Dysrhythmias Flashcards
what is PVC?
PVC - premature ventricular contractions -ectopic beat/impulse from inside ventricles BUT underlying rhythm is NORMAL
what does PVC look like on an EKG strip?
PVC = QRS complexes that appear WIDE & IRREGULAR -unifocal = uniform, QRS complex deformities look similar -multifocal = not uniform, QRS complex deformities differ throughout
is PCV dangerous?
PCV is generally harmless, most of the time!
what causes PCV?!
-ventricular/heart muscle irritability -ischemia -hypoxia -caffeine, stress, anxiety, smoking -reperfusion after stent placement -HYPOKALEMIA (electrolyte imbalances) -HYPOMAGNESEMIA -infection, trauma, surgery -increased risk for w/ increased age
what kind of effects does PVC have on the body?
-asymptomatic/unknown issues **increased levels of PVCs > increased risk of palpitations -dizziness **chest pain -decrease/absence of pulse -3+ PVCs = V-TACH ***PVCs may OR may not perfuse, check pulses to ensure perfusion
what are the treatment options for PVC?
**notify the physician -replace electrolytes (if HYPOkalemia or HYPOmagnesemia) -apply oxygen if needed ***USE MEDICATION LIKE: LIDOCAINE or AMIODARONE -reduce stress or caffeine
why AMIODARONE if PVC?
amiodarone delays rate at which hearts electrical system recharges after repolarization = slowing of speed of conduction in the heart > reduces hearts ability to produce electrical impulses
WHY LIDOCAINE if PVC?
lidocaine reduces irritability in the ventricles of the heart!
what is PAC?
PAC - premature atrial contraction -ectopic beat/impulse from inside the atrium **P WAVE comes sooner + appears distorted
is PAC dangerous?
NO, this is not as concerning as PVC may be
what happens with the AV node in PAC?
1) AV node might stop impulse, or not conduct at all 2) AV node might hold onto it a little longer, **LONGER PR INTERVAL 3) AV node might have completely normal impulse
what can cause PAC?
**EMOTIONAL/PHYSICAL STRESS -caffeine, tobacco, alcohol use -hypoxia -electrolyte imbalance -hyperthyroidism -COPD -CAD -heart disease
what does PAC look like on EKG strip?
P WAVE + T WAVE are combined; not concerning
what does PAC feel like; S/S?
**PALPITATIONS; can eventually lead to SVT
how do you treat PAC?
1) treat the SYMPTOMS 2) stop using alcohol, tobacco, caffeine products 3) utilize beta blockers = minimize PACs occurrences
what is SVT?
SVT - supraventricular tachycardia -ectopic beat ABOVE BOH; can be triggered by PAC **HR - 150-220 BPM
What does SVT look like on EKG strip?
**SHORT PR INTERVAL **NORMAL QRS
what does SVT do to your patient?
-decreased CO **CHEST PAIN **SOB -palpitations -HYPOtension
what is the treatment for SVT?
1)vagal maneuver (jump start getting back into normal rhythm) 2) adenosine > QUICK followed by QUICK NS FLUSH 3) IV medication: CCB, BB, amiodarone 4) synchron cardiovert
What is A-FIB?
A-FIB = atrial fibrillation; R > R intervals = IRREGULAR; NO P WAVE
A-FIB - atrial fibrillation
**COMMON -NO P WAVE > no contraction -NO ARTIAL KICK **irregular R>R intervals —blood pools and clots start to form **reduced cardiac output + HYPOtension
What is atrial flutter?
***NOT as common as A-FIB; contains regular R>R interval ratio -rapid atrial depolarization via SAW TOOTH P WAVES > 4 to 1 ratio; treated same as A-FIB
what are considered lethal arrhythmias?
-ventricular tachycardia -ventricular fibrillation -asystole (PEA - pulseless electrical activity; heart pumps but NO pulse present)
what is VENTRICULAR TACHYCARDIA?
***BPM = 150-220 BPM; patient CAN or CANNOT have pulse, depends on situation
what does VENTRICULAR TACHYCARDIA tend to occur before?
VENTRICULAR TACHYCARDIA often occurs before VENTRICULAR FIBRILLATION
what does V-TACH look like on EKG strips?
**very WIDE QRS complex **NO P WAVE -looks like a tombstone on EKG strip –monomorphic - one shape, looks same throughout
what is the difference between V-TACH w/ PULSE vs PULSELESS
w/ pulse - -awake + talking > asymptomatic -does not last long -slower rates (closer to 150) = more tolerable -GIVE OXYGEN **NEED 12 LEAD EKG -give medications as needed PULSELESS = CODE STATUS = EMERGENT; —unstable w/ pulse = cardiovert
what is CARDIOVERSION?
CARDIOVERSION is used to restore normal heart rhythm in patients experiencing dysrhythmias!
can you use CARDIOVERSION on a patient that has a signed DNR?
you can; BUT only as treatment; not as a lifesaving measure!
my patient is being administered oxygen, and needs cardioversion, what do I do?
TURN OFF, TAKE OFF ALL OXYGEN, you do not want any oxygen crossing the patients chest when cardioversion is performed!
what is TORSADES DE POINTES?
TORSADES DE POINTES = pulseless + polymorphic on EKG; caused by LOW magnesium levels! –HR is usually 200-250 BPM
what does TORSADES DE POINTES look like on EKG strip?
TORSADES DE POINTES looks a lot like ventric. tachycardia - VT **SMALL + LARGE QRS COMPLEXES
what do I do for my TORSADES DE POINTES patient?
**treat like V-FIB **REPLACE mag levels (is low mag is cause)
what is V-FIB or VENTRICULAR FIBRILLATION?
V-FIB = rapid, erratic beats by heart; ineffective heartbeats!; heart is QUIVERING
what does V-FIB look like on EKG strip?
**NO P WAVE **NO QRS COMPLEXES –fine + course in appearance
what is significant about V-FIB in regards to B/P & pulse?
with V-FIB there is NO B/P and there is NO pulse!
what can you do first, to ensure your patient is actually in V-FIB?
**CHECK YOUR LEAD PLACEMENTS! maybe they have moved, been misplaced, etc!
if my patient is truly in V-FIB and has no pulse/B/P, what can I do?
if your patient is truly in V-FIB and there is no pulse, START CPR!!!!!
what are the serious effects of V-FIB?
**NO CARDIAC OUTPUT; NO PULSE; NO B/P –there is NO perfusion!!!
how can we effectively treat V-FIB?!
**START CPR; patients heart is NOT achieving adequate perfusion, CPR will circulate the oxygenated blood to all the organs! + -defibrillation (offer electrical shock) to help jump start normal heart rhythm + -emergency medications: #1 choice = AMIODARONE, epi, vasopressin, lidocaine, mag sulfate
what is DEFIBRILLATION?
electrical shock for heart!; measures in joules (watts) per second **TREATMENT CHOICE FOR: -V-TACH -pulseless V-TACH
what are important things to remember about DEFIBRILLATION?
***make sure ALL CLEAR ***make sure NO O2 FLOW ***make sure PADS ARE CORRECTLY & SECURELY PLACED! ^^^^DO NOT place over pacemakers or ICDs; move over to side of these!
what is ASYSTOLE?
ASYSTOLE is also known as ventricular standstill: no EKG activity; **NO ELECTRICAL ACTIVITY
what does ASYSTOLE look like on EKG strip?
**NO P WAVES **NO QRS COMPLEXES ^^^are your EKG leads placed correctly & securely?
my patient is asystole; do I need to shock?!
NO; you cannot shock asystole rhythm; this is lack of rhythm, there is technically no rhythm to correct
since I can’t shock my asystole patient, what can I do?
you CAN give epi + start CPR Asystole = CPR + EPI!
what is PULSELESS ELECTRICAL ACTIVITY?
PULSELESS ELECTRICAL ACTIVITY is electrical activity on EKG; however, the HEART IS NOT PUMPING!; there is no perfusion occurring; TREAT LIKE ASYSTOLE; NO SHOCKING!!!!
what do I do for my patient experiencing PULSELESS ELECTRICAL ACTIVITY?
fix what is causing the PEA; there is no mechanically movement of heart, START CPR!
what can cause my patients PULSELESS ELECTRICAL ACTIVITY? Hs & Ts: Hs
HYPOxia Acidosis (Hydrogen Ion ) HYPOthermia HYPER/HYPOkalemia HYPOvolemia HYPOglycemia
how can I treat my causes of PEA: Hs
-HYPOxia: intubate; lack of oxygen -Acidotic: push bicarb; lower acidy in body -HYPOthermia: warm your patient! -HYPOvolemia: replace fluids/replace volume -HYPER/HYPOkalemia: replace/deplete potassium as appropriate -HYPOglycemia: IV dextrose 50: super thick; needs GOOD IV LINE
what can cause my patients PULSELESS ELECTRICAL ACTIVITY? Hs & Ts: Ts
Tablets (overdose of drugs) Trauma Tension pneumothorax Tampanode (compression of heart due to fluid buildup) Thrombosis (heart and/or lungs)
how can I treat my causes of PEA: Ts
-Tablets: give act. charcoal; blocks absorption of whats causing overdose! -trauma: address trauma -tamponade: cardiac window; relieve fluid buildup -thrombosis: thrombolytics (dissolve/resolve clots)
my patient just had CPR; what can I do now to reduce risk of death?
you can induce HYPOthermia post cardiac arrest; CPR, to reduce chances of death + improve neuro outcomes!
what is the protocol for HYPOthermia?
1: induction phase #2: maintenance #3: rewarming phase
what is the protocol for HYPOthermia? #1 INDUCTION PHASE
1 INDUCTION PHASE: done in ER, brings down temperature to 89.6-93.2 degrees
is my patient awake during induced HYPOthermia?
NO; patient will be sedated and on the vent; under admin of paralytic meds, on pain meds (can be painful)
How do I know what my patients temperature truly is with induced hypothermia?
CORE TEMP MONITOR
what is the protocol for HYPOthermia? #2: MAINTENANCE
**MONITOR VS; TEMPERATURE, URINE OUTPUT –continue to complete assessments and maintain drips/meds as ordered
what is the protocol for HYPOthermia? #3 REWARMING PHASE
****SLOWLY; occurs over THREE HOURS
what is important to watch for during the REWARMING PHASE?
**watch for ELECTROLYTE REBOUND EFFECT: (HYPERkalemia) -watch for dysrhythmias, HYPOtension, hypoxia
how long does my patient need to stay on the paralytic medication?
wean off after patient has been warmed up!!
what is an AICD - AUTOMATED IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
an AICD is an implantable device that delivers defibrillation when needed
what can I educate my patient on about AICDs?
-follow up with cardiologist to ensure working properly -avoid trauma/pressure on AICD -call HCP IF it fires more than once, if continues CALL EMS -wear medical alert bracelet -AVOID MRI -you can set off metal detector -be careful around antitheft alarms, can disable -have caregivers learn CPR; STILL AT RISK FOR DEVELOPING LETHAL DYSRHYTHMIAS
