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ACU COURSE > Rhythm Interpretation > Flashcards

Rhythm Interpretation Flashcards

1
Q

Where is the heart located? Base? Apex?

A

Set to the left; Superior; Anterior 5th ICS

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2
Q

Which cells are responsible for mechanical heart function?

A

Cardiomyocytes

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3
Q

Which cells are responsible for electrical heart function?

A

Pacemaker

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4
Q

What separates the ventricles?

A

Interventricular septum

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5
Q

What are the 3 functions of the fibrous skeleton?

A

Separate the atrial and ventricular muscle bundles; anchor heart valves; electrical insulation

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6
Q

Systemic Blood Flow

A

LUNGS - PULM VEINS - LA - BICUSPID VALVE - LV - AORTIC VALVE - AORTA - BODY

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7
Q

Pulmonic Blood Flow

A

BODY - SVC/IVC - RA - TRICUSPID VALVE - RV - PULMONIC VALVE - PULMONARY ARTERY - LUNGS

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8
Q

Atrial Contraction

A

Atrial systole

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9
Q

Atrial Relaxation

A

Atrial diastole

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10
Q

Ventricle Contraction

A

Ventricular systole

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11
Q

Ventricular Relaxation

A

Ventricular diastole

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12
Q

S1

A

Closure of AV valves at beginning of ventricular systole

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13
Q

S2

A

Closure of SL valves at end of ventricular systole

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14
Q

Electrical conduction pathway

A

SA - AV node - AV bundle - BB - Purkinje Fibres

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15
Q

Pacemaker Cells

A

Non-neural cells

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16
Q

Heart initiates impulses on its own - the nervous system does not _______ the heart to beat, but plays role in regulation of cardiac function via ___________ nervous system

A

cause; autonomic

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17
Q

Chronotropy

A

Heart rate

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18
Q

Inotropy

A

Contractility

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19
Q

Dromotropy

A

Speed of conduction

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20
Q

SNS - _______ is released to cause an __________ in chronotropy, inotropy, and dromotropy

A

Norepinephrine; increase

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21
Q

PNS - _______ is released to cause a __________ in chronotropy, inotropy, and dromotropy

A

Acetylcholine; decrease

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22
Q

PNS does NOT innvervate ___________, therefore has no impact on __________ ______________

A

ventricles; ventricular contractility

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23
Q

SA Node is the __________ _________, it generates _______ bpm, and is located in the _____

A

main PM; 60-100 bpm; RA

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24
Q

____ node receives impulse from SA node and takes over if SA node does not work; HR _______, located in _______ _____

A

AV node; 40-60 bpm; lower RA

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25
Q

Purkinje fibres

A

Can act as PM if needed, 20-40 bpm

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26
Q

Sinus arrhythmia

A

Irregular rhythm; no treatment if no symptoms present (decreased CO)

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27
Q

Junctional Escape Rhythm: Always _______, HR ________, P-wave _________, QRS _________

Treatment: (1) Asymptomatic (2) Symptomatic

A

regular; 40-60 bpm; absent/inverted; narrow;

(1) Assess for decreased CO, 12-lead ECG, treat underlying cause
(2) If symptomatic: APE —> atropine, pacing, epinephrine

28
Q

Accelerated Junctional Rhythm: Junctional rhythm in which the HR is > __________

Treatment:

A

60 bpm

Treatment 2* to cause - do not suppress rhythm

29
Q

Ventricular Escape Rhythm: Always ________, HR ________; P-wave _________, QRS ______

Treatment

Do NOT give _________

A

regular; 20-40; absent; WIDE

  1. Notify MD STAT
  2. PED –> pacing, epi, dopamine

Lidocaine - will cause ASYSTOLE

30
Q

Accelerated Ventricular Rhythm: Ventricular rhythm in which the HR is > ___ bpm

Treatment:

A

40 bpm

Treat underlying cause and assess for decreased CO

31
Q

PAC: Underlying ______ rhythm with _________ beat

Caused by altered __________

Treatment:

A

regular; irregular atrial

SA automaticity

Treat underlying cause; assess for decreased CO
Can develop into urgent atrial arrhythmia

32
Q

PJC: Underlying ______ rhythm with _________ beat

Caused by altered __________

Treatment:

A

regular; irregular junctional

AV automaticity

Treat underlying cause; assess for decreased CO
Can develop into urgent atrial arrhythmia

33
Q

PVC: Underlying ______ rhythm with _________ beat

Caused by altered __________

Treatment:

A

regular; irregular ventricular

ventricular automaticity

1) Assess for decreased CO + treat the underlying cause
2) Worry about frequent PVCs/run of PVC turning into V-Tach (decreased perfusion)
3) BCA –> BB, CCB, Amiodarone

34
Q

Sinoatrial Block and Arrest:

1) What’s the difference?
2) Treatment

A

Block - impulse is block; rhythm resumes regularity

Arrest - impulse not generated; rhythm does not resume regularity

Treatment: Atropine and Pacing

35
Q

1st Degree Block: delay in conduction from ____ to ___ node

PR interval: ______

Treatment:

A

SA to AV node

> 0.20s

Assess for decreased CO
12-lead ECG
Check electrolytes

can develop into 2nd degree block

36
Q

2nd Degree Block Type 1: _________ PR intervals

An increasing _______ of conduction at level of AV node until a _____ is dropped

“Longer, longer, longer drop”

QRS ______ when present

Treatment:

A

Lengthening

Delay; QRS

Narrow

1) Assess for decreased CO, 12-lead
2) Check electrolytes, adjust medications
3) AIP - atropine, isuprel, pacing

37
Q

2nd Degree Block Type 2: _____ ventricular rate

P-waves with missing QRS complexes

Treatment:

NO ________

A

Irregular

Treatment:

1) Assess for decreased CO
2) 12-lead, check electrolytes + medications
3) Pacing and Pacemaker
4) Prep the crash cart!!!

NO ATROPINE

38
Q

3rd Degree Block: P-P regular & R-R regular

Asymptomatic treatment:

Symptomatic treatment:

A

Asymptomatic: monitor patient and prep to pace

Symptomatic: PIED – pacing, isoprel, epinephrine, dopamine

39
Q

Atrial flutter: ______ rhythm with ______ appearance

QRS ______

Stable:

Unstable:

A

Atrial flutter: REGULAR rhythm with SAWTOOTH appearance

QRS narrow

Stable: BB, CCB, antiarrhythmic

Unstable: synch cardioversion

40
Q

Atrial fibrillation: ________ rhythm

QRS _______

Stable:

Unstable:

Anticoagulation if a-fib is > ____hrs or unk

A

Atrial fibrillation: IRREGULAR rhythm

QRS narrow

Stable: antiarrhythmic

Unstable: synched cardioversion

Anticoagulation if a-fib is > 48hrs or unk

41
Q

SVT: impulse generated ______ ventricles, regular

HR > ______ bpm

Treatment:

A

SVT: impulse generated ABOVE ventricles, regular

HR > 150 bpm

Treatment:

1) Assess for decreased CO
2) Adenosine, BB, CCB
3) Synch cardioversion if unstable

42
Q

Ventricular Tachycardia: WIDE QRS, REGULAR RHYTHM

PULSE:

PULSELESS

A

Ventricular Tachycardia: WIDE QRS, REGULAR RHYTHM

PULSE: synch cardioversion, adenosine, amiodarone

PULSELESS: CPR, defibrillate + epi/amiodarone

43
Q

Torsades de Pointe: Irregular

Caused by prolonged _____ interval

Treatment

A

Torsades de Pointe: Irregular

Caused by prolonged _____ interval

Treatment:

1) 2mg Mg IVP
2) If it does not revert, then SHOCK

44
Q

Ventricular Fibrillation:

Treatment

A

SHOCK, EPI, AMIODARONE

45
Q

Asystole and PEA:

Both are _____-_______ rhythms!!!

Immediate ______ and continue until transition to a ______ rhythm

Administer ______

A

Asystole and PEA:

Both are non-shockable rhythms!!!

Immediate CPR and continue until transition to a SHOCKABLE rhythm

Administer Epi!!

46
Q

Pulseless V-Tach vs PEA

Pulseless V-tach: ____ is the issue and requires a _____ to reset

PEA: ______ is not the issue and therefore it is ______-__________

A

Pulseless V-Tach vs PEA

Pulseless V-tach: CONDUCTION is the issue and requires a SHOCK to resert

PEA: CONDUCTION is not the issue and therefore it is non-shockable

47
Q

5 Hs

A

Hypovolemia
Hypoxia
Hydrogen Ions
Hypo/Hyper-kalemia
Hypothermia

48
Q

5 Ts

A

Tension pneumothorax
Tamponade
Toxins
Thrombosis, pulmonary
Thrombosis, cardiac

49
Q

When is pacing used?

A

Bradycardic arrhythmias

Escape rhythms
Heart Blocks
Sinoatrial arrest and block

50
Q

When is cardioversion used?

A

Tachy-arrhythmias

Atrial Fibrillation
Atrial Flutter
SVT
Ventricular Tachycardia w/ pulse

51
Q

When is defibrillation used?

A

ONLY with pVT and VF

52
Q

What do you do with a patient with asystole or PEA?

A

You start CPR and attach pads until a shockable rhythm is detected + administer Epi/Amiodarone

53
Q

For which rhythm do you NOT administer LIDOCAINE?

A

Ventricular escape rhythm - can worsen bradycardia

54
Q

For which rhythm do you NOT administer ATROPINE?

A

2nd Degree Type 2 - can progress to 3rd degree block

55
Q

What part of the complex does cardioversion sync with?

A

R-wave

56
Q

What is atropine used for?

A

Treat bradycardia/asystole

57
Q

What is lidocaine used for?

A

Ventricular tachyarrhythmias (VT, VF, PVCs)

58
Q

What is the 1st line of defense for hypotension?

What is recommended before administering this medication?

When is it contraindicated?

A

Levophed (Norepinephrine) - causes vasoconstriction

Treat hypovolemia first - administer bolus

In patients with heart failure

59
Q

How is Epi administered?

A

First-line medication treatment for bradycardias/asystole

Give 1mg IVP q3-5 minutes until ROSC or code is called

60
Q

What does sympathomimetic mean? What is an example and what are the manifestations?

A

Sympathomimetics are drugs that mimic the stimulation of the sympathetic nervous system

Ie - Epi

Hyperglycemia, HTN, arrhythmias

61
Q

When is dopamine used (x4)? Mid dose vs high dose?

What to do before administering dopamine?

A

Hypotension + heart failure + increased renal perfusion

Also used for bradycardia (ventricular escape rhythm, 3rd degree block)

Mid-dose: Inotropic effect - increase contractility
High-dose: Vasoconstriction - hypotension

Treat hypovolemia first - administer a bolus

62
Q

What is lidocaine?

What is it used to treat?

What do you need to watch out for when administering lidocaine?

A

Lidocaine is an antiarrhythmic

Used to treat ventricular tachyarrhythmias (VT, VF, PVCs)

Lidocaine toxicity cause lead to bradycardia –> cardiac arrest –> Stop immediately

63
Q

What is amiodarone?

What does it treat?

What is the recommended alternative to amiodarone?

A

First-line anti-arrhythmic

Tachyarrhythmias (VT, VF, pVT, a-fib)

Lidocaine is the recommended alternative

64
Q

What is used to treat hypertensive emergencies?

How should it be infused?

Nursing considering during infusion?

A

Labetalol - used to decrease BP and preload/afterload

Infuse slowly

Pt should remain supine for 3 hours

65
Q

What is adenosine used for?

A

Treat tachyarrhythmias - helps to lower HR

ACU COURSE (8 decks)

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