Академический Документы
Профессиональный Документы
Культура Документы
Degree AV block
Management Lethal
Arrhythmias
NUR 4050
Dr. Oliver-McNeil
Objectives
The
The
The
The
The
Applying Electrodes:
Telemetry
Cardiac monitor
Lead 2
V1
or MCL1
Electrocardiography
(continued)
ECG Analysis
Rhythm
Slightly irregular
Basically regular
1.
2.
3.
Regularly irregular
4.
Irregularly irregular
Rate
6 second method
Atrial Conduction
Atrial Conduction
AV Conduction
Is PR interval normal?
Ventricular Conduction
Electrocardiography
Dysrhythmia Interpretation
Before a rhythm can be indentified, these are the steps that must be
completed.
Sinus Bradycardia
Has a regular rhythm
Rate < 60 beats minute
Normal P wave preceding each QRS
Normal P-R,QRS complex, T wave, and QT interval
Sinus Tachycardia
Regular atrial and ventricular rhythms
Heart rates > 100 beats per minute
P waves are of normal size and shape preceding the QRS. May
be superimposed on the preceding T wave with increasing HR.
PR intervals, QRS complex, and T wave are normal. QT interval
usually shortens.
Atrial Arrhythmias
Conducted/nonconducted PACs
Supraventricular tachycardia
Paroxysmal supraventricular tachycardia
In
SVT
Atrial Flutter
Atrial flutter
Management
Dependent on ventricular response rate
Pharmacologic cardioversion
Ibutilide, sotalol, procainamide, amiodarone
Pharmacologic rate control
Calcium channel blockers, beta blockers, digoxin
Nonpharmacologic interventions
Cardioversion
Overdrive atrial pacing
Permanent termination
Radiofrequency ablation
Atrial fibrillation
Atrial rate of 350 - 600 times/min of
disorganized chaotic stimulus.
AV node acts as a buffer zone to the
ventricles.
Coordinated atrial emptying during
diastole is impaired.
Effects include:
Loss of atrial kick.
Pooling and clotting of blood in the
atria.
Thromboembolism.
Diagnostic Characteristics of AF
Rhythm: irregularly irregular
Atrial rate: indiscernible; often> 400/min
Ventricular rate: < 100 to > 150/min
P waves absent ,PR interval indiscernible
QRS complex < 0.12 sec, T wave and QT interval indiscernible
age
Left Atrium
Coronary
artery disease
Elevated
glucose
Thyroid
disease
Atrial Fibrillation
Management
Rhythm control: conversion to sinus rhythm
Antidysrhythmic drugs: amiodarone and ibutilide
Cardioversion
Rate control: control ventricular rate
Calcium channel blockers, beta blockers, digoxin
Anticoagulation
Significant threat of emboli
Control
IV
IVP
May
Rhythm
IV
Control
Rapid
Convert
May
to PO
Atrial Fibrillation
Procedures
Cox-Maze
procedure
Radiofrequency
Pulmonary
ablation
Vein Isolation
Atrial Fibrillation
Scoring System
H=
Hypertension 1 point
A2
=Age75 y 2 points
D=
Diabetes 1 point
S2=
V
Stroke 2 points
A =Age65
Sc=
y 1 point
36
Score
CHF=1
Hypertension=1
Age
>75=1
Diabetes=1
Stroke
=2
or more
Anticoagulation
High
highly recommended
Warfarin
ula
rR
hy t
hm
Junctional
dysrhythmias-Possible
terminology
Premature junctional contraction
Junctional escape rhythm
Accelerated junctional rhythm
Junctional tachycardia
Characterized by a regular ventricular
rate
without a P wave or very short PR interval
Junctional Rhythm
Monitor BP
Electrocardiography
Ventricular Dysrhythmias
Managing PVCs
Assess need for treatment
Assess for symptoms
Treat cause
Assess electrolytes
Assess for drugs that cause ventricular ectopy
Pharmacologic management
Beta blockers to reduce sympathetic
stimulation
Antidysrhythmic drugs
Electrocardiography
Ventricular Dysrhythmias
Electrocardiography
Ventricular Dysrhythmias
Unifocal vs Multifocal
Electrocardiography
Ventricular Dysrhythmias
(continued)
Electrocardiography
Ventricular Dysrhythmias
(continued)
Chaotic rhythm
Rate-indeterminate
No p waves; immeasurable PR
Indiscernible T waves.
Waveform may appear as a wavy baseline.
This is one of the primary lethal arrhythmias
http:www.ecglibrary.com/vf.html
Electrocardiography
Ventricular Dysrhythmias
(continued)
Heart Blocks
PR interval >0.20 ms
56
pacing
Patient may need a temporary transvenous
pacemaker
Avoid BB and CCB
Third-degree AV block
59
Third-degree AV block
Management
Transvenous or Transcutanous Pacemaker
Will need permeant pacemaker
Do NOT give BB, CCB and antiarrhythmics
Asystole
Cardiac Standstill or total absence of ventricular electrical
activity.
Evidenced clinically by no pulse or cardiac output.
No QRSs seen on the monitor.
Caused by ischemia, hypoxia, drug overdose, electrolyte
disturbances, traumatic arrest.
Think about cause as much as treatment.
Pacemakers.
Are artificial pulse generators which
deliver electrical pulses to stimulate
depolarization in the event of
inadequate intrinsic heart beats to
support CO.
Consist of a pacing lead and a pulse
generator (power source).
Types of Pacemakers
External PacingElectrodes placed
on the chest
delivers impulses
through the chest
wall.
Chest wall
impedance often
causes great
discomfort or
inability to
capture.
Pacemaker System
(continued)
Chamber Paced
Chamber Sensed
Response
V:Ventricle
V: Ventricle
I: Inhibited
A: Atrium
A: Atrium
T: Triggered
D: Dual (A & V)
D: Dual (I & T)
0: None
0: None
0: None
Key Interventions
Assess for chest pain
Evaluate Rhythm
Assess & monitor cardiovascular status.
Complete assessment of peripheral circulation.
Monitor VS frequently.
Evaluate clients response to dysrhythmias.
Monitor appropriate lab tests (i.e. lytes, Mg, cardiac enzymes).
Administer antiarrhythmics
Promote stress reduction
Electrode Placement
Electrocardiography
Electrocardiography
Infarct Location by 12-Lead
Anterior
Inferior
Ventricular septum
Lateral wall
Posterior wall
Right ventricle
Combinations and infarct age
The changes that occur in the corresponding leads is a clue of the
location of the Acute Coronary Syndrome Event
79
Anterior MI
80
81
Inferior MI
82