtach

____ first with unstable
_____ first with stable

A

Cardiovert

Amiodarone

31
Q

Polymorphic ventricular tachycardia
Defibrillate (synchronized cdv often not possible)
Underlying cause
Magnesium
Potassium

A

Torsades de pointes (TdP)

32
Q

What meds can cause a prolonged QT interval preceding TdP?

A

Sotalol and amniodarone cause prolonged QT interval.

33
Q

Ventricular Fibrillation and Pulseless Vtach

A

You, grab the defibrillator (or AED if out of hospital)”

Defibrillation is the immediate treatment goal.

Most common cause of MI. Most common arrhythmia for going into cardiac arrest.

34
Q

Ventricular fibrillation and pulseless ventricular tachycardia treatment continued

Follow defib with . .

A

Epinephrine and chest compressions

300mg amiodarone push

Repeat as necessary

35
Q

What is the underlying cause?

H’s and T’s

major contributing factors to pulseless arrest including PEA, Asystole, Ventricular Fibrillation, and Ventricular Tachycardia. These H’s and T’s will most commonly be associated with PEA, but they will help direct your search for underlying causes to any of arrhythmias associated with ACLS.

A

Hypovolemia
Hypoxia
H+ ion (acidosis)
Hypo/hyperkalemia
Hypoglycemia
Hypothermia

Toxins (meds, poison)
Tamponade
Tension pneumo
Thrombosis (heart or lungs)
Trauma

36
Q

Pulseless Electrical Activity (PEA)

Looks like a decent rhythm but isn’t

Remember for PEA: “you can see me, but you can’t feel me”

Will degrade to _____

How to treat?

A

asystole

Chest compressions
Epinephrine 1 mg every 3-5 minutes
Repeat

NOTHING TO SHOCK.

Look for underlying causes– MI, Hemorrhage, H’s and T’s

37
Q

Asystole

Treatment same as PEA: ____
Poor prognosis
Underlying cause

A

CPR, epi

38
Q

Abnormal potassium (K+) and EKG changes

Hypokalemia

___ present

Arrhythmias:

Sx:

SEE SLIDE!!!!!!

A

U waves (best seen in precordial leads)

Arrhythmias:
PVCs, polymorphic VT, VF

Sx: muscle cramps, weakness, leading to paralysis

T wave inversion
ST depression
Prominent U wave

39
Q

Hyperkalemia

Arrhythmias:

Sx:

See slide!!!

A

Arrhythmias: bradycardia and blocks

Sx: heart palpitations, SOB, chest pain, or N/V

Peaked T waves
P wave flattening
PR prolongation
Wide QRS complex

40
Q

Synchronized Cardioversion

Typically start with ___ energy

Sedation

Synchronized*

Goal:

A

lower

reset the heart to NSR

41
Q

Defibrillation

_____ energy

High quality ____ and _____ in between shocks

Goal:

A

Higher

CPR

ACLS meds

Reset the heart to NSR and return of spontaneous circulation (ROSC)

42
Q

Synchronized cardioversionis a ____ ENERGY SHOCK that uses a sensor to deliver electricity that is synchronized with the ____ of the QRS complex (the highest point of the R-wave).

When the “sync” option is engaged on a defibrillator and the shock button pushed, there will be a delay in the shock. During this delay, the machine reads and synchronizes with the patients ECG rhythm. This occurs so that the shock can be delivered with or just after the _______ in the patients QRS complex.

WHY?

A

LOW

peak

peak of the R-wave

If not, if could cause patient to go into V. Tach

43
Q

Which rhythms?

Syncronized cardiovert-

Defib-

A

A. Fib, A. Flutter, Pulse V. Tach, SVT

Pulseless v. Tach, V. Fib.

44
Q

Pacing

-
-

– common with temporary pacing

Increase mA to ~10% beyond capture

Set rate (often 80)

_____ with transcutaneous pacing

A

Transcutaneous
Transvenous
Epicardial

Single chamber

Sedation

45
Q

Permanent Pacemakers

______ – more common in permanent pacers

What is an important question to ask your patient who comes in with a pacemaker?

A

dual chamber

What is your pacemaker code?

46
Q

Common Pacemaker Malfunctions

A

Failure to capture- complex does not follow pacing spike

Failure to sense
Undersensing—pacing spike occurs at preset interval despite the patient’s intrinsic rhythm
Oversensing—loss of pacing artifact; pacing does not occur at preset interval despite the lack of intrinsic rhythm

Battery failure

47
Q

Implantable Cardioverter Defibrillator

Detects and terminates life-threatening episodes of:

Complications like those associated with pacemaker insertion:

What are the implications for a patient whose ICD is firing several times in a day?

A

ventricular tachycardia or ventricular fibrillation

In the initial hours after a temporary or permanent pacemaker is inserted, the most common complication is dislodgment of the pacing electrode. Minimizing patient activity can help prevent this complication. If a temporary electrode is in place, the extremity through which the catheter has been advanced is immobilized. With a permanent pacemaker, the patient is instructed initially to restrict activity on the side of the implantation.

Maybe they need to go off a drug they are prescribed.

48
Q

Some Postpacer/AICD Teaching

A

Keep arm below head for two weeks
Avoid large magnets
No TSA wands
Monitor s/s infection
Medical bracelet

Module 1 (11 decks)

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