Dysrhythmias Part 3

Question 1

Dysrhythmias of the atrioventricular node:
-junctional rhythms

(What do we see with junctional rhythms?)

Answer 1

Inverted P waves

Absent P waves

Question 2

What is firing during a junctional rhythm?

Treatment for a junctional escape rhythm?

Answer 2

AV node

Tx: (if symptomatic)
Atropine
Transcutaneous pacing
Dopamine
Epinephrine

Question 3

2 types of rates with junctional rhythms?

Causes

How we treat these 2 types

Answer 3

Accelerated junctional 60-100bpm (fast for av)
Junctional tachycardia > 100 bpm

Cause: SA node disease

Tx: assess, tx tachycardia (if symptomatic inform HCP)

Question 4

Premature ventricular contractions (PVCs)

Unifocal vs multifocal
QRS
Is pvc a type of rhythm

Answer 4

Unifocal: look the same
Multifocal: look different

QRS: >0.12 (wide QRS)

The rhythm is not called PVC
(look for other rhythm like NS with unifocal PVCs)

Question 5

PVCs

Pt response

Run of PVCs = what
2 PVCs=what
3 or more in a row = what
What is Bigeminy or trigeminy

Answer 5

Feel like palpitations (or asymptomatic)

Run of PVCs= Vtach

2PVCs (pair)

3 or more = run of V tach

Bigeminal PVCs: every other beat
Trigeminal PVCs: every 2 beats

Question 6

Ventricular tachycardia

Rate
Pt response

Answer 6

> 100 (usually 150-250)

May have pulse or cardiac arrest

Question 7

Ventricular tachycardia tx

If no pulse

Answer 7

No pulse:
-start BLS, ACLS, defibrillate
Meds:
-epi 1mg q3-5min
-amiodarone 300mg IV push (150mg second dose)

Question 8

Ventricular tachycardia tx

If pulse and BP present

Answer 8

IV amiodarone (1st line for both, 150mg bolus)
Lidocaine
Cardioversion

Question 9

Ventricular fibrillation

Rhythm

Pt response

Treatment

Answer 9

Quivering of ventricles

Pt response : cardiac arrest

Tx:
BLS, ACLS, Defibrillate

Defib for Vfib

Question 10

PEA (pulseless electrical activity)

Rhythm

Tx

Answer 10

Rhythm w/o a pulse (conducting but no contractions)

Tx:
-BLS,ACLS (no shock bc theres electrical impulses)
-EPI/atropine

Question 11

Asystole

Electrical activity
(always check what and look at what)

Tx

Answer 11

Cessation of electrical activity
- check in 2 leads
- look at patient

Tx:
-CPR and meds
-DO NOT SHOCK

Question 12

1st degree AV block

2nd degree type 1/mobitz 1/ wenckebach

2nd degree type 2

3rd degree

Answer 12

1: PRI >0.20

2 type 1: progressive lengthening of PRI
(Until absent QRS/skip a beat)

2 type 2: PRI normal or prolonged but CONSTANT
(Absent QRS/skip beat)

3: atria (P waves) and ventricles (QRs) beat independently (complete AV disassociation)
-rhythm of both seperately is normal

Question 13

1st degree AV block

What happens

Answer 13

Delayed conduction thru AV node

Prolonged PRI >0.20 (constant)

(No tx if asymptomatic)

Question 14

2nd degree type 1/mobitz 1/ wenckebach

What is happening

Answer 14

Progressive lengthening of PRI
-until P waves without QRS

Question 15

2nd degree type 2

What is happening

Treatment

Answer 15

PRI: normal or prolonged but constant
-also has drop beat (no QRS)

Tx:
Pacemaker
(transvenous or transcutaneous)

Question 16

3rd degree heart block (complete heart block)

Hallmark sign

How to read it on 6sec EKG

Tx

Answer 16

Atria (P waves) and Ventricles (QRS) beat independently of eachother
(Complete AV disassociation)

Count P waves and QRS
-see if regular rhythm but not beating with eachother

TX: pacemaker