Electricity (Module 4) Flashcards
CPR
check for carotid pulse for 5-10 s
start chest compressions of 100-120 per minute of at least 2 in with no more than 2.4 in. avoid leaning into chest after each one to allow for full chest wall recoil
maintain patent airway
ventilate with a mouth to mask device; give rescue breaths at a rate of 10-12 breaths/min; if advanced airway is in place one breath should be given every 6-8 s (8-10 breaths/min)
30 compressions to 2 breaths if no advanced airway
limit interruptions to compressions to less than 10 s
compressors should be changed every 2 min to maintain effective compressions
Defibrillation
used for pts w/o a pulse
electrical shock removes any intrinsic electrical activity (depolarizes) from the heart allowing it to restart
A Fib
paroxysmal when pt experiences an episode within 7 days that converts back to sinus rhythm
persistent AF is episodes of A Fib that occur for longer than 7 days
permanent AF is defined as pt who remain in AF and a decision is made not to restore or maintain sinus rhythm by either medical or surgical intervention
A Fib Meds
goal is to control HR and clot prevention
beta blockers (-lol): watch HR and BP, caution with asthma
CCB (Diltiazem): IV drip, watch HR/BP
amiodarone: watch BP
digoxin: hold for HR <60 or abnormal K
heparin
warfarin
enoxaparin (LMWH)
dabigatran (Pradaxa)
Heparin
IV, short acting
monitor PT/PTT (Heparin Xa)
bleeding precautions
HIT (platelets <100 or >50% drop)
antidote (protamine sulfate)
Warfarin
3-5 days to reach therapeutic lvl, PO
PT/INR monitoring
bleeding precautions
avoid K-rich foods
antidote (vitamin K)
Enoxaparin (LMWH)
predictable SQ dose (weight based), no monitoring
bleeding precautions
monitor for HIT
Dabigatran (Pradaxa)
novel oral anticoagulant (NOAC); monitor for bleeding
antidote (Idarucizumab)
Cardioversion (Synchronized)
used for pts with fast rhythms (new onset A fib with RVR or stable AF that is resistant to therapy) when perfusion is compromised
similar to defibrillation but shocks (depolarizes) of R wave to avoid shock on T wave (repolarization) (R on T phenomenon=deadly dysrhythmia)
when onset of A Fib is greater than 48 hrs the pt must take anticoagulants for at least 3 weeks or until INR is 2-3 before procedure to prevent clots from moving; if onset of AF is uncertain, TEE may be obtained to assess for clot formation in left atrium
emergency equipment must be available during procedure, pt must sign consent form; a short acting anesthetic agent is administered for sedation
once electrode is placed, the defibrillator should be set in synchronized mode
Ablation Therapy
may be used to destroy an irritable focus in atrial or ventricular conduction
pt must first undergo electrophysiologic studies and mapping procedures to locate the focus
Temporary Pacing
transcutaneous
transvenous
epicardial
Permanent Pacemakers
implanted in upper chest
electronic device sends impulses to heart in place of SA node
can be a fixed rate or demand
Synchronous Demand (Pacing Mode)
heart is stimulated when the HR drops below the preset value (60-80); if pulse drops below it, the pacemaker fires
pacemakers sense intrinsic cardiac activity
if heart beats pacemaker doesn’t fire
Atrioventricular Pacing Mode
ventricle is sensed and the atrium is paced
if ventricle doesn’t depolarize, it’s also paced
Universal Atrioventricular Pacing Mode
both atria and ventricles are sensed and paced
resembles natural cardiac cycle
REVIEW PACING AND PACEMAKER MALFUNCTION ECG RHYTHM INTERPRETATIONS
REVIEW PACING AND PACEMAKER MALFUNCTION ECG RHYTHM INTERPRETATIONS!!!
Pacemaker Malfunction
failure to sense (spike appears at wrong time)
failure to capture (spike is there but no P or QRS follows)
failure to pace (no spikes and heartbeats)
Implantable Cardioverter Defibrillator (ICD)
can sense a deadly dysrhythmia and automatically defibrillate the heart
pts may not realize it fired
any syncope event should be investigated
