Interventions Flashcards
Interventions for Sinus Brady:
causes:
Oxygen, establish IV access, 12 lead EKG, aTropine
Hypoxia, OSA, beta blockers, hyperkalemia, hypothermia, hypothyroidism
Interventions for Sinus Tachycardia:
causes:
Correct underlying cause-fluid replacement, relief of pain, reduce fear or anxiety
(HR above 100 but less than 150)
(Acute MI, caffeine, dehydration, hypovolemia, drugs, exercise, fear, infection, pain, shock, pulmonary embolism)
Interventions for Sinus Arrhythmia:
causes:
No treatment unless it is accompanied by a slow rate with symptoms
(Heart rate increases with inspiration, decreases with expiration)
Abnormalities associated with Sinus Pause/Escape:
One missing QRS complex
Interventions for Sinus Pause/Sinus Escape:
causes:
Monitor for frequent episodes accompanied by slow rate
Hypoxia, Myocarditis, Acute MI
Abnormalities associated with Sinus Arrest:
causes:
More than one QRS complex is missing, no escape beat (lasts longer than 3 seconds)
(Damage to SA node, CAD, acute MI, OSA)
Interventions for Sinus Arrest:
Monitor for signs of hemodynamic compromise. If yes- give IV atropine, temporary pacing
Abnormalities associated with PAC
** Escape beat
P wave appears before it should
P wave is biphasic, pointed, or flattened
Interventions for PACs:
causes:
Continue to monitor, if frequent, correct underlying cause. Electrolyte imbalance, reduce stress, stimulants, treat heart failure
(Common in older adults, electrolyte imbalance, emotional stress, ACS, hyperthyroid, stimulants, heart failure)
Abnormalities associated with Multifocal Atrial Tachycardia:
Ventricular rate is above 100, wandering atrial pacemaker. P waves are visible but vary in size, shape, and direction
Interventions for Multifocal Atrial Tachycardia:
causes:
If symptomatic, call cardiologist.
Vagal maneuvers, IV adenoSine
(Severe COPD, ACS, Hypokalemia, Precursor for a. fib)
Abnormalities associated with Atrial Tachycardia/SVT:
Ventricular rate is above 150, P waves hopes differ, P waves may be lost in T waves
Interventions for Atrial Tachycardia/SVT:
causes:
If sustained and symptomatic, give oxygen, IV access, 12 lead EKG, adenoSine (not in severe asthma), synchronized cardioversion
(Digitalis toxicity, electrolyte imbalance, heart disease, infection, pulmonary embolism)
Abnormalities associated with Atrial Flutter:
Atrial waveforms are produced that resemble “sawtooth” pattern, rhythm is regular
Interventions for Atrial Flutter:
causes:
Consult cardiologist. Beta blockers, diltiazem, cardioversion (for severe signs and symptoms
(AV node is bypassed, pulmonary embolism, cardiac surgery, cardiomyopathy, myocarditis)
Abnormalities for Atrial Fibrillation:
Ventricular rhythm is irregular. No discernible P waves, erratic waves
Interventions for Atrial Fibrillation:
causes:
Diltiazem or beta blockers to control heart rate (avoid beta blockers for severe heart failure or pulmonary disease
(Cardiac conditions, non-cardiac conditions (DM, PE, Obesity))
Abnormalities associated with Premature Junctional Contractions (PJC)
** Escape beat
P waves may/may not be present, could be inverted
causes: heart failure, digitalis toxicity, electrolyte imbalance, stimulants
Interventions for Premature Junctional Contractions (PJC)
remove stimulus or dig toxicity (could be feeling lightheaded)
Abnormalities associated with Junctional Escape Beat:
usually no p wave, QRS comes after a pause and is narrow
Abnormalities associated with accelerated junctional rhythm:
QRS is usually narrow, pacing rate is 40-60 ppm, no p wave or inverted p wave
Interventions associated with Accelerated Junctional Rhythm:
Monitor closely, remove digoxin if it’s the cause
Abnormalities associated with Junctional Tachycardia:
Pacing rate is over 100, no P wave/inverted p wave
causes: acute coronary syndrome, dig toxicity, heart failure
Interventions for Junctional Tachycardia:
Oxygen, 12 lead, vitals, adenoSine
Abnormalities associated with PVC
*escape beat
Width is typically 0.12 seconds or greater, QRS comes early
Interventions for PVCs
Oxygen, relief of pain, remove nicotine, decrease emotional stress
Abnormalities associated with Ventricular Escape beat
QRS comes late, after a pause QRS is wide
Interventions for Ventricular Escape Beat
Oxygen, IV access, 12 lead EKG, IV aTropine, transcutaneous pacing, dopamine drip
Abnormalities associated with V. tach (mono or poly)
3 or more PVCs in a row, No P waves, vent rate 150-300
Interventions for V. tach”
oxygen, IV access, CPR, defibrillation, **epinephrine, amiodarone, vasopressin
Abnormalities associated with V fib:
Chaotic rhythm, rate p waves, QRS waves are not discernible
Interventions for V. Fib:
CPR defibrillation, epinephrine, vasopressin, amiodarone, lidocaine
Interventions for systole:
CPR, epinephrine
Abnormalities associated with First Degree AV block:
PR interval constant and longer than 0.20 seconds
Interventions for First Degree AV block:
Monitor closely
Abnormalities associated with Second Degree AV block type I:
PR interval NOT constant, PR interval prolongs until dropped QRS
Interventions for Second Degree AV block type I:
Atropine, oxygen, vitals, 12 lead EKG
Abnormalities for Second Degree AV block type II:
PR interval is constant, too many Ps for one QRS
Interventions for Second Degree AV block type II:
Atropine, oxygen, vitals, 12 lead EKG
Abnormalities for Third Degree AV block:
PR interval is not constant, QRS rhythm is regular
Interventions for Third Degree AV block:
Atropine, oxygen, vitals, 12 lead EKG, permanent pacemaker
Which rhythms can you cardiovert?
SVTs (tachys) and unstable atrial rhythms
Inverted p waves means..?
junctional rhythm
What do you do for symptomatic brady rhythms?
aTropine, transcutaneous pacing, epic or dopamine
What do you do for unstable tachy (greater than 150)
cardiovert
What are the shockable rhythms?
V. fib and V. tach (even pulseless V. tach)
Meds for V. Fib and V. tach?
epinephrine, amiodorone (antiarrythmic), lidocaine (antiarrhythmic)
Interventions for systole?
CPR and give epinephrine
Edison for pulseless V. tach? V tach with a pulse?
pulseless v tach= defib!
with a pulse=cardiovert!
What interventions do you do for torsades?
defib (pulse or no pulse)
