Dysrhythmias Foundations Quiz Flashcards
Questions to ask yourself when assessing a strip?
- Regular looking?
- Is there a p for every QRS?
- What is the rate
Equation to find the rate?
1500/boxes in between R
What strip is this? And how do you know?
Normal Sinus
Looks regular
P for every QRS
HR is between 60-100.
What is the treatment for Normal Sinus?
Continue to monitor
What strip is this? How do you know?
Sinus Bradycardia
Look regular
P for every QRS
HR is below 60 ***
Some clinical signs of sinus bradycardia?
Fatigue Thready pulse Diaphoretic Low Urine Output Confused
How do you treat Sinus Bradycardia?
Only treat sinus brady if they are symptomatic!
1) Atropine (0.5 mg IV push)+ flush at fast rates
2) Dopamine/Epi (2-10mcg)
3) Cardiac pacing
What strip is this? How do you know?
Sinus Tachycardia
Looks regular
P for QRS
HR between 100-150
Causes of sinus tachycardia?
What meds do we give for these?
Pain - analgesics Fever - antipyretic Caffeine - no caffeine Hypovolemia - IV fluids Stress - relax HF MI Drugs (that raise HR and BP)
Treatment that we can give for sinus tachycardia?
CCB
Beta blockers
Analgesics
Antipyretic
IV fluids
Beta blockers examples?
CCB example?
Metroprolol
Labetolol
Coreg
Verpamil
What strip is this? How do you know?
Supraventricular tachycardia (SVT)
Doesn’t look regular. More smooshed.
Rhythm ..
Rate is 160-220 bpm
Treatment for Supraventricular Tachycardia (SVT)?
Alternative therapies?
Try Vagal Stem first
Use Adenosine IV to reset HR.
Verapamil
Cardioversion
What strip does this show?How do you know?
PAC or premature atrial contraction
Not regular. P wave comes too early.
You can still find the rhythm and HR.
PAC treatment?
(PAC = early p wave)
Beta blockers Diltizaem Amiodarone Magnesium! Reduce caffeine
What strip is this? How do you know?
A. Flutter
Not regular. Too many p waves for the ventricles.
No rate really. Know the ratio.
Treatment for patients with A. flutter? (just the med options)
Heparin drip (any anticoagulant like coumadin at home )
CCB
Beta Blockers
Antiarythmic
Amiodarone Diltizazem Propafenone Flecainide Clonidine
Nonpharm treatments for A. flutter?
Synchronized cardioversion
Radiofrequency catheter
What strip is this? How do you know?
A. Fib
The whole picture will look squiggly
Rhythm is a. fib
Rate doesn’t really matter
Treatment for A. fib patients? (just meds)
Heparin drip for stasis
or Coumadin at home
Digoxin
Beta Blockers
CCB
Amiodarone (to convert to rhythm)
Alternative therapy for A. fib?
And what medication regimen might the a. fib patient have to be on?
DC conversion to sinus rhythm
If in a. fib for more than 48 hours - take anticoagulation drugs for 3-4 weeks beforehand. Then, take them for 4-6 weeks afterwards.
What strip is this? How do you know?
PVC or premature ventricular contractions.
They don’t look regular. Very wide drop.
Rate can be found I think.
Rhythm is PVC + rate.
Treatment for PVCs? (including medications)
Based on cause.
O2 for hypoxia.
Electrolyte replacement
Beta blockers
Amiodarone
What strip is this? How do you know?
Vtach or ventricular tachycardia.
Looks like the strip has 3 or more pvcs (v- dips).
The rate will be 150-250 bpm.
- its temping to say sinus tachy but just know its not.
Common causes of Vtach
MI
CAD
Hypoxia
Electrolyte levels
What type of strip is this? how do you know?
Also a vtach strip due to 3 pvcs.
Its just a polymorphic one - wheres less uniform pvcs.
So, you’ve identified the patient is in vtach .. what is your next course of action?
Check for a pulse. This will decide what you do next.
Vtach patient treatment:
Pulsatile
Hemodynamically stable
Vtach
Pulsatile
Hemodynamically Unstable
- Treat cause of vtach
- Since they’re hemodynamically stable, you can also just monitor them.
- Treat cause of vtach
- Hemodynamically unstable - IV amiodarone or lidocaine to slow HR with a fast push.
Cardioversion
This time your patient is in Vtach but pulseless. What treatment do you do?
Do we give them any meds?
- CPR
- Defibrillation
- Epi or vasopressin.
- Amiodarone or lidocaine as well.
Torsades polymorphic Vtach patient
Pulse
Stable
What treatments will you give?
(They’re doing fine)
ACLS algorithm measures
Beta blockers
Lidocaine
Amiodarone
Magnesium!!!!!!!!
Vtach torsades polymorphic patient has no pulse.
What treatments do you do?
Automatically a code… just like you would for any other type of rhythm.
- Start the CPR
- Defibrillation
- Epi or vassopressin
- Amiodarone, lidocaine
What will Torsades look like on the stip?
Main cause of Torsades?
Ribbon like. Proloned QT interval
Magnesium levels being low
Vtach torsades polymorphic patient has a pulse and is stable.
What do you do?
You do ACLS measures
beta, lido, amio, MAGNESIUM
intubate, transcutaneous pacer, IV epi + atropine
What will V.fib look like? What will pulse be? Will there be a rhythm?
A line of squiggles with no QRS anywhere to be seen.
There won’t even be a pulse
There will be a rhythm to shock
V.fib treatment?
- CPR
- Defibrillation
- ACLS
- Epi/Vasopressin
- Amiodarone, Lidocaine, MAGNESIUM
Asystole treatment? (flatline)
- CPR
- ACLS (intubate, pacer, IV epi + atropine)
- Amiodarone
PEA treatment? (pulseless electrical activity)
- CPR
- ACLS (intubate + IV epi)
- Amiodarone
1st degree av node block treatment
Monitor and observe for progression incase it progresses
- why? It is common and can happen in athletes too
2nd degree av node block type 1 (Wenkebach) treatment
- Decide if they’re symptomatic or asymptomatic
asymptomatic - monitor and keep transcutaneous pacer on standby
symptomatic - atropine or temporary pacemaker
2nd degree av node block type 2 (Mobitz type II) treatment
Immediate transcutenous or transvenous pacing.
If not available - use atropine (but not if MI is on table).
3rd degree av node block treatment?
Transcutenous pacing
