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56 Cards in this Set
- Front
- Back
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What are some distinguishing feature's between SVT and Sinus Tach? |
In V-tach, you will not be able to clearly distinguish the entire PQRS complex.
Also, you will more than likely see a rate much greater than SVT than in Sinus Tach. |
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Slows rhythms usually correspond with what kind of etiologies? |
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What algorithm do we use to treat a heart or rhythm problem? |
Rate/Volume/Pump |
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What are some misc beta blockers other than Propanolol (Inderal)? |
Esmolol & Sotalol |
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Fast rhythms usually correspond with what kind of etiologies? |
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Main distinction in identifying PAC's vs PJC's? |
PAC: have a p-wave (positive deflection), but it looks distinctively different (Aberrant) than the underlying rhythm p-waves.
PJC: has a missing, negative, or hidden p-wave. |
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3 or more PVC's in a row is considered what? |
A "run of V-Tach" |
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What is the overall "goal" when treating SVT? |
To increase cardiac output...by slowing down the heart rate. |
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We do not Valsalva our patient for more than how many seconds? |
5 seconds |
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What does the Valsalva maneuver work? |
We are increasing the intrathoracic pressure, thus stimulating the baroreceptors which in turn stimulate the cardiac center & vagus nerve. End result is a reflex slowing of the heart rate.
Increase BP=Baroreceptors=Cardiac/Vagus=
result= slowed heart rate |
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Possible complications of the Valsalva maneuver? |
* why we attempt to establish an IV first before asking patient to perform maneuver. |
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What does "Dig Toxicity" refer to? |
This means that a patient has received an excess amount Digoxin medication.
Digoxin works by increasing inotropy, but DECREASING heart rate and DECREASING AV conduction.
***Dig Toxicity can cause almost any kind of dysrhythmia. |
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Does Adenosine work for FAST A-Fib @ 150 HR? |
No, it does not. Straight to sedation & Cardioversion is key. |
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How long does it take to conduct an impulse through the AV junction? |
0.08 - 0.12 seconds |
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In Junctional rhythms the p-wave will be what? |
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What drug would be indicated for pulseless V-tach or V-Fib? |
Amioderone (Anitdysrhythmic)
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Ventricular rhythms look wide, fat, and bizarre because why? |
Because of the increased travel time it takes to conduct through the heart.
Usually greater then 0.12 seconds. |
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PVC morpholoy is usually show what in the QRS complex? |
ST segment and T-wave are usually opposite in polarity to the QRS |
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When we are Pacing, what point on the ECG are we targeting on the monitor? |
R-wave |
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Where would you anticipate a PVC to fall on a PQRST complex? |
On top of the T-wave (the vulnerable spot) |
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What rhythm are you most likely to see after you get ROSC? |
Ventricular Escape Rhythm |
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What do "bunny ears" indicate on top of the R-waves? |
Bundle Branch Blocks (BBB). This is because there is a disconnect in the conductivity between the bundle branches. |
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One, maybe two beats, on a 6 second strip would be what kind of rhythm? |
Agonal |
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What must we do additionally on our monitors to confirm that we have an Asystole rhythm? |
Must confirm in at least two leads. |
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Is Asystole a shockable rhythm? |
No, No, No!!!
(V-Fib and Pulseless V-Tach= YES!!!) |
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Peaked T-waves are an indication for what? |
Hyperkalemia
What drug could we give if they were symptomatic bradycardia?
Answer: 5mg Albuterol, two times via a continuous face mask. |
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Mobitz 1 is also know as? |
2nd Degree heart block, Type 1
and
Wenckebach |
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Is a 1st degree heart block a dependent or independent rhythm? |
Dependent rhythm.
Example: Sinus tachycardia with a 1st degree heart block |
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Which two types of heart blocks usually present with a very sick patient? The kinds that get your attention? |
2nd and 3rd degree type heart blocks |
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In this type of block, the AV junction is blocking ALL impulses coming from the atria, thus no impulse ever reach the ventricles. |
"Bad Marriage" 3rd degree block
P-waves and QRS complexes are on their own seperate rhythm (uncoordinated). |
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In regards to Ref. No. 1212, what is the treatment for a poorly perfusing patient with Mobitz II, and 3rd Degree heart blocks? |
2 2, 3, Straight to TCP |
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What are the "low dose" effects of Dopamine? |
(>5 mcgtt/min)
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What are the "moderate dose" effects of Dopamine? |
(5-10 mcgtt/min)
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What are the "high dose" effects of Dopamine? |
(>10 mcgtt/min)
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In what dosage amounts is Epinephrine indicated for a patient in Cardiopulmonary Arrest? |
1mg (1:10,000) IV/IO
May repeat every 3-5 minutes prn |
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34 yr old male, conscious, but poorly perfusing, heart rate 180, BP 74/40, rhythm is A-Fib.
What is your treatment plan? |
General ALS - Supine - IV - O2 titrated - Monitor/12-Lead - D-stick
Call BASE, advise of heart rhythm, expect to an order(s) for:
- Sync Cardio 1/2 - Midazolam: 1-2mg SLOW IVP, titrate till sedation - Sync Cardio 3/4 - Transport & monitor |
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42 yr old male, conscious, but poorly perfusing, heart rate 110, BP 76/42, rhythm is Wide Complex Tach.
What is your treatment plan? |
General ALS - Supine - O2 prn - Monitor/12-lead - D-stick - IV
Straight to Sync Cardio 1/2 BASE
Anticipate orders for: - Midazolam: 1-2mg SLOW IVP, titrate till sedation - Sync Cardiovert 3/4 |
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56 yr old female, conscious, perfusing well, heart rate 190, BP 102/76, rhythm is Narrow Complex Tach.
What is your treatment plan? |
General ALS - IV/O2 - Monitor/12-lead - D-stick
- Valsalva - 6mg Adenosine, FLUSH - 12mg Adenosine, FLUSH, within 1-2 BASE Monitor/Transport |
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49 yr old female, conscious, perfusing okay, heart rate 164, BP 104/40, rhythm is Wide Complex Tach.
What is your treatment plan? |
General ALS - IV/O2 titrate - Monitor/12-Lead - D-stick
- 12mg Adenosine, FLUSH - 12mg Adenosine, FLUSH, within 1-2 mins BASE Monitor/Transport |
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32 yr old male, unconscious, but poorly perfusing, heart rate 158, BP 76/30, rhythm is Narrow Complex Tach.
What is your treatment plan? |
- General ALS - Straight to Sync Cardio 1/2 BASE - Sync Cardio 3/4 - Monitor/transport |
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32 yr old male, conscious, but poorly perfusing, heart rate 78, BP 74/40, rhythm is Sinus Brady.
What is your treatment plan per 806.1? |
- General ALS - Meets 80/40, thus: Atropine 0.5mg IVP - If, no improvement, TCP, per dept. guidelines. BASE - Midazolam: 1-2mg IVP, titrate till sedation, may repeat every 5 mins, to a max of 10mg. - Fluid challenge: 10ml/kg providing lungs are clear. - Dopamine: 400mg/500ml conc in NS IVPB, 30 mcgtt/min, increase 5 mcgtt/min every 5 mins till SBP is 90-100 and adequate perfusion returns. Max drip of 120 mcgtt/mins. - MS: as long as SBP is above 100*** |
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62 yr old female, conscious, but poorly perfusing, heart rate 76, BP 72/38, rhythm is 2nd degree type 2 heart block.
What is your treatment plan per 806.1? |
- General ALS - TCP indicated 1st for Mobitz 2 (Atropine can increase myocardial demand, thus contraindicated). BASE - Midazolam - Fluids - Dopamine - MS |
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45 yr old male, conscious, but poorly perfusing, cool/pale/diaphoretic, heart rate 52, BP 90/58, rhythm is Sinus Brady.
What is your treatment plan per 806.1? |
- General ALS BASE, but anticipate orders to: - Atropine (providing no heart Hx) - TCP, providing there are no heart blocks - Midazolam - Dopamine - MS: 2-12mg SLOW IVP for analgesia, Max dose of 20mg for adults.
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Name the drug with these side effects?
- Chest Pain - Palpitations - Dyspnea - Dizziness - Blurred Vision - Numbness/Tingling - Hypotension - Bradycardia/Asystole - Metallic taste/throat tightness |
Adenosine |
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Name the drug with these side effects?
- Bradydysrhythmia's - Hypotension - CHF |
Amioderone |
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Name the drug with these side effects?
- Increased Intraoccular pressure - Dry mouth/thirst - Flushed Dry skin - Hyper/Hypotension - Dysrhythmia's - Paradoxical Bradycardia - Increased myocardial demand - Mydriasis (pupil dilation) |
Atropine |
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Name the drug with these side effects?
- Cardiac: almost ANY dysrhythmia's - Non Cardiac: nausea, vomiting, drowsiness, confusion, and visual disturbances |
Digoxin (Lanoxin, Digitalis) |
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Name the drug with these side effects?
- Hypertension (high dose) - Hypotension (low dose) - Ectopic beats - Tachydysrhythmia's - Palpitations - Necrosis - Tissue sloughing |
Dopamine |
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Name the drug with these side effects?
- Anxiety - Tremors - CVA - Palpitations - Hypertension - MI - Tachydysrhythmia's |
Epinephrine |
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Name the drug with these side effects?
- Hypotension - Retrograde Amnesia - Pinpoint pupils - Respiratory Arrest |
Midazolam |
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Name the drug with these side effects?
- Respiratory Depression - Nausea and vomiting - Disorientation - Decrease cough reflex - Hypotension |
Morphine |
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This drug is contraindicated for:
- Hypovolemia - Severe Hypotension |
Morphine |
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This drug is contraindicated for:
- Shock - Coma - Acute alcohol intoxication |
Midazolam |
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These drugs have NO contraindications, per the drug cards. |
Epinephrine Amioderone Atropine (caution with heart Hx) |
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This drug is contraindicated for:
- Tachydysrhythmia's over 150 - Adrenal gland tumors |
Dopamine |
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This drug is contraindicated for:
- History of Sinus Node Disease - Pre-existing 2nd or 3rd degree heart blocks |
Adenosine |
