Dysrhythmia qs Flashcards by Eire Bradley

Defibrillation is the treatment of choice for which cardiac rhthym?

pulseless v-tach

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Which waveforms on the ECG is indicative of ventricular repolarization?

t wave

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Which of the waveforms on the ECG is indicative of atrial depolarization?

P wave

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What is the characteristics of sinus Brady?

PR interval between .12-.20 secs
regular rhythm
normal QRS

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Why are rhythms important?

regular rate and rhythm are required to circulate oxygenated blood and life-sustaining nutrients to body organs

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what info is obtained from and EKG rhythm strip analysis?

HR
Rhythm regularity
impulse conduction time intervals

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P wave:

-represents the electrical impulse -starting in the SA node and spreading through the atria, atrial muscle depolarization
-<0.11 secs in duration

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QRS complex:

-represents ventricular muscle depolarization
-1st negative deflection Q wave
-1st negative deflection R wave
-1st negative defelction after the R wave: S wave
-<0.12 seconds in duration

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T wave:

-represents ventricular muscle repolarization
-resting phase
follows the QRS complex

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PR Interval

-measured from the beginning of the P wave to the begging of the QRS complex
-represents time needed for sinus node simulation, atrial depolarization and conduction through the AV node
-0.12-0.20 seconds in duration

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ST Segment:

-represents early ventricular muscle repolarization
-Lasts from the end of the QRS complex to the beginning of the T wave
-normally isoelectric
-analyzed above or below the baseline

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EKG Waveforms:

-a waveform recorded on the EKG strip refers to movement away from the baseline or isoelectric line and is represented in the following manner:
-a positive deflection is above the isoelectric line
-a negative deflection is below the isoelectric line
-as the electrical impulse leaves the SA nodes, waveforms are produced on the graph paper

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How many little boxes in a box?

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How long is one little box?

0.04 secs

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How long is five little boxes?

0.2 secs

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Five step Approach for EKG Interpretation:

1: HR
2: HR rhythm/ regularity
3: P wave
4: PR interval
5: QRS complex

EVALUATE! CAN ONLY DO 1500 METHOD IF A REGULAR SINUS RHYTHM

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Arrthymias/dysthrythmias:

disorders of the formation or conduction of the electrical impulses in the heart

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Why is someone sinus Brady?

-SOB/decreased consciencesness
-angina
-ekg changes
-vomitting
-meds
-H&Ts

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Sinus Brady management:

-withhold meds
-decrease vagal stimulation
-Atropine 0.5 mg IV (vagolytic) HR goes UP
-pacemaker

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why is someone sinus tachycardia?

-exercise
-fear
-MI
-CHF
-fever
-stimulants
-meds
-pain
-infection

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mangagment for sinus tachy:

-beta-blockers
-calcium channel blockers
-increased fluid/sodium
-abolish cause

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atrial flutter:

-in atrium
-creates atrial rate between 250-400times/min
-not all impulses conducted to ventricle: therapeutic block at AV node
-2:1, 3:1, 4:1

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why would someone have A flutter?

-hypoxia
-pulmonary embolism
-pneumonia
-MI
-hyperthyroidism
-cardiac surgery

A flutter management unstable:

cardio version

A flutter management stable:

-beta-blockers/calcium channel blockers -digitalis -Adenosine (6mg max 12mg) basically flatlines and jumpstarts heart

When would you shock a pt?

only in V tach, V fib

A flutter misc:

everytime on an R shock -sedate pt, defibrillator, turn button to cardiovert, shocks on 'r'

A-fib:

rapid, never regular, disorganized and uncoordinated twitching of atrial muscle, parsoysmal or chronic, rapid ventricular response, loss of atrial kick (25-30% of cardiac output) ventricular rate 120-200 bpm

why does a fib happen?

-old age -obesity -heart issues -alch use -excessive caffeine -hypoxia -stress -electrolyte imbalance -pulm embolism

a fib manifestations:

palpations, fatigue, malaise, SOB, very tired, CP

a fib management:

depends on pt, -adenosine, digoxin, calcium channel blockers, beta blockers

Amiodarone protocol:

150mg/10mins drip 400/500 ml 33.5ml/hrs x6 198ml 0.5mg (16.7) until MD discontinues

Premature Atrial complex (skipped beat) PAC:

a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node

why does PAC happen?

-caffeine -alch -nic -anxiety -hypokalemia -hypovolemia -hypermetabolic states -atrial ischemia -injury or infarction

PAC management:

- quit smoking/drinking -reduce stress/stimulants -treat CHF -correcting electrolyte imbalances

premature ventricular complexes (PVC)

impulses thaat start in ventricle and is conducted through the ventricle before the next normal sinus impulse -characterized by a QRS that is wide and bizarre

Bigeminy:

every other complex is a PVC

Trigeminy:

every third complex is a PVC

Quadrigemy;

every fourth complex is a PVC

why do PVCs happen?

-can occur on a healthy pt (intake of caffeine, alc, nicotine) -cardiac ischemia -digitalis toxicity -hypoxia -acidosis -electrolyte imbalance -cardiac Cath

Management of PVC:

-correct cause, medicate w amiodarone, sotalol

AV Nodal reentry tachycardia :

-impulse conduction in the AV node that causes the impulse to be rerouted back into the same area over and over again at a very fast rate -causes very fast ventricular rate -paroxysmal -atrial rate 150-250 -ventricular rate 120-200

manifestations:

restless, chest pain SOB pallor hypotension loss of conscienceness

management:

-aimed at breaking reeentry impulse -vagal maneuvers (carotid sinus massage, gag reflex, breath holding) -adenosine -cardioversion

if there isnt P-waves it can be identified as what?

Supraventricular Tachycardia (SVT)

SVT can be what:

-a fib -a flutter -AV Nodal reentry tachycardia

ventricular tachycardia:

is defined as 3 or more PVCs in a row, MEDICAL EMERGENCY

v tach causes:

large AMI low ejection fraction

v tach management:

12 lead EKG procainamide, amiodarone supportive care cardioversion defibrillation precordial thump ICD IV mag IV amiodarone

v fib:

rapid disorganized ventricular rhythm >300bpm, no atrial activity, unrecognizable QRS

v fib causes:

CAD, MI, untreated VT, electrical shock

v fib manifestations:

fatal dysrhythmia, pulseless, apneic, no cardiac activity, cardiac arrest will occur

v fib management:

CPR, intubate, defibrillation, epinephrine, anti-arrhythmic drugs

asystole:

flatline, absent P and QRS complex, nothing going on, call time of death after 5 mins

asystole management:

CPR, Call code, intubation, establish IV access, epinephrine bolus 3-5 mins, vasopressin