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Critical Care > Ventricular Dysrhythmias > Flashcards

Ventricular Dysrhythmias Flashcards

1
Q

What are ventricular dysrhythmias?

A

Slow, abnormal, non-simultaneous depolarization of ventricles at a rapid rate

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2
Q

What does the QRS of a ventricular dysrhythmia look like?

A

Large, wide QRS

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3
Q

Where is the p wave in a ventricular dysrhythmia?

A

Usually hidden in the QRS

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4
Q

What are the 3 H’s (causes) of ventricular dysrhythmias?

A

Heart disease
Hypoxia
Hypokalemia

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5
Q

What does a decreased CO lead to a loss of?

A

Atrial kick

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6
Q

What are the 12 reversible causes of ventricular dysrhythmias called?

A

Hs and Ts

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7
Q

What are the Hs of the Hs&Ts?

A

Hypovolemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia

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8
Q

What are the Ts of the Hs and Ts?

A

Tension pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (PE)
Thrombosis (MI)

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9
Q

What does the QRS look like during a PVC?

A

Wide

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10
Q

What are types of PVCs?

A

unifocal, multifocal, bigeminy, trigeminy

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11
Q

List 4 types of ventricular dysrhythmias

A

PVCs
V tach
V fib
Torsades de Pointes

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12
Q

What is the definition of a PVC?

A

Ectopic impulses that originate in the ventricle that discharge before the next sinus is due

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13
Q

There is no __ wave associated with PVCs

A

P wave

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14
Q

How long in seconds is the qrs of a PVC?

A

> 0.12 seconds

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15
Q

What does the HR look like in someone having PVCs?

A

Regular except for when premature beat interrupts

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16
Q

What is the r to r interval for a PVC?

A

It’s equal

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17
Q

What are unifocal PVCs?

A

All originate from the same ventricular location, so their configuration looks identifcal

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18
Q

List 5 types of PVCs

A

Unifocal
Couplets
Multifocal
Bigeminy or bigeminal
Trigeminy or trigeminal

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19
Q

What is a couplet PVC?

A

Two PVCs originating from the same ventricular location that occurs togethers

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20
Q

What is a multifocal PVC?

A

A PVC that originates at two or more ventricular locations and therefore have different configurations

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21
Q

What is a bigeminy PVC?

A

Repeated pattern of one normal SA node-initiated beat followed by one PVC

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22
Q

Bigeminy PVCs occur at…

A

every other beat

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23
Q

Trigeminy PVCs occur at…

A

every two beats

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24
Q

What is a trigeminy PVC?

A

Repeated pattern of two normal beats followed by one PVC

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25
Q

If the PVCs look the same they are…

A

unifocal

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25
Q

If the PVCs look the same they are…

A

unifocal

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26
Q

PVCs that look uniform =

A

unifocal

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27
Q

What type of dysrhythmia is this?

A

Unifocal PVC

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28
Q

What type of dysrhythmia is this?

A

Couplet PVC

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29
Q

Two PVCs that occur together are called…

A

Couplet

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30
Q

What type of dysrhythmia is this?

A

Multifocal PVC

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31
Q

Multifocal PVCs can have many forms such as…

A

One flipped on positive axis
One flipped on negative axis

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32
Q

Which is worse, multi, couplet or unifocal PVCs?

A

Multifocal PVCs because multiple places in the ventricle are firing

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33
Q

What type of dysrhythmia is this?

A

Bigeminy PVC

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34
Q

What type of PVC occurs every other beat?

A

Bigeminy

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35
Q

How frequent to bigeminy PVCs occur?

A

Every 2nd beat

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36
Q

What PVC can be characterized as having “bunny ears”?

A

Bigeminy PVC

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37
Q

How can you differentiate between a bigeminy PVC and a couplet PVC?

A

Bigeminy PVCs occur at every other beat

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38
Q

What type of dysrhythmia is this?

A

Trigeminy PVC

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39
Q

Is it normal to occasionally have a PVC?

A

Yes, many people will occasionally have a pVC

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40
Q

What are common causes of a PVC?

A

Hypokalemia
Hypomagesemia
Hypoxia/hypoxemia
Caffeine
Tobacco
Stress
Reperfusion after lysis of a clot (Acute MI)

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41
Q

How do you treat PVCs?

A

Treat the cause!

42
Q

If someone is having a PVC, what amount is criteria for a concern?

A

More than 6 per minute or three in a row

43
Q

What types of PVCs are a cause for concern?

A

Couplet PVCs
More than 3 ina row
Multifocal
PVC occurring in R on T

44
Q

What does a multifocal PVC indicate?

A

Ventricular irritability

45
Q

What does a PVC occurring in R on T mean?

A

Down stroke of the t-wave during relative refractory or vulnerable period

46
Q

What type of dysrhythmia is this?

A

PVC occurring in R on T

47
Q

What causes a R-on-T phenomenon?

A

a ventricular depolarization superimposing on the previous beat’s repolarization

48
Q

What is the danger of a R-on-T phenomenon?

A

It can cause someone to go into cardiac arrest

49
Q

What type of dysrhythmia is this?

A

Ventricular tachycardia

50
Q

Where are the p-waves in ventricular tachycardia?

A

You cannot see them, usually absent

51
Q

What is the R-R interval like in ventricular tachycardia?

A

Usually regular

52
Q

What does the QRS look like in ventricular tachycardia?

A

Wide and bizarre

53
Q

What the the heart rate of someone experiencing ventricular tachycardia?

A

100-250 bmp

54
Q

What are common causes of ventricular tachycardia?

A

Poor oxygenation/decreased CO
Increase in catecholamines
Electrolyte imbalances
MI/ischemia
Acute heart failure
Drugs
Etc

55
Q

What two catecholamines are a potential cause of ventricular tachycardia?

A

Epinephrine
Norepinephrine

56
Q

What two electrolyte imbalances are potential causes of ventricular tachycardia?

A

Potassium and/or magnesium

57
Q

What is a slow ventricular tachycardia?

A

Heart rate of 100-150

58
Q

What is a fast ventricular tachycardia?

A

Heart rate greater than 150

59
Q

If someone is experiencing ventricular tachycardia, what two things must you always check?

A

LOC and pulse

60
Q

What is important concerning pulse checks and ventricular tachycardia?

A

You can have pulse and pulseless ventricular tachycardia

61
Q

If someone is experiencing a SLOW ventricular tachycardia, initially the may…

A

Have compensated CO but will deteriorate quickly

62
Q

Does someone with fast ventricular tachycardia have CO compensation?

A

No, there is not enough filling time and the patient will decompensate quickly

63
Q

What is the main function of amiodarone?

A

Antiarrhythmic

64
Q

How does amiodarone work?

A

Blocks potassium channels thereby delaying repolarization and prolonging refractory period
Also affects sodium and calcium with alpha and beta blocking properties

65
Q

What is another name for the refractory period on an EKG?

A

QT interval

66
Q

Amiodarone works by prolonging…

A

QT interval

67
Q

Amiodarone works by delaying…

A

repolarization

68
Q

Amiodarone is used as a first line agent for which dysrhythmias?

A

Ventricular tachycardia
Ventricular fibrillation
Uncontrolled atrial fibrillation

69
Q

What is the IV loading dose of amiodarone?

A

150mg over the first 10 minutes

70
Q

How is the IV loading dose of amiodarone diluted?

A

Dilute 150 mg in 100 ml of D5W

71
Q

After the IV loading dose of amiodarone, what is the next dose?

A

After 10 minutes, 360mg over the next 6 hours (1mg/min)

72
Q

After the IV loading dose of amiodarone, and the next maintenance dose, what is the remaining dose for amiodarone?

A

540mg over next 18 hrs (0.5mg/min)

73
Q

After a patient is stabilized, how is amiodarone given?

A

PO to bridge the gap after IV is tapered off

74
Q

What are the side effects of amiodarone?

A

Headache
Dizziness
Hypotension
Bradycardia
Blue-gray skin color

75
Q

What are symptoms that a patient is not tolerating amiodarone well?

A

Hypotension and bradycardia

76
Q

What are two types of defibrillators?

A

Monophasic
Biphasic

77
Q

What is a monophasic defibrillator?

A

Energy goes in one direction, requires more energy

78
Q

What type of current does a monophasic Lifepak defibrillator have?

A

Fixed current to deliver 200-360 joules

79
Q

What type of defibrillator is a biphasic zoll?

A

Delivers energy in two different directions, uses less energy

80
Q

What type of current is the biphasic zoll?

A

Can manually or automatically adjust strength of current to deliver 120-200 joules

81
Q

What is the advantage of a biphasic zoll over a monophasic lifepak?

A

Less tissue damage due to less current

82
Q

What can an elective cardioversion cause?

A

It can cause an R-to-T phenomenon which can put patient into a life threatening dysrhythmia

83
Q

What is an elective cardioversion?

A

Form of shock that delivers an electrical current that is synchronized with the patient’s heart rhythm

84
Q

When is an elective cardioversion typically used?

A

For SVT, Afib, a flutter, V tach, and unresponsive to meds

85
Q

What must you do before an elective cardioversion?

A

Must “sync” prior to shocking

86
Q

What should you do if an initial cardioversion is unsuccessful?

A

Repeat using higher voltage

87
Q

Defibrillation is an __ procedure

A

emergency

88
Q

When is defibrillation used?

A

Pulseless ventricular tachycardia
Ventricular fibrillation
Torsades de pointes

89
Q

What is defibrillation?

A

Unsynchronized electrical shock that administers large amount of joules

90
Q

What must the nurse do before administering the shock during defibrillation?

A

Announce “all clear”

91
Q

What is this dysrhythmia?

A

An example of synchronized cardioversion

92
Q

How many joules is given during synchronized cardioversion?

A

100 joules, up to 200 joules

93
Q

What should the nurse say to the patient before elective cardioversion?

A

Obtain consent
Educate patient regarding cardioversion and what to expect during procedure

94
Q

What does the nurse want IV wise for a patient undergoing an elective cardioversion?

A

At least two good working IVs, large bore greater than 20g

95
Q

If a patient is hemodynamically stable, what should the nurse administer before cardioversion?

A

Light sedation

96
Q

When is light sedation before a cardioversion contraindicated?

A

If the patient is hemodynamically unstable

97
Q

What should the nurse make sure is done before starting an elective cardioversion?

A

Ensure optimal pad placement
Make sure Oxygen/Ambu bag in place
Ensure BP is cycling every 2-3 minutes

98
Q

What is the exception to making sure a patient has blood pressure readings taken every 2-3 minutes during a cardioversion?

A

If the patient has an arterial line

99
Q

What should be obtained both before and after an elective cardioversion?

A

EKG strip for documentation

100
Q

Who should assist the nurse with an elective cardioversion?

A

RT, physician or APP at bedside

101
Q

What is the difference between pulseless ventricular tachycardia and pulseless electrical activity?

A

PEA has a normal rhythm
Pulseless VT has a disorganized rhythm

102
Q

Why is there no pulse in pulseless cardiac output?

A

The heart is not contracting effectively enough to generate a pulse, which means no cardiac output

Critical Care (2 decks)

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