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86 Cards in this Set

  • Front
  • Back
What is a tachycardic rate?
>100.
What rhythms can be tachycardic?
Sinus tach
SVT
A-fib
A-flutter
MAT
V-tach (torsades de pointes)
Uncertain tach
What are the causes of sinus tachycardia?
hypoxia
hypovolemia
some drug OD's
fever
fear, anxiety
exercise
caffeine
aympathetic response
anemia
What are possible signs and symptoms of tachycardia?
Possible signs: low BP, diaphoresis, pulmonary edema, acute MI, PVC's.
Possible symptoms: chest pain, shortness of breath, decreased LOC, weakness, dizziness.
Do we treat asymptomatic tachycardia?
Probably not.
Signs and symptoms of instability
altered mental status
hypotension
significant CP
significant SOB
And if the patient is unstable?
Cardioversion!!!
What is the potential problem with converting A-fib with RVR and why?
Clots, pooling in the atria...
Even a patient with chronic A-fib must be cardioverted if the rate is fast and the patient is truly unstable.
Rate related symptoms are uncommon if heart rate is <150/min. Does this mean that we will never cardiovert a patient with a rate <150/min?
No but it's rare.
And if the patient is stable?
Look at the QRS.
Narrow, regular?
SVT.
Vagal maneuvers.
Adenosine.
Diltiazem.
Narrow, irregular?
A-fib, A-flutter, or MAT.
Diltiazem works for rate control (usually not conversion).
What are the precautions with administering diltiazem?
BP may drop after giving diltiazem.
Don't give if patient's systolic BP is <100.
Wide, regular?
V-tach.
Amiodarone.
Can also be an uncertain rhythm.
What does uncertain rhythm mean?
Sometimes it can be difficult to tell V-tach from SVT with a wide QRS.
Wide, irregular?
T. de P. or A-fib with BBB.
How do we treat T. de P.?
Magnesium sulfate.
WPW has 2 dysrhythmias associated with it:
SVT and A-fib.
What rhythms can be bradycardic?
All possible bradycardic rhythms.
Is the patient symptomatic?
If the answer is no, don't treat the bradycardia.
The cornerstone of bradycardia treatment...
Don't treat asymptomatic bradycardia!!!
"Poor perfusion" implies low ______________.
blood pressure
What are some possible signs and symptoms of hypoperfusion caused by a bradycardic rhythm?
Possible symptoms: chest pain, shortness of breath, decreased LOC, weakness, dizziness.
Possible signs: low BP, diaphoresis, pulmonary edema, acute MI, PVC's.
Is it possible to have a patient who is symptomatic and bradycardic, yet the bradycardia does not cause the symptoms?
Yes.
Is the bradycardia causing the symptoms?
Don't treat the bradycardia unless the bradycardia is causing the symptoms.
How shall we treat bradycardia?
Always begin treatment with the basics: oxygen, supine positions, possibly fluids.
Both atropine and TCP are considered first-line treatments.
What kind of drug is atropine?
Parasympatholytic.
How does the parasympathetic system affect the heart rate?
Decreases HR.
Why not forget about atropine and always go straight to pacing?
It hurts!
atropine dosage
0.5-1 mg every 3-5 minutes (maximum dose is 0.04 mg/kg)
dopamine dosage
5-10 mcg/kg/minute
epinephrine dosage
2-10 mcg/min
adenosine dosage
6 mg IV bolus followed with 20 cc flush. If no response, repeat in 1-2 minutes with 12 mg followed with 20 cc flush. This dose can be repeated one more time
diltiazem dosage
0.25 mg / kg over 2 minutes. Repeat 0.35 mg / kg if no response in 15 minutes. Maintenance infusion of 5 – 15 mg / hr
amiodarone dosage
Infusion of 150 mg over 1st 10 minutes (15 mg/minute). May repeat every 10 minutes as needed.
magnesium sulfate dosage
1-2 grams IV, over 5-60 minutes
aspirin dosage
324 mg (4 baby chewable aspirin
nitro dosage
1 tablet (0.4 mg) given sublingually q 5 minutes, 0.4 mg metered dose spray given sublingually q 5 minutes, 1-2” paste, 5 mcg / min IV (titrate up 5 mcg / min every 5 min until desired effect is achieved)
morphine dosage
2-5 mg slow IV push, titrated to effect. Max dose usually not to exceed 20 mg without OLMC approval. MS can be given IM
midazolam dosage
2.5 – 10 mg IV or IM
BBB
A block in the conduction of one of the bundle branches. It can be permanent or temporary.
The etiology of a BBB may include:
Acute ischemia
Damage from an MI
Age related deterioration
Drugs
Electrolyte imbalance
How does a BBB present on an EKG strip?
For a BBB to show, impulse must originate above the ventricles (a supraventricular rhythm). The QRS MUST be > or = 0.12 seconds.
EKG criteria for RBBB
1. QRS > or = 0.12 seconds
2. Look at V1
A. Rabbit ears in V1
B. The deflection just before the J point will be positive
EKG criteria for LBBB
1. QRS > or = 0.12 seconds
2. Look at V1: The deflection just before the J point will be negative.
3. Look at V5, V6 and lead I for rabbit ears
Why do we need to recognize BBBs?
1. For good EKG recognition
2. To suspect past cardiac history unknown to the patient
3. An LBBB will obscure an acute MI
A standard assessment tool that uses 10 electrodes-one on each limb and six on the chest.
12-lead ECG
Leads V3 and V4, which are positioned over the front (anterior) of the left ventricle.
anterior leads
Augmented voltage leads; they use an average rather than a single identifiable negative lead.
aV leads
Leads I, II, and III.
Bipolar limb leads.
Graphic representation of the electrical activity of the heart.
electrocardiogram (ECG)
An adhesive pad that contains conductive gel and is designed to be attached to the patient's skin
electrode
Leads V5, V6, I, and VL, which look at the heart from the lower and upper aspects of the left side.
lateral leads
Electrodes connected to the monitor or ECG by wires, which relay the electrical impulse from the generator to the myocardium.
leads
Precordial voltage leads, when acquires with a 3- or 4-lead monitor.
modified chest left (MCL)
The six precordial or voltage leads, which are designedated V1 through V6; second type of electrode and true chest leads.
precordial lead electrodes
A dividing wall or membrane, especially between bodily spaces or masses of soft tissue.
septum
Leads aVR, aVL, and aVF.
unipolar limb leads
The bottom of the calibration spike (one millivolt or two large squares), found at the start of the 12-lead printout.
isoelectric line
Millimeters.
mm
Milliseconds.
ms
Millivolts.
mv
Represents depolarization of the left and right atria.
P wave
Represents the conduction of the electrical impulse from the bundle of His throughout the ventricular muscle, or ventricular depolarization.
QRS complex
Refers to the width of the QRS complex; used to determine wide vs. narrow complexes. In adults >120 milliseconds is considered wide.
QRS duration
Determines conditions such as the presence of an enlarged heart, ST segment elevation, or pulmonary conditions stemming from the lack of voltage.
QRS-size measurement
Determines certain drug and electrolyte imbalances and othe conditions of delayed depolarization; it is measures from the start of the QRS complex to the end of the T wave.
QT interval
Refers to the size of the positively deflected R wave in the precordial V leads as they progressively increase in size from Leads V1 to V4.
R wave progression
Seconds.
sec
Represents ventricular repolarization and follows the ST segment.
T wave
Occurs between Leads V3 and V4; it is the point at which the overall R wave should go from predominantly negative to positive.
transition zone
A right bundle branch block combined with a hemiblock or a left bundle branch block.
bifascicular block
An electrical phenomenon characterized by a widened QRS complex of at least 0.12 seconds (120 milliseconds)or greater, and, in most cases, a definitive QRS morphology pattern.
bundle branch block (BBB)
The volume percent of blood ejected in one contraction; one measure of left ventricular effectiveness; the normal range is between 60 and 75 percent.
ejection fraction
The point at which the QRS complex turns into the ST segment.
J point
Cardiac muscle cell groups that are connected together and function collectively as a unit; the feature of the ventricles or the atrium that produces simultaneous depolarization.
synccytium
Used to diagnose bundle branch blocks and works only in Lead MCL-1 (V1) when the QRS is 0.12 seconds (120 milliseconds) or three small squares on the ECG paper.
turn signal criteria
An MI can develop because of an increase in demand...
or a decrease in supply.
In an already diseased artery the precipitating event is commonly the formation of a...
thrombus.
An MI can also be caused by
-Coronay artery spasm
-Microemboli (cocaine)
-Acute volume overload
-Hypotension
-Acute respiratory failure
-Trauma
In which ventricle do most MI's occur?
Left ventricle.
Ischemia?
Inadequate supply of blood.
Reciprocal changes?
Mirror image that occurs when 2 electrodes view the same MI from opposite angles.
If II, III, and aVF have ST depression the I and aVL have ST _________.
elevation.
With right sided heart failure blood backs up into the venous side. This drops the BP. What happens if we increase venous capacitance?
With a confirmed right sided MI consider witholding nitro.
Some things that masquerade as an MI...
LBBB, pericarditis.