VENTRICULAR RHYTHMS Flashcards
VENTRICULAR ESCAPE BEAT
(P wave, PRI, QRS, RATE, RHYTHM)
-A ventricular ectopic beat that occurs after a pause in which the supraventricular pacemaker fails to initiate an impulse
P wave/PRI: No P waves/No PRI
QRS: .12 secs or more Wide and “bizarre” T wave of QRS
Rate: 6 sec method, Atrial & ventricular rates based on underlying rhythm
Rhythm: Upright P waves (if present): irregular Ventricular rhythm: irregular
- -protective mechanism (protects the heart from even more slowing or asystole)*
- -occurs LATE in the cardiac cycle*
IDIOVENTRICULAR RHYTHM (IVR)
(P wave, PRI, QRS, RATE, RHYTHM)
Three or more sequential ventricular escape beats occurring at a rate of 20 to 40 beats/min
P wave/PRI: No P waves/ No PRI
QRS: .12 secs or more
Wide and “bizarre”
T wave opposite of QRS
RATE: 20-40 BPM
RHYTHM: Atrial: None (pacemaker in the ventricles!)
Ventricular: Regular
ACCELERATED IDIOVENTRICULAR RHYTHM (AIVR)
(P wave, PRI, QRS, RATE, RHYTHM)
P wave/PRI: No P waves/ No PRI
QRS: .12 secs or more
Wide and “bizarre”
T wave opposite of QRS
RATE: 41-100 BPM
RHYTHM: Atrial: None
Ventricular: Regular
AIVR is often seen during the first 12 hours of a myocardial infarction and is particularly common after successful reperfusion therapy. AIVR is seen in both anterior and inferior MI and in 90% of patients during the first 24 hours after reperfusion.[i] AIVR has been reported in 10% to 40% of patients with acute MI.[ii] AIVR has been reported in patients with digitalis toxicity, subarachnoid hemorrhage, and in patients with rheumatic and hypertensive heart disease.
VENTRICULAR TACHYCARDIA (VTACH/VT) [monomorphic VT]
[Q,S,T WAVES]- THINK CUTIES (QTS) //(if upside down and point is up it is [R,T]
P wave/PRI: No P waves/ No PRI
QRS: .12 secs or more
Wide and “bizarre”
T wave opposite of QRS
RATE: 101-250 BPM
RHYTHM: Atrial: None
Ventricular: Regular
TORSADE de POINTES (TdP)
[Polymorphic VT)
(EKG CHARACTERISTICS)
P wave/PRI: No P waves/ No PRI
QRS: .14 secs or more
Wide and “bizarre”
T wave opposite of QRS
RATE: 150-300 BPM
RHYTHM: Atrial: None
Ventricular: Regular or IRREGULAR
NURSING INTERVENTIONS FOR IDIOVENTRICULAR RHYTHM (IVR) & ACCELERATED IDIOVENTRICULAR RHYTHM (AIVR)
Vital Signs (incl SPO2)
Assess for shock
Low HOB for hypotension
Oxygen if hypoxic
Assess for angina
IV access is symptomatic
12 Lead EKG
- *Identify & tx poss causes (hold neg. chronotropic, DROMOTROPIC meds)**
- -Hold amiodarone, lidocaine, procainamide, digoxin*
PHARMACOLOGIC AND ELECTRICAL TREATMENT FOR FOR IDIOVENTRICULAR RHYTHM (IVR)
PHARM: Atropine (0.5mg IV) (positive chronotropic agent)- if symptomatic
Isoproterenol (Isuprel) (if symptomatic)
ELECTRIC: Pacing- If rate is slow and unresponsive to meds
- Isuprel is a synthetic derivative of adrenaline*
- Isoproterenol is a beta-1 and beta-2 adrenergic receptor agonist [positive inotropic agent] indicated primarily for bradydysrhythmias.*
- Hold amiodarone, lidocaine, procainamide, digoxin*
PHARMACOLOGIC AND ELECTRICAL TREATMENT FOR FOR ACCELERATED IDIOVENTRICULAR RHYTHM (AIVR)
PHARM:
Treatment unnecessary if pt. is asymptomatic
Atropine (0.5mg IV) - is symptomatic
ELECTRIC:
Pacing- If rate is slow and unresponsive to meds
If the patient is asymptomatic, no treatment is necessary. If the patient is symptomatic because of the loss of atrial kick, atropine may be ordered in an attempt to block the vagus nerve and stimulate the SA node to overdrive the ventricular rhythm, or transcutaneous pacing may be attempted. Medications to suppress the ventricular rhythm (e.g., lidocaine) should be avoided because this rhythm is protective and often transient, spontaneously resolving on its own.
NURSING INTERVENTIONS FOR VTACH AND TORSADE de POINTES (TdP)
Check pulse 1st – if none (call code blue, start CPR, ambu-bag pt, IV access)
**_If there is pulse,_** Vital Signs (incl SPO2)
Assess for shock
Low HOB for hypotension
Oxygen if hypoxic
Assess for angina
IV access is symptomatic
12 Lead EKG
Identify and treat reversible causes (VTAC ONLY)
-for TdP: Prepare to give 1-2 G Magnesium over 5-60 min, followed by IV infusion of 0.5 mg- 1 G/hr (slowly because painful)
PHARMACOLOGIC AND ELECTRICAL TREATMENT FOR VTACH/VT
PHARM: Epinephrine 1 mg every 3- 5 minutes
ELECTRIC: Defibrillation
- biphasic 120-200 J (IED)
- monophasic 360 J
PHARMACOLOGIC AND ELECTRICAL TREATMENT FOR TORSADE de POINTES (TdP)
PHARM:
Epinephrine 1mg every 3-5 minutes
Prepare to give 1-2 g Magnesium IV over 5-20 mins
ELECTRIC:
Defibrillation
-biphasic 120-200 J
-monophasic 360 J
NURSING INTERVENTIONS FOR V-FIB (6)
Check for pulse 1st!
No pulse, call Code Blue
Start CPR
Ambu-bag the patient
IV access
Identify and treat reversible causes
- *Fine VF- Low amp waves < 3 mm**
- *Corse VF- LAMF waves > 3 mm**
NURSING INTERVENTIONS FOR ASYSTOLE/PEA (7)
ALWAYS check for pulse 1st!
No pulse, call Code Blue
Start CPR
Confirm asystole in 2 different leads
Ambu-bag the pt
IV access
Identify and treat reversible causes
PHARMACOLOGIC AND ELECTRICAL TREATMENT FOR V-FIB
PHARM: Epinephrine 1mg every 3-5 minutes
ELECTRIC:
Defibrillation
-biphasic 120- 200 J
-monophasic 360 J
PHARMACOLOGIC AND ELECTRICAL TREATMENT FOR ASYSTOLE/PEA (PULSELESS ELECTRICAL ACTIVITY)
PHARM:
Epinephrine 1 mg every 3-5 minutes
ELECTRIC:
*only if rhythm is shockable
Defibrillation (for VF or pulseless VT)
-biphasic 120-200 J
-monophasic 360 J
PEA (PULSELESS ELECTRICAL ASYSTOLE)
PEA is not a shockable rhythm. If the patient is in PEA, continue CPR and giving epinephrine (1 mg every 3-5 minutes) until the rhythm reduces into a shockable rhythm (VF or pulseless VT) or there is a return of spontaneous circulation (ROSC)
HYPOVOLEMIA AND HYPOXIA ARE TWO MOST COMMON REVERSIBLE CAUSES
*only if rhythm is shockable Defibrillation (for VF or pulseless VT) -biphasic 120-200 J -monophasic 360 J
