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NUR4630 > Week 8: Cardiac Emergencies and Life Saving Interventions: Part 1 > Flashcards

Week 8: Cardiac Emergencies and Life Saving Interventions: Part 1 Flashcards

1
Q

Pacemaker Cells

A

ability to initiate an electrical impulse within themselves (automaticity)

  • SA node, AV node, Junction, Purkinje fibers
  • SA: originates electrical impulse. Allows working cells to react
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2
Q

excitability

A

ability of all cells to react to electrical impulse

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3
Q

Isometric Line

A
  • Resting membrane potential of cardiac cells
  • There is a lack of movement of ions
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4
Q

As potassium is moved outside of the cells the intracellular potential becomes?

A

increasingly negative

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5
Q

cardiac conduction pathway

A

SA node–>AV node–> Bundle of Hiss—> left and right bundle branches–> purkinje fibers.

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6
Q

SA node

A

Sinus node. Dominant pacemaker of the heart. Upper posterior wall location of the right atrium. Results in the depolarization of the heart.

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7
Q

AV node

A

-located in posterior wall of R atrium below tricuspid valve. Allows atrial conduction to move into ventricular portion of the heart allowing ventricular contraction

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8
Q

lead normally used in ecg monitoring

A

lead 2. Looking through the heart at the patient’s right side of the heart and up into the heart watching the electrical impulse that’s being generated.

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9
Q

p wave

A

arterial depolarization

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10
Q

pq and pr segments

A

conduction through AV node and AV bundle

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11
Q

ST segment

A

ventricles contract

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12
Q

t wave

A

ventricular repolarization

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13
Q

rule of 300

A

Divide 300 by the number of boxes between each QRS = rate

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14
Q

6 second method

A

distance between the number of boxes until you get to the initiation of the second beat. Multiply how many complete complexes you have within 6 seconds, times 10 gets you a heart rate/minute.

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15
Q

normal PR, QRS, and QT

A

PR
0.20 sec (less than one large box)

QRS
0.08 – 0.10 sec (1-2 small boxes)

QT
Half the R-R interval with normal HR
0.38-0.42 seconds

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16
Q

type of rhythm?

Originating from SA node
P wave before every QRS
P wave in same direction as QRS
PR 0.12- 0.20
QRS less than 0.12

A

Sinus:

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17
Q

type of rhythm?

  • Regular rhythm, rate less than 60
  • P waves present before each QRS and between 0.12-.020
  • QRS less than 0.12
A

sinus bradycardia

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18
Q

Treatments of Sinus Bradycardia

A

Atropine
-0.5mg IV bolus
-Repeat every 5 min
-Max dose 3 mg
-Side effects: Dry mouth, Blurred vision, Urinary retention,
Less than 0.5 mg, Slowed heart rate

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19
Q

type of rhythm?

  • Rhythm regular, rate greater 100
  • P Waves present before each QRS, PR interval .12- .20
  • QRS less than 0.12
A

sinus tachycardia

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20
Q

treatment of sinus tachycardia?

A

ID cause and tx
Pain
Anxiety
Infection
CHF
MI

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21
Q

Characterized by:

  • Varied rate with periods of bradycardia and tachycardia
  • Caused by dysfunction of SA node without escape mechanisms
  • Seen in elderly
  • QRS narrow
  • R to R irregular
A

sick sinus syndrome

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22
Q

treatment of sick sinus syndrome

A

symptomatic tx:

ex: If too brady, give atropine and 02

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23
Q
  • Rapid rate usually above 150 to 250 bpm
  • P waves hidden behind t waves
  • QRS complex narrow
  • R to R regular
A

supraventricular tachycardia

24
Q

treatment of SVT

A

Oxygen

Adenosine

  • 6mg IV push fast
  • Repeat with 12mg if needed
  • Causes asystole
  • run a continuous strip
25
Q
  • Rapid depolarization of the AV node
  • Usually a regular rhythm
  • Narrow QRS
  • Atrial rate can be up to 350 bpm
A

atrial flutter

26
Q

treatment of atrial flutter

A

Adenosine
Calcium Channel Blockers (Diltiazem)
-Slow conduction
-15-20 mg IVP slow
Beta Blockers
-Decrease HR
-Decrease BP
-Slow IVP

27
Q
  • no effective atrial contraction
  • Narrow QRS
  • Rhythm irregular
  • Rapid ventricular rate 100-160 bpm
A

atrial fibrillation

28
Q

treatment of A-fib

A
  • Previous interventions
  • Warfarin INR 2-3
29
Q
  • AV node or Bundle of His
  • Replace the SA node P wave may be inverted or buried
  • Rate 40-60 Junctional escape
  • Rate 60+ junctional tachycardia
  • QRS regular and narrow
A

junctional rhythm

30
Q

treatment of junctional rhythm

A

tx only if underlying problem

31
Q
  • Just an early beat that originates from the AV node
  • Rhythm regular except early beat
  • One P wave for each QRS
  • QRS narrow
A

premature atrial contraction

32
Q

treatment of PAC

A

tx only if underlying problem

33
Q
  • Early beat with wide QRS complex
  • No p wave with beat
A

premature ventricular contraction

34
Q

treatment of PVC

A
  • Check electrolytes
  • Treat if symptomatic
35
Q
  • QRS greater than 0.12 usually regular
  • Sustained vs. Nonsustained
  • Usually no p wave
A

ventricular tachycardia

36
Q

treatment of ventricular tachycardia

A

Lidociane
1-1.5mg/kg IV then a maintenance drip 1-3 mg/kg/min
Magnesium
For long QT induced V-tak
1-2mg in 10ml of D5W over 10-20 min

37
Q
  • Undeterminable
  • Looks like squiggly lines
A

ventricular fibrillation

38
Q

treament of vfib

A
  • CPR
  • ACLS
39
Q

what meds can cause junctional rhythm

A

digoxin, beta blockers

40
Q
  • Polymorphic V-tak
  • Usually underlying long QT interval
A

torsades de pointes

41
Q

treatment of torsades

A
  • Magnesium
  • Treat underlying cause
42
Q
  • A conduction delay
  • Regular rhythm
  • PR interval long greater than 0.20
  • QRS normal
A

first degree block

43
Q

treatment of first degree heart block

A

treat underlying cause

44
Q

wide bizar formation of the qrs is indicative of what kind of premature contraction?

A

premature ventricular contraction

45
Q
  • Regularly irregular
  • Progressivly longer PRI until dropped QRS
  • QRS narrow
A

second degree heart block/ Mobitz 1/ Wenckebach

46
Q

treatments of second degree heart block

A
  • Tx if symptomatic
  • Pacing
  • Atropine
47
Q
  • PR interval fixed,
  • QRS dropped intermittently
  • Rapidly progresses
A

second degree block/Mobitz 2

48
Q

Treatment of second degree HB/mobitz 2

A
  • pacing
  • atropine
49
Q

Atrial and ventricle disassociated

A

third degree complete block

50
Q

treatment for third degree complete block

A

PACE

51
Q
  • Short PR interval <0.12 sec
  • Prolonged QRS >0.10 sec
  • Delta wave
  • Can simulate ventricular hypertrophy, BBB and previous MI
A

WPW block

52
Q
  • prolonged QT greater than 0.42
  • increased chance of going into a ventricular arrhythmia, most often torsades
  • most often congenital in pts with families who had sudden cardiac death under age 50
  • treatment=prevention (have you had any syncope, seizures, felt dizzy when you ran)
A

prolonged QT syndrom

53
Q

Synchronized shock

  • Delivered on R wave
  • Pediatric cardioversion gets 0.5-1 J/kg first shock
    - Additional cardioversion shocks are at 2 J/kg.
  • Adult cardioversion
    - Cardioversion for atrial rhythms is 50-100-200-300-360 J
  • Need pain and sedation medication
A

cardioversion

54
Q

Unsynchronized

  • Pediatric: use a dose of 2 J/kg for the first attempt and 4 J/kg for subsequent attempts.
  • Adults: Physio‐Control Biphasic
    - 200 joules – 1stshock
    - 300 joules – 2nd shock
    - 360 joules – all following shocks
  • Monophasic: 360 joules – all shocks
A

defibrillation

55
Q
  • implanted
  • delivers shock as needed
A

implantable cardioverter/defibrillator

56
Q
A

NUR4630 (34 decks)

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