Ventricular Rhythms Flashcards
Steps for interpreting EKGs
> Is it regular or irregular?
-look at the P-P (atrial) if present and R-R (ventricular)
> What is the rate?
> Are there P waves?
- do they look the same or are they different?
- is there a P wave in front of every QRS?
> If there are P waves, is there a regular PR interval?
-is it 0.12-0.20 seconds?
> What does the QRS look like?
- narrow (< 0.10)- above ventricles
- wide (> 0.10)- above the ventricles- wide QRS
- wide (> 0.10)- below the ventricles
> What is the QT interval?
- is it between 0.36-0.44 seconds?
- normal QT should be less than half the R-R interval (less than R-R interval is normal, the same it is borderline, and longer it is prolonged)
> Interpretation?
Intervention?
Ventricular Rhythms
Originate below the bundle of HIS; this is why the QRS is so wide and bizarre
-normal ventricular rate is 20-40 bpm
>the shape of the QRS is influenced by the site of origin
-the origin occurs below the bundle of HIS
-may originate from any part of the ventricles
-abnormally shaped
-QRSs are much wider than those that originate above the ventricles (greater than 0.12 seconds (normal is
Premature Beats- Early Beats
premature beats appear early before the next expected beat
-its an early beat originating from n ectopic site, which interrupts the regularity of the basic rhythm
-occurs in addition to the basic underlying rhythm
-a PVC is a single neat, not an entire rhythm (always identify underlying rhythm)
-rhythm will be regular except for the early beat- makes the rhythm appear “irregular”
-premature beats are identified by their site of origin
>PVCs originate in the ventricular area
Premature Ventricular Contraction (PVC) on EKG
occurs when an irritable site within the ventricles discharges early before the next underlying impulse is due to discharge
- can originate anywhere in the ventricles
- QRS: wide and bizarre (>0.12 seconds)
Patterns of a PVC
- Isolated PVC: occur alone
- Pair/Couplet: two consecutive PVCs
- Burst/Run: three or more ventricular beats in a row
- Configuration of a PVC: unifocal (look same) or multifocal (look different)
- Ventricular BIgeminy- every other beat is a PVC
- Ventricular Trigeminy- every third beat is a PVC
- Ventricular Quadrigeminy- every fourth beat is a PVC
Interventions for a PVC
- assess patient; unstable or stable?
- identify and treat underlying causes; check O2, electrolytes, what drugs or medications are they taking
- if unstable, call RR, notify MD
- medications to treat PVC: amiodarone, lidocaine, procainamide
- always identify underlying rhythm
Interventions for a PVC
- assess patient; unstable or stable?
- identify and treat underlying causes; check O2, electrolytes, what drugs or medications are they taking
- if unstable, call RR, notify MD
- medications to treat PVC: amiodarone, lidocaine, procainamide
- always identify underlying rhythm
Idioventricular Rhythm
- three or more ventricular beats occur in a row at a rate of 20-40 bpm
- P waves: none
- PR interval: none
- QRS complex: >/= 0.12 seconds
- QT interval: not measurable
Interventions for Idioventricular Rhythm (IVR)
-assess patient
>Unstable: call RR; pacing (TCP until TVP)
-vasopressors: Dopamine 2-20 mg/kg/min IV; Epinephrine 2-10 mcg/kg/min IV
Accelerated Idioventricular Rhythm (AVIR)
three or more ventricular escape beats occur in a row at a rate of 41-100 bpm
- P waves: none
- PR interval: none
- QRS complex: >/= 0.12 seconds
- QT interval: not measurable
Interventions for Accelerated Idioventricular Rhythm (AVIR)
- assess patient
- usually no treatment
Idioventricular Vs Junctional Rhythms
note the wide QRS in the idioventricular rhythm
- Idioventricular: wide QRS (happens in ventricles)
- Junctional: narrow QRS
Ventricular Tachycardia (VT)
series of 3 or more consecutive PVCs at a rate of >100 bpm
- monomorphic: look the same
- polymorphic (Torsade de pointes) : look different
Interventions for Ventricular Tachycardia (VT)
-assess patient: Pulse or no pulse >Stable w/ pulse: -call a RR -get provider to bedside -anti-arrhythmics -Amiodarone 150mg/100 ml DSW x 10 min -Procainamide
> Unstable with a pulse:
- call a RR, get provider to bedside
- Synchronized cardioversion
> Unstable w/o a pulse:
- start CPR
- call a code, get code cart to bedside
> polymorphic VT (torsades)
- Mg sulfate
- 1-2 gm in 10ml D5W- load over 5-60 min IV
- follow w/ 0.5-1 gm per hour, titrate to control torsades
- defibrillate 120-200j
Defibrillation
-delivery of an UNSYNCHRONIZED direct current to the external chest wall to eradicate life threatening arrhythmias
-opportunity for the “natural” pacemaker to resume normal activity
-restores coordinated electrical and mechanical pumping action of heart
>used only for: Pulseless VT and V-Fb
