Arrhythmias and Treatments Flashcards
Bradycardia
Rate below 60
Treat if symptomatic
discontinue offending medications
atropine
pacing
dopamine
atrial kick
The electrical stimulation of the muscle cells of the atria causes them to contract. The structure of the AV node slows the electrical impulse, giving the atria time to contract and fill the ventricles with blood. This part of atrial contraction is frequently referred to as the atrial kick and accounts for nearly one third of the volume ejected during ventricular contraction
Tachycardia
Rate over 100
Treat if symptomatic- underlying cause which could be a wide range of things
Beta blockers
Supraventricular tachycardia
Vagal Maneuvers, Adenosine ( 6 mg then 12 mg fast)
Calcium Channel Blockers or beta blockers
Cardioversion if hemodynamically unstable
hemodynamically unstable
Adenosine Administration for SVT
slows cardiac conduction through the AV node and interrupts reentry pathways.
given by rapid IV bolus
6 mg over 1-3 seconds followed by a 20 mL NS bolus, followed by 12 mg dose
What is the common side effect after the adenosine bolus?
Patient will briefly go into asystole
Atrial fibrillation and atrial Flutter
Rate control
Anticoagulation
Rhythm conversion
Meds
Cardioversion
Ablation
Antiarrhythmics
• diltiazem
• digoxin
• amiodarone
• sotalol
• metoprolol)
First degree heart blocks
2nd degree type I
Commonly temporary,
may resolve on own.
• Less severe of the 2nd
degrees.
• Discontinue offending
medications.
• Treat symptomatic
bradycardia with atropine
and/or pacing
2nd degree Type II
Serious business » CHB or asystole
Often 2° MI
External pacing
Transvenous pacing
Permanent pacer
Dopamine for symptomatic hypotension
Atropine ineffective
3rd Degree Heart Block
May lead to asystole, especially with wide
QRS’s.
• Pace it, permanently if not resolved
Junctional arrhythmias
Often bradycardic
Atropine
Dopamine
Pacing
Underlying cause (dig toxicity,
hypoxia, inferior MI
ventricular tachycardia (stable)
Amiodarone
bolus and drip
• Cardioversion
Ventricular tachycardia (unstable w/pulse)
Unstable with pulse
• Cardiovert
• Amiodarone drip
• AICD
• Ablation
Underlying cause
Torsades de pointes (TdP)
Polymorphic
ventricular
tachycardia
• Defibrillate
(synchronized cdv
often not possible)
• Underlying cause
• Magnesium
• Potassium
Ventricular Fibrillation and Pulseless VTach
Defibrillation is the
immediate treatment goal
Follow defib with . . .
Epinephrine and
chest compressions
300mg amiodarone
push
Repeat as
necessary
Pulseless electrical activity
Looks like a decent rhythm, isn’t.
Will degrade to asystole.
Chest compressions.
Epinephrine 1mg every 3-5 minutes.
Repeat.
Nothing to shock. Underlying cause
Asystole
Treatment same as PEA: CPR, epi • Poor prognosis • Underlying cause
Abnormal Potassium (K+) and ECG changes
Hypokalemia:
U waves (best seen in
precordial leads)
• Arrhythmias: PVCs,
polymorphic VT, VF
• Sx: muscle cramps,
weakness, leading to
paralysis
Abnormal Potassium (K+) and ECG changes
Hyperkalemia:
Arrhythmias: bradycardia
and blocks
• Sx: heart palpitations, SOB,
chest pain, or N/V
Synchronized Cardioversion
Typically start with lower energy
(despite what the video states,
although depends on HCP)
• Sedation
• Synchronized*
• Goal: reset the heart to NSR
Defibrillatiion
Higher energy
• High quality CPR and ACLS meds
in between shocks
• Goal: Reset the heart to NSR
and return of spontaneous
circulation (ROSC)
Pacing
Temporary pacing
Transcutaneous
Transvenous
Epicardial
Single chamber – common with temporary
pacing
Increase mA to ~10% beyond capture
Set rate (often 80
Permanent Pacemaker
Dual chamber – more common in permanent
pacers
Common Pacemaker Malfunctions
• Failure to capture
• Failure to sense
• Battery failure
Postpacer/AICD Teaching
Keep arm below
head for two weeks
Avoid large magnets
No TSA wands
Monitor s/s infection
Medical bracelet
How can you tell a fib from Sinus Tach, junctional tach, SVT and Vtach, at a glance??
Atrial fibrillation is IRREGULAR
Treatment of Afib and Aflutter
Is the patient symptomatic? What does that mean to you?
Patient may c/o dizziness, feeling faint, SOB, low BP, High HR, mental status changes
Atrial fibrillation with RVR…what does that mean?
Rapid ventricular response
So the goal: rate control, anticoagulation, and rhythm control
What is an important consideration for treatment of new onset afib and aflutter?
Time of onset, if greater than 48 hours or unknown, client will need to anticoagulated and/or TEE, in case there is a thrombus sitting in the atrium.
Because what could happen if you cardiovert someone with a thrombus?
Could dislodge thrombus and cause emboli…already at high risk for stroke with a fib
Let’s say you are working in the ed………….
You put a client on the monitor and without really examining the strip you can see the HR is 42 and patient is c/o being dizzy, slightly confused.
What is a safe practice you could automatically do without an order?
Apply transcutaneous pacer pads
What drug may you anticipate being given and why?
Atropine for sinus brady. Need to increase the heart rate.
Second-degree HB, type II Why?
constant PRI, but there are dropped QRS. Concerned this might progress to CHB.
Atropine
Increases heart rate
Used for?
sinus bradycardia, first-degree AV block, second-degree AV block, type 1
NOT with…
second-degree block, type 2 and CHB
Adenosine
Decreases heart rate
Used for?
stable SVT
Synchronized Cardioversion
Start with lower energy
Sedation
Synchronized button*
Goal: reset the heart to NSR
Used for unstable afib, aflutter, vtach with a pulse
*synchronized means shock delivered on specific point on QRS. Want to avoid T-wave (ventricular repolarization) because it can induce vfib
Defibrillation
Higher energy
High quality CPR and ACLS meds in between shocks
Goal: Return of spontaneous circulation (ROSC)
Used for pulseless vtach, vfib, torsades
