Dysrhythmia

Question 1

this is an early rhythm complex that occurs for the next SA impulse

Answer 1

premature complexes

Question 2

PVC/PAC that occurs every other beat / every 2 beats / every 3 beats?

Answer 2

bigeminy , trigeminy, quadrigeminy

Question 3

2 regular beats then PVC or PAC =

Answer 3

trigeminy

Question 4

3 regular beats then PAC PVC =

Answer 4

quadrigeminy

Question 5

sxs of prematures complexes

Answer 5

Palpitations or symptoms of low cardiac output –> check BP

*note: may be asxs as well

Question 6

premature complexes can be generated by other parts of the heart, what do we see when the PAC starts in the atrium?

Answer 6

see P wave that is abnormal, narrow QRS complex

Question 7

premature complexes can be generated by other parts of the heart, what do we see when the PAC starts in the ventricles?

Answer 7

no P wave, wider QRS complex

Question 8

brady dysrthymia = HR < ____

Answer 8

60!

Question 9

concerns with brady-dysrhythmia - what does it to diastole? what are 3 things we are checking in patient to assess their perfusion?

Answer 9

• Prolonged diastole → improved perfusion to heart

OR

• Decreased perfusion to heart if Cardiac Output decreases (low BP)
◦ check BP! to determine if CO is poor perfusion
◦ check LOC
◦ check urine output

Question 10

tachy dysrhythmia = HR >_____

Answer 10

100!

Question 11

what does tachy-dysthymia do to diastole? what do we need to assess?

Answer 11

• Shortens diastole –> heart itself doesn’t get as much O2
• Increased work of heart (heart needs more O2)
◦ uses too much energy
• get BP - low from decrease stroke volume

Question 12

what will BP be with tach and brady dysthrhytmia

Answer 12

low if poor perfusion

Question 13

causes of sinus tachy

Answer 13

• Anxiety, Pain, Fever, Hypoxia, Anemia, Drugs
• May be compensatory

Question 14

sinus brady s/s

Answer 14

• Low BP, Confusion, SHOB, chest pain, dizzy, syncope

Question 15

who might naturally have a low HR?

Answer 15

arthletes

Question 16

is sinus brady always bad?

Answer 16

has therapeutic benefit of reducing myocardial O2 demand and allws for increased perfusion time

Question 17

when do we use pacing- HR too slow or HR too fast?

Answer 17

hr too slow! –> patient not perfusing

Question 18

type of pacing =

◦ Two large electrodes (Pads)
◦ Stimulates ventricular depolarization
◦ Emergency

Answer 18

• Temporary Transcutaneous Pacing

Question 19

type of pacing: Lead Wires are threaded to right atrium of heart

=

Answer 19

• Transvenous Pacing

Question 20

type of pacing- pacemaker Placed in SubQ pocket =

Answer 20

permanent pacemaker

Question 21

pacemakers can pace different parts of the heart -

◦ Atrial (Sick Sinus) - initiates p wave
◦ Ventricular
◦ Biventricular (Heart failure)

the take home from this is you need to know….

Answer 21

what your patient is pacing

Question 22

wtf are pacer spikes?

Answer 22

= initiates something to happen in the heart

Question 23

3 types of atrial dysrthymias

Answer 23

• Premature Atrial Complexes (see above)
• Supraventricular Tachycardia
• Atrial Fibrillation

Question 24

this type of dysrhythmia =
• Rapid stimulation of atrial tissue
• 100 bpm to 280 bpm
- No visible P wave

Answer 24

Supraventricular Tachycardia (SVT)

Question 25

what is • Paroxysmal Supraventricular Tachycardia

Answer 25

short run of SVT and got back to normal

Question 26

interventions for SVT

Answer 26

- take BP -identify cause -Vagal maneuver -Adenosine (6mg, 12mg, 12mg) -Fluids - BB, CCB -Cardioversion (= synchronous shock)

Question 27

adenosine protocol for SVT?

Answer 27

◦ causes period of asystole. ◦ feels like you are getting kicked in the chest ◦ Give 6 then 20 cc fluid, 12 then 12 if needed

Question 28

cardiovert or defib SVT?

Answer 28

cardiovert --> synchronous

Question 29

Atrial fibrilation- what are the main causes?

Answer 29

Related to atrial fibrosis and muscle mass ◦ Hypertension ◦ Heart Failure ◦ CAD

Question 30

this dysrhythmia = irritable atria, multiple rapid impulses depolarizing the atria causing decreased CO and NO P WAVE

Answer 30

atrial fibrillation

Question 31

do you see a P wave with A fib?

Answer 31

no P wave on afib

Question 32

A Fib interventions

Answer 32

- O2 -decrease anxiety -Meds (dilt (drip) + amiodoarone (drip) + anticoag) -Cardioversion (synchronized) -Ablation

Question 33

type of dysrhytmia with HR of 140-180 fired from ventricles

Answer 33

V tach

Question 34

risk factors for V tach

Answer 34

◦ Myocardial Ischemia ◦ Cardiomyopathy ◦ Low K+ ◦ Drugs ◦ Shock

Question 35

V tach + pulse = vs V tach + no pulse =

Answer 35

V tach + pulse = check BP , cardioversion, ablation (stable enough) V tach + no pulse = defibrillate, Antidysrhythmic (Amiodarone)

Question 36

type of dysrhythmia with electrical chaos is ventricles meaning the ventricles can't contract =

Answer 36

v fib

Question 37

V fib is chill or not chill?

Answer 37

EMERGENCY, not okay, not chill -- no blood perfusing to body

Question 38

V fib risk factors

Answer 38

• CAD • MI • Low K+ • Low Mg • Surgery, Procedure • Trauma

Question 39

interventions fr V fib =

Answer 39

defibrilate CPR • Antidysrhythmic

Question 40

you have a person in V fib and you shock their ass. Are they gonna be cool now?

Answer 40

must fix underlying cause--- can go back into v fib after you defibrillate

Question 41

type of dysrthymia with no impulses being conducted in the ventricle leading to no cardiac output =

Answer 41

ventricular asystole

Question 42

ventricular aystole is a _____ rhythm

Answer 42

terminal

Question 43

interventions for ventricular asystole

Answer 43

CPR, ventilate, epinephrine

Question 44

type of defibrillator: ◦ Emergency ( have in pyblic places) ◦ BLS

Answer 44

• Automated External Defibrillator

Question 45

type of defibrillator: ◦ Similar to pacemaker ◦ Patient remains on an antidysrhythmia

Answer 45

• Implantable Cardioverter/ Defibrillator

Question 46

type of defibrillator ◦ Vest worn at all times other than bathing ◦ Ability to prevent shock

Answer 46

• Wearable Cardioverter Defibrillator

Question 47

3 types of defibrillators

Answer 47

-AED -Implantable -Wearable

Question 48

dysrhythmias are typically the result of another.....

Answer 48

pathology or disease state so we have to treat that!