Week 8 - Basic EKG Review Flashcards
What is included in the AANA & ASA standards of basic monitoring?
Continuous ECG, Pulse ox, Temp, Ventilation, HR & BP every 5 min at least
*basic monitoring is meant to insure patient safety, cover ABCs
What is the purpose of the ECG monitor?
- Gives us a picture of the heart
- Lets us know how the patient is doing
- Always relate the rhythm seen to other data to get the whole clinical picture
- Base treatment decisions on the whole picture
What two leads are typically monitored for ECG? Why?
Usually lead II and V5
Looks at both sides of the heart – RCA and the left side
What are the steps in rhythm identification of an ECG?
- Is it regular?
- Is there P waves, are they regular in size and shape?
- Does the QRS follow every P wave?
- Are they regular in size and shape?
- What are all the intervals?
- What does the ST segment look like?
- What does the QT look like?
- Are there any aberrant beats?
What steps should you go through if there is a rhythm change?
- Look to see how the pt is tolerating the change
- Think of what may have caused the change
- Base treatment on the answers from above
- Think of the risks of your treatment, and the risk of doing nothing
- Know how long you have to act – its a guess
What are the causes and treatment of Sinus Tachycardia?
HR > 100 (relative)
Causes: sympathetic stimulation, pain, hypovolemia, ischemia, impending CHF
Treatment: control pain, increase anesthetic depth, volume, beta blocker
*only use BB after doing the previous treatments – it is a last resort treatment
What are the causes and treatment of Sinus Bradycardia?
Sinus with HR < 60 (relative)
Causes: reflexes, volatile agents (Iso - too deep), loss of sympathetic tone, digoxin toxicity
Treatment:
- removal of offending agent (tugging on the eye, insufflation)
- atropine or glycopyrrolate
- inotropic agents (beta agonists)
- sympathomimetics (role of Phenylephrine and Ephedrine)
What are the causes and treatment of atrial fibrillation?
Irregular R-R, absence of P waves — Controlled if rate <100, likely chronic
Causes: mitral valve disease, CHF, hypoxia, hypovolemia, ischemia, electrolytes, cardiac surgery
Treatment: assess tolerance of loss of atrial kick, continuous fluids, reverse hypoxia, beta blockers, amiodarone, cardioversion
-less likely = diltiazem gtt (myocardial depressant on top of volatile agent), digoxin, procainamide
- *Caution - Ca+ blockers and anesthetics do not mix
- *Look for anticoagulant while doing preop
What are the causes and treatment of Atrial Flutter?
Sawtooth P wave pattern – Atrial Rate >150 and Ventricular Rate is variable
Causes: HTN, COPD, CAD, Dilated cardiomyopathy, ETOH intoxication, thyrotoxicosis
Treatment: if compromised, cardiovert (be ready to pace)
-beta blockers, calcium channel blockers, amiodarone
- May diagnose with carotid massage or adenosine
- Usually paroxysmal, may convert to NSR or A-Fib
What is a AV Junctional Rhythm? How do you treat it?
- Narrow QRS, retrograde, inverted or absent P wave
- Rate usually <60 (if >60 then it is accelerated junctional)
- common during GA, resolves on its own
- if accelerated, consider digoxin toxicity, MI or stress of recent cardiac surgery, also hx of rheumatic fever
- May not respond to atropine, ephedrine may work
- Consider beta blocker to relieve ischemia (common reperfusion rhythm)
- Consider temporary pacing if hemodynamic compromise
What is Accelerated Idioventricular Rhythm? Causes?
- Uniform widened QRS rate <60
- Considered “slow VT” if 60-100
Causes: MI, reperfusion of cardiac surgery, digoxin toxicity, rheumatic fever, cardiomyopathy
- sign of a sick heart, rarely responds to atropine
- avoid the urge to use lidocaine (will worsen the “escape rhythm”) – instead try to relieve ischemia
- be ready to pace
What are the causes and treatment of Ventricular Tachycardia?
Uniform, widened QRS, rate 100-250
Causes: CAD, ventricular dysfunction, recent MI (<96hr), cardiomyopathy, hypokalemia, low Mg, central line placement
Treatment: depends on rate & duration, tolerance, extent of known disease
- amiodarone, lidocaine, possibly procainamide
- ICD placement
What are the causes and treatment of Torsades de Pointes?
Continuously changing, widened QRS, looks like “twisting around a point”
Causes: R on T phenomena (reason for synchronized cardioversion), ischemia
Treatment: magnesium, cardioversion – placement of ICD
- may terminate spontaneously or degenerate to VF
- if associated with relative bradycardia, consider Isuprel, Epinephrine, overdrive pacing
What is the treatment of Ventricular Fibrillation? (ACLS algorithm)
- High Quality CPR
- Shock
- CPR, Access
- Shock
- Epi, Shock (Vasopressin no longer in ACLS)
- Amiodarone (or Lidocaine), -Shock
- CPR, shock, repeat, think 5Hs and 5Ts
- Where is AIRWAY (when it is convenient
- CPR and SHOCKING are the most important components*
What are the 5 H’s and 5 T’s?
Hypovolemia Hypoxia Hydrogen ion Hypo/hyperkalemia Hypothermia
Tension Pneumothorax Tamponade, Cardiac Toxins Thrombosis, Pulmonary Thrombosis, Coronary
