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33 Cards in this Set
- Front
- Back
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Where do Ventricular Rhythms originate |
Originates in the ventricles |
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Premature Ventricular Complexes (PVCs)Interventions |
Treat pt not the monitor The treatment of PVCs focuses on treatment of the underlying cause Assess patient's tolerance of the rate Assess for pulses which indicates perfusion Ensure adequate oxygenation Rapidly identify and correct, hypoxia, heart failure, and electrolyte or acid-base imbalances Check electrolytes and Mg levels If PVC frequency < 6/min, optimize the above parameters and continue to monitor and observe If PVC frequency > 6/min, notify MD Consider Lidocaine, Procainamide, or Amiodarone especially if MI or chest pain |
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Idioventricular Rhythm (IVR)Interventions |
Treat the pt, not the monitor Assess patient's tolerance of the rate If pt symptomatic w/ palpable pulse, begin TCP Consider Rx w/ Epi Intubation, oxygenation No antiarrhytmic suppressive therapy No lidocaine, procainamide, or amiodarone |
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Accelerated Idioventricular RhythmInterventions |
Treat pt, not the monitor Don't mistake for VT (carefully calculate rate) Assess patient's tolerance of the rate No antiarrhytmic suppressive therapy No lidocaine, procainamide, or amiodarone If rate is in the slower range and pt symptomatic, treat the same as IVR If rate is in the faster range and pt asymptomatic use supportive therapy (O2, ventilation, etc)- monitor and observe Notify MD if lasting longer than transiently |
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Ventricular Tachycardia (VT)Interventions |
Treat pt, not the monitor Assess patient's tolerance of the rate Check for Dig toxicity Check Mg level and electrolytes especially K Check acid-base balance If pulses present: Rx w/ O2, antiarrhythmics: Amiodarone, Lidocaine, Procainamide If pulses absent: call code, begin CPR, defibrillate If TdP (Torsades de Pointes), Rx w/ Mg followed by defib if needed |
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Ventricular Fibrillation (VF)Interventions |
Artifact can mimic VF, so always confirm in a second lead and confirm absence of pt's pulse prior to beginning treatment Call code Begin CPR Defib Rx w/ Epi Consider amiodarone or lidocaine |
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Pulseless Electrical Activity (PEA)Interventions |
Treat the pt, not the monitor Assess patient's tolerance of the rate Confirm absence of pulses Call code, begin CPR Intubation, oxygenation
Search aggressively for cause (PATCH-4-MD) Pulmonary embolism Acidosis Tension pneumothorax Cardiac tamponade Hypovolemia (most common cause) Hypoxia Hypo/hyperthermia Hypo/hyperkalemia Myocardial infarction Drug OD/accident |
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Asystole (Cardiac standstill)Interventions |
Assess the pt Verify the 2nd lead Confirm absence of pulses Call code, begin CPR Intubation, oxygenation Rx w/ Epi Search aggressively for cause (PATCH-4-MD) Pulmonary embolism Acidosis Tension pneumothorax Cardiac tamponade Hypovolemia (most common cause) HypoxiaHypo/hyperthermia Hypo/hyperkalemia Myocardial infarction Drug OD/accident |
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PVCs and QRS |
QRS> 0.12 sec and occurs prematurely |
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Patterns of PVCs |
Pairs (couplets): 2 in a row Runs, bursts, or salvos: 3 or more in a row of short duration Bigeminal (ventricular bigeminal): every 2nd complex is a PVC Trigeminal (ventricular trigeminal): every 3rd complex is a PVC Quadrigeminal (ventricular quadrigeminal): every 4th complex is a PVC |
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Other types of PVCs |
Uniform (unifocal): look the same as each other and arise from the same site (focus) Multiform (multifocal): look different from one another and often arise from different sites (foci) R-on-T PVC: R wave of PVC falls on the T wave of the preceding complex |
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IVR rate |
20-40 bmp <20 bpm- agonal rhythm dying heart |
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IVR description |
A protective mechanism to avoid asystole, it is a ventricular escape rhythm where there are >3 ventricular escape complexes in a row The QRS is wide and bizzare |
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AIVR rate |
41-100 bpm Max 120 |
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AIVR description |
Usually considered a benign escape rhythm Commonly seen after successful re-perfusion therapy |
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VT rate |
150-250 bpm |
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VT caused by |
Three or more PVCs in a row at a rate >100 bpm |
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Monomorphic VT |
All complexes are the same shape and amplitude |
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Polymorphic VT |
Variation in shape and amplitude from complex to complex Associated w/ long QTI- Torsades de Pointes (TdP) |
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VF rate |
None |
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VF description |
Chaotic rhythm with deflections that vary in shape and amplitude No normal looking waveforms visible |
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Coarse VF |
waves >3 mm high |
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Fine VF |
waves <3 mm high |
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PEA description |
Appearance of a rhythm on the monitor but no associated perfusion- no pulses |
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Asystole description |
Absence of ventricular electrical activity Some atrial activity may be present- P wave asystole or ventricular standstill May occur temporarily following termination of a tachycardia w/ medications, defib, or synchronized cardioversion |
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Premature Ventricular Complexes (PVCs) |
Rhythm Regular w/ early beats Rate Based on underlying rhythm P waves Usually absent or, with retrograde conduction to the atria, may appear after the QRS (usually upright in ST segment or T wave) (lead II) PR interval None QRS duration >0.12 |
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Ventricular Escape Beat |
Rhythm Regular w/ late beats Rate Based on underlying rhythm P waves Usually absent or, with retrograde conduction to the atria, may appear after the QRS (usually upright in ST segment or T wave) (lead II) PR interval None QRS duration >0.12 |
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Idioventricular Rhythm (IVR) |
Rhythm Essentially regular Rate 20-40 P waves Usually absent or, with retrograde conduction to the atria, may appear after the QRS (usually upright in ST segment or T wave) (lead II) PR interval None QRS duration >0.12 |
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Accelerated Idioventricular Rhythm (AIVR) |
Rhythm Essentially regular Rate 41-100 P waves Usually absent or, with retrograde conduction to the atria, may appear after the QRS (usually upright in ST segment or T wave) (lead II) PR interval None QRS duration >0.12 |
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Monomorphic Ventricular Tachycardia |
Rhythm Usually regular Rate 101-250 P waves May be present or absent; if present, they have no set relationship to the QRS complexes, appearing between the QRSs at a rate different from that of the ventricular tachycardia (VT) (lead II) PR interval None QRS duration >0.12 |
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Polymorphic Ventricular Tachycardia |
Rhythm Irregular Rate 150-300 P waves Independent or none (lead II) PR interval None QRS duration >0.12 |
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Ventricular Fibrillation |
Rhythm Chaotic Rate Not discernible P waves Absent (lead II) PR interval None QRS duration Not discernible |
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Asystole |
Rhythm None Rate None P waves Atrial activity may be observed; P-wave asystole (lead II) PR interval None QRS duration Absent |
