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CHA 1 > Dysrythmias > Flashcards

Dysrythmias Flashcards

1
Q

the 3 A meds

A
  1. Amiodarone (antidysryth) 2. Adenosine (slows heart down) 3. Atropine ( increase HR)
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2
Q

Adenosine

A

-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”

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3
Q

Amiodarone

A

-antidysrythmic -causes lung toxicity and respiratory distress

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4
Q

NSR

A
  • regular rhythm
  • PRI : .12-.20 seconds (3-5 TB)
  • QRS= .04-.12 seconds (1-3 TB)
  • distinguished based on rate
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5
Q

sinus bradycardia

A
  • 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
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6
Q

sinus bradycardia Tx

A
  • find underlying cause if symptomatic
  • Atropine (increase HR)/pacing
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7
Q

sinus tachycardia

A

all NSR criteria except rate > 101-150 (>150 is SVT)

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8
Q

sinus tachy tx

A
  • 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
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9
Q

premature atrial contraction (PAC)

A
  • 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
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10
Q

PAC tx

A
  • continue to monitor
  • look for underlying cause for more PACs >6/min
  • no meds, but if symptomatic Beta blockers to decrease HR
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11
Q

atrial flutter

A
  • 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”

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12
Q

atrial flutter tx

A
  • 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
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13
Q

atrial fibrillation

A
  • 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)
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14
Q

atrial fibrillation Tx

A
  • 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
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15
Q

SVT Supraventricular Tachycardia

A
  • 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),
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16
Q

SVT tx

A
  • 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
17
Q

scheduled cardioversion process

A
  • either get TEE to verify no clots -or, 2-3 weeks on anticoagulants
18
Q

1 st degree AV block

A
  • changes in PR interval , PR >0.20 sec (> 5TB)
  • CM: usually asym, if sym its r/t rate not prolonged PRI
19
Q

1 st degree AV block tx

A
  • monitor for changes
  • may progress to second degree HB and eventually complete HB
20
Q

2nd degrees AV block Type 1

A

-Wenke back Mobitz -Winky boc - progressive lengthening until QRS is blocked -Tx usually asympt -symptomatic , tx atropine, pacemaker

21
Q

2nd degrees AV block Type 2

A
  • 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
22
Q

3rd degree heart block

A
  • 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)

23
Q

3rd degree heart block -complete Tx

A
  • rapid response
  • transcutaneous
24
Q

Premature ventricular contractions (PVCs)

A

-QRS=>.12 seconds (>3TB)

-Wide, ugly looking QRS complexes

  • often asym, “heart skipping a beat”, find underlying (hypoxia, hypokalemia, acidosis
  • apical-radial pulse deficit
25
Q

PVC Tx

A
  • 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
26
Q

Ventricular Tachycardia

A
  • 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

27
Q

VT Tx

A
  • 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
28
Q

Ventricular Fibrillation

A
  • no rhythm, no p-waves, no PRI-no p-waves
  • “Quivering” irregular waveforms of varying shapes and sizes, no true QRS
  • pulseless. dead.
29
Q

VF Tx

A
  • 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
30
Q

Asystole

A
  • flat line
  • no p-waves, PRI, QRS
  • absence of electrical activity
  • pulseless, dead
31
Q

Asystole Tx

A
  • Start CPR
  • Call a code
  • Meds: epinephrine or vasopressin
  • Tx cause

CHA 1 (5 decks)

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