Dysrythmias Flashcards
the 3 A meds
- Amiodarone (antidysryth) 2. Adenosine (slows heart down) 3. Atropine ( increase HR)
Adenosine
-slows heart down -chemical defibrillator -6 second half-life -push rapidly 1-2 seconds -then follow then 20 ml NS flush -forewarn “kick to the chest”
Amiodarone
-antidysrythmic -causes lung toxicity and respiratory distress
NSR
- regular rhythm
- PRI : .12-.20 seconds (3-5 TB)
- QRS= .04-.12 seconds (1-3 TB)
- distinguished based on rate
sinus bradycardia
- all NSR criteria except HR< 60 bpm -can be significant if it lowers CO
- CM: asymptomatic for athletes, or beta blocker takers; symptomatic= HotN, decreased LOC
sinus bradycardia Tx
- find underlying cause if symptomatic
- Atropine (increase HR)/pacing
sinus tachycardia
all NSR criteria except rate > 101-150 (>150 is SVT)
sinus tachy tx
- continue to monitor if asymptomatic
- Tx underlying cause
- meds: determined from underlying cause; diltiazem may be used to slow HR but needs to used cautiously
premature atrial contraction (PAC)
- irregular -some beats are early
- Early beats (PACs) have different morphology of p-wave
- PRI= .12-.20 seconds (3-5 TB)
- QRS = .04-.12 (1-3 TB)
- measure “normal” beats
- often asymptomatic, “heart skipping a beat”, caffiene, insomnia, stress
PAC tx
- continue to monitor
- look for underlying cause for more PACs >6/min
- no meds, but if symptomatic Beta blockers to decrease HR
atrial flutter
- sick heart
- multiple p-waves for each QRS
- QRS= .04-.12 sec (1-3 TB)
- Atrial 2oo–350 bpm -ventricular > 150-irreg
- PR interval variable , not measureable
-SAW TOOTH SHAPED
--CM: asymptomatic , rate dependent, “heart fluttering”
atrial flutter tx
- depends on SS
- goal: decrease rate and prevent clots
- meds tried before electricity
- Cardioversion (and happy drugs) if unstable (low BP, decreased LOC)
- Meds: Diltiazem for rate control, Coumadin to prevent clots, Amiodarone, LC: digoxin
atrial fibrillation
- No discernable p-waves irregular
- controlled A-fib <100
- uncontrolled a-Fib > 100 (w/ RVR-rapid ventricular response)
- unable to measure PRI
- QRS= .04-.12 seconds (1-3 TB)
- CM: may be asym; rate dependent, “heart skipping beats”, SS directly linked to CO, sym (dizziness, HoTN, or decreased LOC)
atrial fibrillation Tx
- Depends on SS; Goal: decrease rate + prevent clots
- meds tried before electricity
- Cardioversion (and happy drugs) if unstable (low BP, decreased LOC)
- elective cardioversion (stable pt not responding to meds): either need TEE or Coumadin (2-3 wks) before procedure
- meds: diltiazem for rate control, coumadin to prevent clots, Amiodarone, Digoxin for LC, Ablation
SVT Supraventricular Tachycardia
- HR>150
- very fast, usually regular but often too fast to determine
- unable to see p-waves due to rate
- PRI=unable to measure
- QRS= .04-.12 (1-3 TB)
- CM: r/t low CO==severe HoTN , decreased LOC, dizziness),
SVT tx
- Rapid response if severe HoTN and sym
- Vagal down (rarely works)
- Adenosine to slow rate (Give LAC, push FAST, followed by 20 ml NS; stops the heart )
- Diltiazem if unresponsive to adenosine or underlying is A-flutter or A-fib
- determine underlying rhythm and treat
- cardiovert if unable to convert with meds or if unstable
- ablation
scheduled cardioversion process
- either get TEE to verify no clots -or, 2-3 weeks on anticoagulants
1 st degree AV block
- changes in PR interval , PR >0.20 sec (> 5TB)
- CM: usually asym, if sym its r/t rate not prolonged PRI
1 st degree AV block tx
- monitor for changes
- may progress to second degree HB and eventually complete HB
2nd degrees AV block Type 1
-Wenke back Mobitz -Winky boc - progressive lengthening until QRS is blocked -Tx usually asympt -symptomatic , tx atropine, pacemaker
2nd degrees AV block Type 2
- Mobitz II -constant PR variables, blocked QRSs -can progress to 3rd AV block -Tx: pacemaker
- PRI= consistent. May be normal or prolonged but stays the same on perfused beats
- multiple p-waves w/out QRS complexes
3rd degree heart block
- bradycardia
- regular atrial + ventricular rate but no r/t between the 2
- PRI=inconsistent. Unable to measure. May be short, normal or prolonged and varies
-multiple p-waves w/out QRS complexes
-CM: SS r/t low CO (severe HoTN, decreased LOC, dizziness)
3rd degree heart block -complete Tx
- rapid response
- transcutaneous
Premature ventricular contractions (PVCs)
-QRS=>.12 seconds (>3TB)
-Wide, ugly looking QRS complexes
- often asym, “heart skipping a beat”, find underlying (hypoxia, hypokalemia, acidosis
- apical-radial pulse deficit
PVC Tx
- determine and Tx underlying cause
- monitor for : (can progress to VT)
- >6/ min =VT
- Bigeminy -every 2 beats
- Trigeminy -every 3 beats
- Couplet -2 in a row
- VT- 3 in a row
- close to T wave
- meds: amiodarone, lidocaine
Ventricular Tachycardia
- regular fast ventricular rhythm (150-250)
- no p-waves- no atrial level, no PRI, no p-waves
- QRS-wide, ugly and bizarre in continuous pattern
-dead or near dead
-may have weak pulse for a short period of time
VT Tx
- if pulseless, follow VF protocol
- if pt has a pulse it won’t be for long
- call a code
- be prepared to follow VF protocol
- Meds: Amiodarone med of choice if pt has a pulse or for intermittent runs
- See VF meds of pt pulseless
Ventricular Fibrillation
- no rhythm, no p-waves, no PRI-no p-waves
- “Quivering” irregular waveforms of varying shapes and sizes, no true QRS
- pulseless. dead.
VF Tx
- START CPR
- Call a Code
- 2 minutes CPR- Defibrillate. Repeat. Meds with CPR.
- hyopthermia protocol for successful resuscitation
- meds: epinephrine or Vasopressin, Mg (for alcohol abuse), amiodarone
Asystole
- flat line
- no p-waves, PRI, QRS
- absence of electrical activity
- pulseless, dead
Asystole Tx
- Start CPR
- Call a code
- Meds: epinephrine or vasopressin
- Tx cause
