Dysrhythmias Flashcards
What indicated MIs?
ST is elevated (ST segment is usually on the baseline)
ST is depressed
Treatment for bradycardia
Only tx if symptomatic Atropine 0.5-1mg IVP Epi 2-10 mcg/min Transcutaneous pacemaker Dopamine 5-20 mcg/kg/min
Treatment for Tachycardia
Treat underlying cause (fever, anxiety, hypovolemia, CHF, pain)
Tx goal for Aflutter?
Aimed at decreasing HR and ventricular response since rapid HR decreases ventricular filling and CO
Medications used to tx aflutter
Digitalis
Diltiazem/Verapamil (Ca channel blockers) - AV block and decreases conduction through the AV node, thus decreases ventricular rate
Complication of Afib
Thrombi formation in atria due to dilated state of the atria and stagnation of blood in the atria
May take ASA or coumadin
Tx for Afib
Amiodarone
Diltiazem/ Verapamil (Ca Channel blockers)
Digitalis - blocks AV node conduction to allow more time for ventricular filling
Synchronized cardioversion
Characteristics of SVT
HR > 150 bpm
S/S of SVT
Dizziness Palpitations Chest Pain SOB/Dyspnea Syncope (temporary loss of consciousness) Hypotension
Tx of SVT
Vagal maneuvers If symptomatic: Adenosine 6mg IVP, if no change adenosine 12mg IVP Ca Channel blockers B-blokers Amiodarone Synchronized cardioversion
Long-term tx for SVT
Avoid caffeine, smocking, stimulants(drugs)
Digoxin, Ca channel blockers, B-blockers
Radio frequency ablation treatment
Characteristics of First Degree AV block
PR interval > 0.20sec (each complex looks the same)
1:1 P to QRS ration
Causes of First Degree AV block
Digoxin Toxicity
B-blockers
CAD
Tx of First Degree AV block
Monitor
check serum levels
Characteristics of Second Degree AV block Type 1
Progressive lengthening of PR interval until a QRS complex is missed
Causes of Second Degree AV block Type 1
Any drug or disease affecting AV node
Myocarditis
MI
Tx of Second Degree AV block Type 1
Monitor signs of decreased CO and signs of progressive block
Characteristics of Second Degree AV block Type 2
Occurs usually below AV node, usually bundle branches;
PR interval may be > 0.20sec or normal but not progressive in length.
Misse QRS complexes after P wave
QRS greater then 0.10sec if BBB (bundle branch block): 0.11 sec is incomplete BBB, 0.12sec is complete BBB
Causes of Second Degree AV block Type 2
Anterior MI
Fibrotic disease of conduction system
Tx of Second Degree AV block Type 2
Watch for S/S of complete heart block
Cardiac monitoring
Transcutaneous Pacemaker
Characteristics of Third Degree AV block (Complete Heart Block)
P wave is not related to QRS (Shark Fan appearance)
No arterial impulses are conducted to the ventricles
Block occurs at AV node, bundle of His, or bundle branches.
Atria and Ventricle beat independently of each other
Tx of Third Degree AV block
Transcutaneous Pacemaker
Dopamine
Epi
Schedule OR for permanent pacemaker
Characteristics of Premature Ventricular Contractions (PVC)
A beat that occurs anywhere in the ventricle prior to the time of the expected beat.
Rate is irregular
QRS > 0.10sec
No P wave
Followed by a compensatory pause
ST segment of PV is in the opposite direction of the QRS
Tx of PVCs
Check electrolytes (K ang Mg) #1 Tx Mg #2 Tx Amiodarone If there are more than 6 PVCs per minute may bolus with Lidocaine 1mg/kg followed by continuous infusion of lidocaine 2-4mg/min or Amiodarone.
Tx of Ventricular Tachycardia
Stable Pt: O2, Amiodarone, if meds don’t work cardioversion
Unstable Pt: Cardioversion
Pt with NO pulse need to be treated as VF and defibrillate immediately
Tx of Ventricular Fibrillation
Defibrillate immediately
Follow ACLS protocol
Tx of Asystole
CPR
Intubation
Epi 1mg IVP
Explain Pulseless Electrical Activity (PEA) and the treatment
A rhythm on the monitor but no pulse
Tx same as asystole
Look for underlying causes H’s and T’s
