Dysrhythmias Foundations Quiz Flashcards

1
Q

Questions to ask yourself when assessing a strip?

A
  1. Regular looking?
  2. Is there a p for every QRS?
  3. What is the rate
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2
Q

Equation to find the rate?

A

1500/boxes in between R

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3
Q

What strip is this? And how do you know?

A

Normal Sinus

Looks regular
P for every QRS
HR is between 60-100.

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4
Q

What is the treatment for Normal Sinus?

A

Continue to monitor

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5
Q

What strip is this? How do you know?

A

Sinus Bradycardia

Look regular
P for every QRS
HR is below 60 ***

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6
Q

Some clinical signs of sinus bradycardia?

A
Fatigue
Thready pulse
Diaphoretic 
Low Urine Output
Confused
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7
Q

How do you treat Sinus Bradycardia?

A

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

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8
Q

What strip is this? How do you know?

A

Sinus Tachycardia

Looks regular
P for QRS
HR between 100-150

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9
Q

Causes of sinus tachycardia?

What meds do we give for these?

A
Pain - analgesics
Fever - antipyretic 
Caffeine - no caffeine
Hypovolemia - IV fluids
Stress - relax
HF
MI
Drugs (that raise HR and BP)
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10
Q

Treatment that we can give for sinus tachycardia?

A

CCB
Beta blockers

Analgesics
Antipyretic
IV fluids

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11
Q

Beta blockers examples?

CCB example?

A

Metroprolol
Labetolol
Coreg

Verpamil

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12
Q

What strip is this? How do you know?

A

Supraventricular tachycardia (SVT)

Doesn’t look regular. More smooshed.
Rhythm ..
Rate is 160-220 bpm

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13
Q

Treatment for Supraventricular Tachycardia (SVT)?

Alternative therapies?

A

Try Vagal Stem first
Use Adenosine IV to reset HR.
Verapamil
Cardioversion

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14
Q

What strip does this show?How do you know?

A

PAC or premature atrial contraction
Not regular. P wave comes too early.
You can still find the rhythm and HR.

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15
Q

PAC treatment?

A

(PAC = early p wave)

Beta blockers
Diltizaem
Amiodarone 
Magnesium! 
Reduce caffeine
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16
Q

What strip is this? How do you know?

A

A. Flutter

Not regular. Too many p waves for the ventricles.
No rate really. Know the ratio.

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17
Q

Treatment for patients with A. flutter? (just the med options)

A

Heparin drip (any anticoagulant like coumadin at home )

CCB
Beta Blockers
Antiarythmic

Amiodarone 
Diltizazem
Propafenone
Flecainide
Clonidine
18
Q

Nonpharm treatments for A. flutter?

A

Synchronized cardioversion

Radiofrequency catheter

19
Q

What strip is this? How do you know?

A

A. Fib

The whole picture will look squiggly
Rhythm is a. fib
Rate doesn’t really matter

20
Q

Treatment for A. fib patients? (just meds)

A

Heparin drip for stasis
or Coumadin at home

Digoxin

Beta Blockers

CCB

Amiodarone (to convert to rhythm)

21
Q

Alternative therapy for A. fib?

And what medication regimen might the a. fib patient have to be on?

A

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.

22
Q

What strip is this? How do you know?

A

PVC or premature ventricular contractions.

They don’t look regular. Very wide drop.
Rate can be found I think.
Rhythm is PVC + rate.

23
Q

Treatment for PVCs? (including medications)

A

Based on cause.
O2 for hypoxia.
Electrolyte replacement

Beta blockers
Amiodarone

24
Q

What strip is this? How do you know?

A

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.

25
Common causes of Vtach
MI CAD Hypoxia Electrolyte levels
26
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.
27
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.
28
Vtach patient treatment: Pulsatile Hemodynamically stable Vtach Pulsatile Hemodynamically Unstable
1. Treat cause of vtach 2. Since they're hemodynamically stable, you can also just monitor them. 1. Treat cause of vtach 2. Hemodynamically unstable - IV amiodarone or lidocaine to slow HR with a fast push. Cardioversion
29
This time your patient is in Vtach but pulseless. What treatment do you do? Do we give them any meds?
1. CPR 2. Defibrillation 3. Epi or vasopressin. 4. Amiodarone or lidocaine as well.
30
Torsades polymorphic Vtach patient Pulse Stable What treatments will you give?
(They're doing fine) ACLS algorithm measures Beta blockers Lidocaine Amiodarone Magnesium!!!!!!!!
31
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. 1. Start the CPR 2. Defibrillation 3. Epi or vassopressin 4. Amiodarone, lidocaine
32
What will Torsades look like on the stip? Main cause of Torsades?
Ribbon like. Proloned QT interval Magnesium levels being low
33
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
34
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
35
V.fib treatment?
1. CPR 2. Defibrillation 3. ACLS 4. Epi/Vasopressin 5. Amiodarone, Lidocaine, MAGNESIUM
36
Asystole treatment? (flatline)
1. CPR 2. ACLS (intubate, pacer, IV epi + atropine) 3. Amiodarone
37
PEA treatment? (pulseless electrical activity)
1. CPR 2. ACLS (intubate + IV epi) 3. Amiodarone
38
1st degree av node block treatment
Monitor and observe for progression incase it progresses - why? It is common and can happen in athletes too
39
2nd degree av node block type 1 (Wenkebach) treatment
1. Decide if they're symptomatic or asymptomatic asymptomatic - monitor and keep transcutaneous pacer on standby symptomatic - atropine or temporary pacemaker
40
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).
41
3rd degree av node block treatment?
Transcutenous pacing