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57 Cards in this Set

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Tx for Symptomatic bradycardia
atropine
cardiac pacing
Tx for PAC
No specific Tx. Monitor for A flutter, A fib, PSVT
differentiates PSVT from sinus tach
PSVT
1) rate 150-250
2) ends/begins abruptly (often with PAC i.e. irregular)
3) converts to NSR with vagal
Why is DCCV usually TOC for a flutter
Rx generally not effective
When is DCCV indicated in a flutter
Unstable
-Sx and/or dec CO (usually with rapid ventric response rate i.e. <4:1)
Rx that increases HR by inhib of ACh
atropine
used in brady's and heart block
initial TOC for Afib in absence of hemodynamic compromise
Slow HR
-BB, CCB, Dig
BB, CCB, Dig did not decrease vent response in stable Afib.

Then what?
-At this point its probably been greater then 48 h thus pt at risk for thrombi so
-Anticoagulate for 3-4wks and DCCV
DCCV did not work to restore NSR in stable Afib. Now what?
Ablation
MAZE
TOC in hemodynamically unstable Afib
DCCV
atropine did not increase bradycardia enough, what next
pacer
why might psvt pt be unstable
hr 150-250
key feature of Afib rhythm
irregular
key features of jxnal rhythm
p wave inverted or absent
whats the main diff between all the jxnal rhythms
rate
brady <40
reg 40-60 DDx with reg brady? (inverted p wave)
accel 60-100
tachy 100-150
NSR, all of a sudden you see an ivnerted, premature p wave

What rhythm do you suspect
Premature jxnal contraction
NSR and all of a sudden a wide bizarre QRS pops up

You think
PVC
AKA for non-sustained V tach
PVC run
-trigeminy
Action/Tx when you see PVC on monitor
If isolated, nothing. Check lytes (K, Mg-replacement) and monitor. Can lead to Vtach, Vfib
You would however Tx PVC runs(same as stable Vtach i.e. amiodarone)
Mg is always kept ??
>2
AKA short and non sustained V Tach
Run of PVC's
Diff between trigeminy (PVC)and non sustained V Tach
Non ustained v tach is defined as <30 sec's
When do you definately call a Cond C for V Tach
Unstable with a pulse
TOC for stable VT with a pulse
amiodarone
if doesn't work-DCCV
After call Cond C for unstable VT with a pulse, then what
DCCV
torsades Tx
Mg Sulfate
When does atropine Tx jxnal rhythms
jxnal brady and jxnal rhythm
-C/I in jxnal accel
-vagal/adenosine in jxanl tach
Tx reg jxnal
Asympt (just monitor)
Sympt-atropine
and underlying cause (dig/BB/CCB tox??)
Tx jxnal brady
usually pretty sympomatic
-atropine
-possibly external pacer
rate in reg jxnal
40-60
rate in jxnal accel
60-100
-often asympt, just monitor
rate in jxnal tachy
100-150
Tx jxnal accel
often asympt (just monitor)
-treat underlying cause
-atropine C/I
atropine C/I
jxnal accel
Mobitz 2
Which jxnal rhythm might be Tx'd with adenosine/DCCV
jxnal tach
Tx jxnal tach
Same as PAC
vagal
adenosine
DCCV
Rhythms often assoc with Dig tox
Jxnal
Which two rhythms req immed pacing
Mobitz 2
#rd degree/complete heart block
Difference in pathologic cause of jxnal and HB
jxnal=AV node tajes over d/t failure of SA node
aV block=disturbance in some portion of AV conduction system. SA is sending out regular signals but none or only some make it to ventricles.
Monitor rings out VT. You assess your pt. v.s. 120, 26, 110/80. C/o no chest pain. Your suggest
Amiodarone
If that doesn't work, DCCV
Monitor rings out VT. You assess your pt. v.s. 175, 32, 100/65. C/o SOB and lightheadedness. You suggest
Cond C
DCCV
Monitor rings out VT. You assess your pt. v.s. 250, 32, 90/30 and unresponsive. You suggest
SCREAM
Cond A
Defib (360 joules)
CPR (30:2 q2min)
Epi
Amiodarone
Lidocaine/Mg
During a code/SCREAM how often must you reassess
q 2 minutes after every 30:2 CPR
PAC's may be precursor to?
PSVT, A flutter, AF (usually moreso in pt's who have decompensated). Just monitor. No Tx needed excpet for underlying cndx's.
Most common sustained dysrhythmia?
AF
anticoag-cardiovert
ablate/maze
2 or mote episodes of AF that resolve spontaneously
recurrent/persist/chronic
recurrent
AF sustained>7d. Also describes AF>1y in which cardiversion has failed
recurrent/persist/chronic
persistant
Where is shock timed to occur in DCCV
R wave
procedure where AV node is destroyed and pacemaker takes over
Ablation, usually reserved for AF pt's in 60-70's
Procedure that uses incisional scars to block abnormal conductin
MAZE
Tx for PVC runs
amiodarone (same as VT)
Tx isolated PVC's
Monitor for progression to VT/VF
Check lytes
Therapeutic INR in AF
2.5-3.0
Cndx's that may cause torsades
R on T phenom (PVC, Defib)
amiodarone infusions
Lyte imbalances
Common reperfusion arrhythmia
Accelerated idioventric, requires no Tx
PEA Tx called for in these cndx
idioventric
Asystole
PEA (rhythm present but no pulse)
Why might atropine be indic in Mobitz 1
Slow vent rt
Not used in (both really need pacing)
Mobitz 2 (paradoc fx)
3rd degree (may be fx'ive in temp 3rd degree block)