Rhythm Interpretations and Intervention Flashcards
Normal Sinus Rhythm
Continue to monitor
Sinus Tachycardia
- Assess patient
- identify and treat underlying causes (pain, fever, anxiety)
Sinus Bradycardia
- Assess patient
- If symptomatic: call a RR or get provider to the bedside; identify and treat possible causes
- Atropine 1 mg. Repeat every 3-5 min. Max: 3 mg
- TCP (Transcutaneous pacing)
- PPM (Permanent pacemaker)
- Dopamine 2-20 mg/kg/min
- Epinephrine 2-10 mcg/min
Premature Atrial Contractions (PAC)
- Assess patient; usually benign
- identify and treat possible causes
Atrial Tachycardia/ Paroxysmal AT/SVT
- Goal: control the ventricular rate and converting the rhythm
- Stable: sedation may lower HR; Vagal Maneuvers; Adenosine 6mg IV rapid infusion (if first dose not effective may give second dose of 12 mg IV rapid infusion); rate control (Beta or Calcium channel blockers)
- Unstable: Call RR or MD; Synchronized Cardioversion at 50-100 Joules (consider pre-sedation)
Atrial Flutter
> Stable:
-identify and treat reversible causes
-Rate control: Beta blockers or Calcium channel blockers (diltiazem 0.25mg/kg over 2 min, follow w/ infusion)
-Rhythm control: Onset <48 hours synchronized cardioversion at 50-100 joules; amiodarone 150 mg IVP x 10 min
Onset >48 hours anti-coagulate w/ low intensity heparin; synchronized cardioversion at 50-100 joules
> Unstable: call RR or get MD to bedside; synchronized cardioversion at 50-100 joules (consider pre-sedation); anti-arrhythmic post rhythm conversion; radio frequency catheter ablation
Atrial Fibrillation
- Assess patient
- anti-coagulate w/ low intensity heparin
- narrow irregular complex
- synchronized cardioversion at 120-200 joules
Premature Junctional Contractions (PJC)
- Assess patient
- usually benign
- identify and treat possible causes
Junctional Rhythm
- If HR is slow and patient symptomatic, call RR or get provider to bedside
- same tx as sinus bradycardia; Atropine 1 mg. Repeat every 3-5 minutes. Max: 3mg; TCP, PPM, Dopamine 2-20 mg/kg/min, Epinephrine 2-10 mcg/min
Accelerated Junctional Tachycardia
- assess patient
- identify and treat possible causes
Junctional Tachycardia
- Assess patient
- identify and treat possible causes
- Beta or Calcium channel blockers, Amiodarone
Normal Sinus Rhythm w/ First Degree AV block
- Assess patient
- check medications for possible cause
Second degree AV block Type 1/ Mobitz 1/ Wenckebach
> Stable: notify MD if new for patient; asses patient; check medications for possible cause
> Unstable: call a RR or get MD to bedside; tx same as sinus bradycardia (Atropine 1 mg. Repeat every 3-5 min. Max: 3 mg.; TCP, PPM, Dopamine 2-20 mcg/kg/min, Epinephrine 2-10 mcg/min)
Second Degree AV Block Type II/ Mobitz II
- assess patient
- if symptomatic call RR or get provider to bedside
- prepare for pacemaker
- review meds for possible cause
Third degree AV block/ Complete Heart Block
- Call a RR if new onset
- Emergent transcutaneous pacing and prepare for permanent pacemaker
- Dopamine or Epinephrine IV to treat symptoms
Premature Ventricular Contraction (PVC)
- monitor for increased frequency
- assess patient
- infrequent/asymptomatic: no treatment
- frequent/symptomatic: identify and treat possible causes (especially electrolytes); Anti-arrhythmics: Amiodarone 150 mg IV over 10 min, Lidocaine 1-1.5 mg/kv IV
Ventricular Tachycardia (VT): Stable w/ pulse
- call a RR
- antiarrhythmics
- amiodarone 150 mg/100 ml D5W x 10 min
- procainamide
Ventricular Tachycardia (VT); Unstable w/ a pulse
- call a RR
- synchronized cardioversion 100 joules
Ventricular Tachycardia (VT); w/o a pulse
- start CPR, call a code, get code cart to bedside
- defibrillate 120-200 joules
Torsades de Pointes
- assess for pulse, no pulse start CPR
- call a code and get code cart to bedside
- defibrillate 120-200 joules
- Magnesium 1-2 gm/10 ml D5W x 5 min, followed by 0.5 to 1 gm/hr IV drip
Ventricular Fibrillation (Vfib)
- Start CPR, call a code, get coder cart to bedside
- Defibrillate 120-200 joules
- Epinephrine 1 mg IV/IO every 3-5 min
- CPR- Shock- CPR- drug sequence
- Anti-arrhythmics: Amiodarone, Lidocaine
Idioventricular Rhythm (IVR)
- Assess Patient
- Symptomatic: call RR or get provider to bedside; Pacing (TCP until TVP); Vasopressors (Dopamine 2-20 mcg/kg/min IV, Epinephrine 2-10 mcg/kg/min IV)
Accelerated Idioventricular Rhythm (AIVR)
- assess patient
- usually no treatment
Asystole/ Ventricular Standstill
- Check you patient!, check for pulse
- no pulse, start CPR
- call CODE, get code cart to bedside
- Epinephrine 1 mg IVP every 3-5 min
- Consider H’s and T’s
100% Paced and Captured Rhythm
- continue to monitor
- pacemaker working properly
Failure to Pace
- Assess patient
- If permanent: attach defibrillator pads b/c patient will need transcutaneous pacing; have patients pacemaker interrogated
- If transvenous or epicardial: replace battery; check connections; avoid EMI exposure; check on/off button (turn on pacer)
Failure to Capture
- assess patient
- If permanent: attach defibrillator pads b/c patient will need transcutaneous pacing; have patients pacemaker interrogated
- If transvenous or epicardial: increase mA; check connections; turn pt. to left side, MD to reposition lead; check electrolyte balance and treat as needed; may consider TCP
Failure to Sense
> Under-sensing:
- If permanent: attach defibrillator pads b/c patient will need transcutaneous pacing; have patients pacemaker interrogated
- If transvenous or epicardial: increase sensitivity; turn pt. to left side, MD to reposition lead; turn dial to demand/synchronous mode; decrease sensitivity
> Over-sensing
-If transvenous or epicardial: decrease sensitivity
