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EKG > Chapter 9 > Flashcards

Chapter 9 Flashcards

1
Q

Ventricular Dysrhythmias

A

Referred to as ventricular escape rhythms. Current is not traveling down the nol ventricular conduction pathway to activate both the R and L ventricles simultaneously, which causes delay to depolarize (contract) the ventricles. Indicated by a QRS measuring 0.12 seconds or longer.

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2
Q

Where are ventricle pacemaker cells found?

A

In the Purkinje fibers (the last natural pacemaker)

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3
Q

Nl rate in Purkinje fibers

A

20-40 bpm

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4
Q

Ventricular rhythms either occur as a result of:

A
  1. Failure of the higher pacemaker sites within the heart or
  2. The rate of automaticity from this portion of the heart is faster, and it takes over as the primary pacemaker within the heart
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5
Q

How to identify ventricular dysrhythmias

A

Missing P waves and “wide and bizarre” QRS complexes that measure 0.12 or greater

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6
Q

Premature Ventricle Complex (PVC)

A

Caused by an ectopic impulse that occurs early in the cycle and originates form the ventricles which causes excitability of the ventricular myocardium

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7
Q

What causes ectopic impulses?

A

By an ischemic region within the ventricles. Ischemia increases excitability of the ventricular myocardium.

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8
Q

Unifocal premature complex

A

Early complex (has similar shape, suggesting only one irritable focus present)

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9
Q

Multifocal premature complex

A

Varied shapes and forms of the PVCs

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10
Q

Interpolated PVC

A

PVC occurs during the normal R-R interval without interrupting the underlying rhythm

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11
Q

Occasional PVC

A

More than one to five PVCs per minute

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12
Q

Frequent PVC

A

Six or more PVCs per minute

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13
Q

Bigeminy PVC

A

Every other complex is a PVC

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14
Q

Trigeminy PVC

A

Every third complex is a PVC

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15
Q

Quadgeminy

A

Every fourth complex is PVC

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16
Q

R on T PVCs

A

PVC occurs on the downslope of the T wave or the vulnerable period of the ventricular refractory period

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17
Q

Coupling PVC

A

Two PVCs that occur back to back

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18
Q

PVC criteria for classification

A

Early QRS complex that measures 0.12 sec or greater and has a wide and bizarre appearance. There is no P wave

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19
Q

Signs and sx’s of PVCs

A

Depend on their frequency and the amount of decrease in cardiac output that occurs with each. My be asymptomatic, others may complain of “thump or skipping” sensation with each PVC, dizziness and other low cardiac output sx’s.

20
Q

Tx for PVCs

A

Observation, oxygen, blood samples taken to evaluate hypoxic state as well as electrolyte values POTASSIUM AND CALCIUM

21
Q

Agonal Rhythm

A

When all of te pacemakers in the heart have failed. This is the last semblance of ordered electrical activity in the heart. The only ventricular impulses are less than 20 bpm. Presents with “wide bizarre” QS complexes and an absence of P waves

22
Q

Agonal rhythm criteria for classification

A

Has an absent P wave, a ventricular rae of less than 20 bpm, and wide and bizarre QRS complexes

23
Q

Signs and sx’s of agonal rhythm

A

Pt has a profound loss of cardiac output due to the loss of atril kick and slow ventricular rate. Pt will be unconscious

24
Q

Tx for agonal rhythm

A

Basic life support and advanced cardiac life support intervention.

25
Idioventricular Rhythm
Occurs when the sinoatrial and junctional pacemakers fail to initiate an impulse and all that is remaining is the slow ventricular pacemaker. Presents with the classic "wide" QRS (0.12 or greater), a slow ventricular rate and an absence of P waves
26
Idioventricular rhythm criteria for classification
Absence of P waves, slow ventricular rate of 10-40 bpm, and wide and bizarre QRS complexes
27
Signs and sx's of idioventricular rhythm
Loss of cardiac output, pt will be unconscious
28
Tx for idioventricular rhythm
Cardiac medication and/or pacing
29
Accelerated idioventricular rhythm
Faster. Same as idioventricular rhythm and idioventricular dysrhythmias only with a faster fate. This dysrhythmia still presents with the classic "wide" QRS (0.12 second or greater) complex and an absence of P waves. The impulse rate is 40 -100 bpm
30
Accelerated idioventricular rhythm criteria for classification
Has an absence of P waves, a ventricular rate of 40-100 bpm, and wide and bizarre QRS complexes
31
Signs and sx's of accelerated idioventricular rhythm
Pt may or may no be able to tolerate this dysrhythmia due to the decrease of cardiac output, may or may not be unconscious
32
Tx for accelerated idioventricular rhythm
Pt may require medications and/or pacing
33
Ventricular Tachycardia
Occurs when three or more PVC's occur in a row and the ventricular rate is greater than 100 bpm, the ventricles are in continuous contraction-relaxation patten, and no period of delay exists between depolarization
34
Ventricular tachycardia criteria for classification
Has wide and bizarre QRS complexes with a classic "sawtooth" appearance, a rate in excess of 100 bpm and no P waves
35
Signs and sx's of ventricular tachycardia
Sx's of decreased cardiac output, may remain conscious or be unresponsive immediately (50% of ppl with no pulse or respiration)
36
Tx for ventricular tachycardia
Blue code when pt is unresponsive then CPR, may need defibrillator, medications, and intubation equipment. If responsive, medications and electrical treatments.
37
Ventricular Fibrillation
Chaotic asynchronous electrical activity within the ventricular tissue. Ventricle walls quiver, due to small isolated portions of the ventricles depolarizing. There is no classic, uniform depolarization causing a true contraction. This prevents any ejection of blood out of the ventricles, no cardiac output. The entire myocardium is quivering.
38
Ventricular fibrillation criteria for classification
Absence of organized electrical activity. The tracing is disorganized or chaotic in appearance.
39
Signs and sx's in ventricular fibrillation
Pt will be unresponsive, call Code blue, may lead to biological death, will always be unconscious, apneic (not breathing), and pulseless.
40
Tx for ventricular fibrillation
CPR, Advanced cardiac life support (ACLS) to regain nl cardiac function.
41
What is crash cart
A cart or try used during emergencies containing medication/equipment at site of medical/surgical emergency for life support
42
Asystole
Absence of ventricular activity and depolarization. This is called "the straight or flat line"
43
Asystole criteria for classification
No waveform, no rate, no P waves, no PR interval, no QRS complexes
44
Signs and sx's of asystole
Pt will display no pulse, no cardiac outpu, unconsciousness, and apnea. Pt is in cardiac arrest
45
Tx for asystole
CPR and advanced cardiac life support

EKG (9 decks)

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