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Tachyarrhythmia

Bradyarrhythmia
Shifa College of Nursing
Critical Nursing Care
Gideon Victor
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Objectives
• By the end of presentation students will be
able to

– Identify arrhythmia related to tachycardia and


bradycardia

– Follow the algorithm for the identification and


treatment of brady/tachycardia

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Conduction System

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Tachyarrhythmia

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http://www.ceufast.com/courses/viewcourse.asp?id=239 6
Sinus Tachycardia

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Junctional Tachycardia

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Paroxysmal Atrial Tachycardia

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Paroxysmal Junctional Tachycardia

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Paroxysmal Ventricular
Tachycardia

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Ventricular Tachycardia

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Tachyarrhythmia Management
• Are the symptoms present of absent?

• Are symptoms due to Tachyarrhythmia?

• Is the patient stable or unstable?

• Is the QRS complex wide or narrow?

• Is the rhythm regular or irregular?

• Is the pulse present or absent?

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regular irregular

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Bradyrrhythemia

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Sinus Bradycardia

Junctional Bradycardia

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Classification of AV Heart
Blocks
AV Conduction
Degree
Pattern
Uniformly prolonged
1St Degree Block
PR interval
2nd Degree, Mobitz Progressive PR interval
Type I prolongation
2nd Degree, Mobitz Sudden conduction
Type II failure

3rd Degree Block No AV conduction


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2nd Degree Type-I
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2nd Degree Type-II

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Cardiac Pacing

• Temporary
– Transcutaneous
– Transvenous

• Permanent
– Transvenous

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PPM

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TPM

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Indications
• Compromising bradycardias
– Symptomatic
– Mobitz type II second-degree heart block
– Third degree heart block
• Unresponsive to atropine
• Sinus node dysfunction
• Cardiac arrest

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Patient with TPM & Permanent
Pacemaker

• Observe patient’s response to pacing


• Determine and document pacing capture and
sensing
• Determine when the battery was last changed
• Examine the insertion site monitor for signs of
postpericardiotomy syndrome
– Blood in pericardium, fever, leukocytosis, >ESR,
pericardial or pleural pain, dyspnea and friction rub

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• Instruct patient not to tamper with pacemaker or wire in
any way.

• Warn patient not to use any electrical equipment that


isn't grounded.

• Constant EKG monitoring

• Observe for absence or loss of ability of pacing.

• Restrict patient activity as ordered by the physician.

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• Monitor patient level of comfort and administer pain
medications as ordered PRN.

• Check pacemaker setting and ALL connections every


shift and document.

• Document sensitivity and stimulation threshold at least


every 24 hours.

• Obtain vitals signs as per unit policy or as ordered by


the physician.

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• Change dressing in accordance with Central Line
Hospital Policy.

• Observe patient closely for any signs and symptoms of


perforation of myocardium with resultant pericarditis or
pericardial tamponade.

• Keep the incision dry for 7-10 days from the time of the
surgery.

• There may be some discomfort associated with the


pacemaker 39
• Do not attempt to remove the bandage or steri strips
(tape) from the incision.

• You should not lift your arm above the level of your
shoulder for two weeks.

• You should not engage in sports or lift objects heavier


than 20 lbs. for the first two weeks after pacemaker
implantation.

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http://www.ca-nh.com/html/pacemaker_care___instructions.html
Electromagnetic Interference
• Can interfere with function of pacemaker or ICD
• Device misinterprets the EMI causing
– Rate alteration
– Sensing abnormalities
– Asynchronous pacing
– Noise reversion
– Reprogramming

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Pacemaker Complications
• EKG abnormalities due to
– Failure to output
– Failure to capture
– Sensing abnormalities
– Operative failures

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Pacemaker Complications
• Pacemaker syndrome
– Patient feels worse after pacemaker placement
– Presents with progressive worsening of CHF
symptoms
– Due to loss of atrioventricular synchrony, pathway
now reversed and ventricular origin of beat

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Indications for deactivation
When is Pacemaker Deactivation indicated?

• Irreversible cognitive failure


• Patient preference in advanced disease
• Activation would be inappropriate in the dying phase
• Following withdrawal of anti-arrythmic drug therapy
• While an active DNR order is in force
• May be considered in intensive care if inotropic and
ventilatory support is being withdrawn

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http://www.mcw.edu/fastFact/ff_111.htm
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