ekg Flashcards
Normal Sinus Rhythm
Assess, O2, IV
Sinus Tachycardia
Assess, O2, IV
Identify and treat possible causes
Sinus Bradycardia
Assess, O2, IV
IF SYMPTOMATIC:
- identify and treat possible causes
- *ATROPINE 0.5 mg q 5 minutes. MAX of 3 MG.
- TCP (Transcutaneous Pacemaker)
- PPM (Permanent Pacemaker)
- *DOPAMINE 2-10 mcg/kg/min
- *EPINEPHRINE 2-10 mcg/min
Sinus Arrhythmia
Assess, O2, IV
(same as sinus brady)
IF SYMPTOMATIC:
- identify and treat possible causes
- *ATROPINE 0.5 mg q 5 minutes. MAX of 3 MG.
- TCP (Transcutaneous Pacemaker)
- PPM (Permanent Pacemaker)
- *DOPAMINE 2-10 mcg/kg/min
- *EPINEPHRINE 2-10 mcg/min
Sinus Pause/ Sinus Arrest/ Sinus Block
Assess, O2, IV
(same as sinus brady)
IF SYMPTOMATIC:
- identify and treat possible causes
- *ATROPINE 0.5 mg q 5 minutes. MAX of 3 MG.
- TCP (Transcutaneous Pacemaker)
- PPM (Permanent Pacemaker)
- *DOPAMINE 2-10 mcg/kg/min
- *EPINEPHRINE 2-10 mcg/min
Wandering Atrial Pacemaker
Assess, O2, IV
(same as sinus brady)
IF SYMPTOMATIC:
- identify and treat possible causes
- *ATROPINE 0.5 mg q 5 minutes. MAX of 3 MG.
- TCP (Transcutaneous Pacemaker)
- PPM (Permanent Pacemaker)
- *DOPAMINE 2-10 mcg/kg/min
- *EPINEPHRINE 2-10 mcg/min
Premature Atrial Contraction (PAC)
Assess, O2, IV
INFREQUENT:
No treatment
Frequent:
- Identify and treat possible causes
- May need beta blockers, calcium channel blockers or *Amiodarone
Wandering Atrial Pacemaker (WAP)
Assess, O2, IV
(same as sinus brady)
IF SYMPTOMATIC:
- identify and treat possible causes
- *ATROPINE 0.5 mg q 5 minutes. MAX of 3 MG.
- TCP (Transcutaneous Pacemaker)
- PPM (Permanent Pacemaker)
- *DOPAMINE 2-10 mcg/kg/min
- *EPINEPHRINE 2-10 mcg/min
Atrial Tachycardia/Paroxysmal Tachycardia/Supraventricular Tachycardia
(AT/PAT/SVT)
Assess, O2, IV
IF STABLE:
-Vagal Maneuvers
-ADENOSINE 6 MG IVP over 1-2 sec., followed by rapid 10 mL NS IVP
-If ineffective, repeat ADENOSINE 12 MG in 2 mins in same manner
-FOR RATE CONTROL:
BETA or CALCIUM CHANNEL BLOCKERS
IF UNSTABLE:
- SYNC CARDIOVERSION (consider presedation)
- BECAUSE PT IS NOT ABLE TO CIRCULATE HIS MEDS ANYMORE!
Ventricular Fibrillation (VFIB)
Assess, O2, IV
-Defib 120 J- 200 J
(1st 120 joules - 2nd 150 joules - 3rd 200 joules)
-CPR (5 cycles over 2 minutes; at least 100 compressions/minute)
-EPI 1 mg IVP every 3-5 minutes (NO MAX!)
- VASOPRESSIN 40 UNITs to replace 1st or 2nd dose of EPI
-CPR - SHOCK - CPR - DRUG SEQUENCE
-ANTIARRHYTHMICS:
-AMIO 300 MG IVP (consider mixing with 20 ml D5W)
- after 3-5 minutes, AMIO 150 mg IVP
- Follow with IVP drip (see VT TX)
-LIDOCAINE 1-1.5 mg/kg IVP
-second dose in 5-10 min: 0.5-0.75 mg/ kg every 5-10 min, max 3 mg/kg
-Follow with IV Drip at 1-4 mg/min
ASYSTOLE
ASSESS, O2, IV
- CHECK in 2 leads; increase gain on cardiac monitor
- CPR
- EPINEPHRINE 1 mg IVP every 3-5 minutes
- VASOPRESSIN 40 units IVP x 1 dose to replace 1st or 2nd dose of EPI - CONSIDER H’s & T’s
Idioventricular Rhythm (IVR)
ASSESS, O2, IV
ASYMPTOMATIC:
-NO TREATMENT!
SYMPTOMATIC:
- PACING (TCP until TVP)
- VASOPRESSORS:
- DOPAMINE 2-10 mcg/kg/min IV
- EPI 2-10 mcg/ min IV
accelertated ivr- no tx 60-100, no antiarrythmics
VTACH
ASSESS, O2, IV
STABLE WITH PULSE!:
- AMIO 150 MG/100 ml D5W IVPB x 20 mins
- –may repeat x 1
- –if successful, amio 900 mg/500 ml D5W, 1 mg/min x 6 hrs
- –then decrease to 0.5 mg/min x 18 hours
- -total dose less than OR equal 2.2 g/24 hours
- -follow with oral amio
- -sync cardio version 100 joules (consider presedation)
UNSTABLE WITH PULSE!:
- sync cardioversion 100 joules (consider presedation) ((hit sync to get marker!))
- followed by amio drip, then oral (see above)
WITHOUT PULSE!:
-treat like vfib! … 120 joules!
*ICD or reentry circuit ablation
NSR with FIRST DEGREE AV BLOCK
ASSESS, O2, IV
-check meds and d/c as needed.
(first degree have to say underlying rhythm !)
SECOND DEGREE AV BLOCK TYPE 1/ MOBITZ 1/ WENCHEBACH
ASSESS, O2, IV
- check meds and d/c as needed
- treat like symptomatic brady, see below…(TX COMPLAINTS IF SYMPTOMATIC)
IF SYMPTOMATIC:
- identify and treat possible causes
- *ATROPINE 0.5 mg q 5 minutes. MAX of 3 MG.
- TCP (Transcutaneous Pacemaker)
- PPM (Permanent Pacemaker)
- *DOPAMINE 2-10 mcg/kg/min
- *EPINEPHRINE 2-10 mcg/min
SECOND DEGREE AV BLOCK TYPE 2/ MOBITZ 2
ASSES, O2, IV
- TCP UNTIL, TVP (TRANSVENOUS PACEMAKER); MAY REQUIRE PPM
- DOPAMINE 2-10 MCG/KG/MIN
- EPI 2-10 MCG/MIN
THIRD DEGREE AVB/COMPLETE HEART BLOCK
ASSES, O2, IV
- TCP UNTIL, TVP (TRANSVENOUS PACEMAKER); MAY REQUIRE PPM
- DOPAMINE 2-10 MCG/KG/MIN
- EPI 2-10 MCG/MIN
SAME AS TYPE 2!
ATRIAL FLUTTER
ASSESS, O2, IV
IDENTIFY AND TREAT REVERSIBLE CAUSES
RATE CONTROL:
BETA OR CALCIUM CHANNEL BLOCKERS
RHYTHM CONTROL:
- ->ONSET < 48 HOURS:
- SYNC CARDIOVERSION 50-100 JOULES. (CONSIDER PRESEDATION)
- AMIO 150 MG IVP X 10 MINS
- ->ONSET >48 HOURS:
- ANTICOAG FOR SEVERAL WEEKS. (BC THEY MIGHT HAVE A CLOT)
- SYNC CARDIOVERSION 50-100 JOULES. (CONSIDER PRESEDATION)
IF UNSTABLE:
- SYNC CARDIOVERSION 50-100 JOULES. (CONSIDER PRESEDATION) ((NEVER MOVE JOULES UP))
- ANTIARRHYTHMIC POST SHYTHM CONVERSION.
RADIOFREQUENCY CATHETER ABLATION
AFIB (CONTROLLED OR UNCONTROLLED)
((SAME AS A FLUTTER))
ASSESS, O2, IV
IDENTIFY AND TREAT REVERSIBLE CAUSES
RATE CONTROL:
BETA OR CALCIUM CHANNEL BLOCKERS
RHYTHM CONTROL:
- ->ONSET < 48 HOURS:
- SYNC CARDIOVERSION 50-100 JOULES. (CONSIDER PRESEDATION)
- AMIO 150 MG IVP X 10 MINS
- ->ONSET >48 HOURS:
- ANTICOAG FOR SEVERAL WEEKS. (BC THEY MIGHT HAVE A CLOT)
- SYNC CARDIOVERSION 50-100 JOULES. (CONSIDER PRESEDATION)
IF UNSTABLE:
- SYNC CARDIOVERSION 50-100 JOULES. (CONSIDER PRESEDATION) ((NEVER MOVE JOULES UP))
- ANTIARRHYTHMIC POST SHYTHM CONVERSION.
RADIOFREQUENCY CATHETER ABLATION
