Critical Care: Test 2: EKG/treatment part 2 Flashcards
Which types of PVC’s are worrisome?
1) Paired or Coupled PVC (couplet)
2) Multi-focal PVC’s
3) Run of PVC’s (5 or more in a row)
4) Patient is symptomatic (hypoxic s/s) with PVC’s (trumps what they look like)
5) R on T phenomenon (may trigger V-tach or V-fib) (when the QRS isn’t able to finish before T comes)
Rhythm, Rate, P waves, PRI, and QRS for PVC (Premature Ventricular Contraction):
Rhythm: Underlying rhythm normal–with a premature beat
Rate: Determined by underlying rhythm
P waves: Normal for underlying rhythm; if P seen with PVC it is not responsible for causing that beat
PRI: normal for underlying rhythm
QRS: Normal for underlying rhythm; >0.12 for PVC—will look wide and bizarre with T wave in opposite direction of QRS
- First determine underlying rhythm
- When you see more than one PVC, you have to address morphology (Unifocal=constant morphology–look alike; Multifocal=variable morphology–look different; Bigemeny=normal beats: PVC’s = 1:1 (ie. N-V-N-V-N); Trigemeny=normal beats:PVC’s=2:1 (ie. N-N-V-N-N-V)
*This rhythm will show a compensatory pause with PVC’s (doesn’t with PAC & PJC)
Can lead to V-tach
Treatment of PVC’s:
Use Amiodarone or Lidocaine (calm ventricles; want to see decrease in PVC’s).
O2
Identify the cause, then treat the PVC on the basis of the cause.
CTM
Rhythm, Rate, P waves, PRI, and QRS for T-tach:
Rhythm: Regular Rate: 100-200 or higher P waves: None PRI: None QRS: Wide and bizarre
***Life-threatening- check BP, pulse, LOC
Treatment for V-tach:
with Pulse and BP: CTM, Potential Lidocaine or Amiodarone, Cardioversion
NO Pulse & BP: Call Code, Start CPR, Prepare to Defibrillate
Rhythm, Rate, P waves, PRI, and QRS for V-Fib:
Rhythm: Irregular
P, QRS, T cannot be determined
Electrical Activity chaotic/waveforms vary in shape/size
Rate: Not measurable
Described as either “Course” or “Fine”
- Can’t measure anything–put dashes for everything on test**
- *Equivalent to cardiac standstill–no cardiac output! Patient is pulseless and unconscious!
Treatment for V-Fib (VF):
Call code, start CPR, prepare to defibrillate
Rhythm, Rate, P waves, PRI, and QRS for Idioventricular or Ventricular Escape (aka Agonal Rhythm):
Rhythm: Starts regular then becomes irregular
Rate: <40 (remember ventricular rate is 20-40)
P wave: None
PRI: None
QRS: >0.12
Classic look: R wave in opposite direction of T wave*
Ventricular pacemaker has taken over in absence of SA/AV nodes
Emergency rhythm!!***
Some Cardiac Output
Treatment for Idioventricular or Ventricular Escape (aka Agonal Rhythm):
Atropine
May pace it
Rhythm, Rate, P waves, PRI, and QRS for Accelerated Idioventricular:
Same as Idioventricular or Ventricular Escape (Agonal Rhythm), except that HR is 40-100
Rhythm: Starts regular then becomes irregular Rate: 40-100 P wave: None PRI: None QRS: >0.12
- T wave in opposite direction of R= Classic Look**
- Emergency Rhythm**
Rhythm, Rate, P waves, PRI, and QRS for Pulseless Electrical Activity (PEA):
Rhythm: Starts regular then becomes irregular
Rate: 20-40 (can be >40)
P wave: Typically none
Rhythm present with no corresponding pulse. Electrical activity present but no muscle activity. Always check your patient’s BP/HR, even with normal rhythm.
*Treated as asystole
Treatment for PEA (Pulseless Electrical Activity):
Call code, start CPR, prepare to give epinephrine/atropine
Complete absence of electrical activity; straight line on EKG =
Asystole
Treatment for Asystole:
Confirm it in a 2nd lead Call Code Start CPR Epinephrine/atropine You DON'T shock Asystole (if they do, they either don't know what they are doing or they may think that it's a Fine V-Fib)
Rhythm, Rate, P waves, PRI, and QRS for 1st Degree Heart Block:
Rhythm: Regular Rate: 60-100 P waves: Present, uniform, 1 present for every QRS PRI: >.20 *** QRS: 0.04-0.12
Difference is increased PR interval***
