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58 Cards in this Set
- Front
- Back
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Normal Sinus Rhythm |
Rate: 60-100 Rhythm: Regular P waves: Normal PRI: 0.12-0.20 sec QRS: narrow <0.10 sec |
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Sinus Bradycardia |
Rate: 40-60 Rhythm: Regular P waves: Normal PRI: 0.12-0.20 sec QRS: narrow, <0.10 sec |
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Field Treatment of Sinus Bradycardia |
Asymptomatic: Monitor Symptomatic: Atropine (0.5mg up to 3mg) If refractory to Atropine, either TCP or Dopamine |
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Sinus Tachycardia |
Rate: 100-150 Rhythm: Regular P waves: Normal PRI: 0.12-0.20 sec QRS: Narrow, <0.10 sec |
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Field Treatment of Sinus Tachycardia |
Asymptomatic: Monitor Symptomatic: Treat underlying causes |
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Sinus Arrhythmia |
Rate: 60-100 may drop below 60 or exceed 100 Rhythm: Regularly irregular P waves: Normal PRI: 0.12-0.20 sec QRS: Narrow, <0.10 sec (Note: there is no treatment for this rhythm) |
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Sinus Arrest |
Rate: depends on underlying rhythm Rhythm: depends on underlying rhythm P waves: normal for underlying rhythm PRI: depends on underlying rhythm QRS: Usually normal |
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Causes of sinus arrest |
Blocked conduction from the SA node Increased vagal tone Hypoxia Hyperkalemia Dig/propanolol/quinidine toxicity SA node damage from AMI Myocarditis |
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Field Treatment of sinus arrest |
Asymptomatic: Monitor Symptomatic: Atropine (0.5mg up to 3mg) If refractory to Atropine, TCP or dopamine or Epi drip |
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Premature Atrial Complex |
Rate: depends on underlying rhythm Rhythm: regularly irregular, or irregularly irregular P waves: P' PRI: varies depending on atrial ectopic site QRS: narrow, <0.10 sec (Treatment is Oxygen) |
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Patterns of PACs |
Couplet: 2 in a row Atrial Tachycardia: 3 or more in a row Bigeminy: every other beat Trigeminy: every third beat Quadrageminy: every fourth beat Frequent: every fifth beat |
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Causes of PACs |
Increase in catecholamines Stimulants Electrolyte imbalance Hypoxia Dig toxicity CHF, ischemia, AMI Ideopathic Enhanced automaticity or reentry |
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Supraventricular Tachycardia |
Rate: 150-250 Rhythm: Regular P waves: not discernable PRI: not discernable QRS: Narrow, <0.10 sec |
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Causes of SVT |
Increase in catecholamines Stimulants Electrolyte imbalance Hypoxia Dig toxicity Rheumatic heart disease, CAD, post MI Ideopathic Preexcitation syndrome |
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Field Treatment of SVT |
Oxygen IV NSS Vagal Maneuvers Adenosine (6mg IVP, 12 mg, 12 mg) Diltiazem (0.25 mg/kg slow ivp, 0.35 mg/kg slow ivp) Synchronized cardioversion |
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Atrial Tachycardia |
SVT that exceeds 150 bpm but still has visible P waves. Managed the same as SVT |
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Atrial Flutter |
Rate: Varies Rhythm: Varies P waves: Non existent F (flutter) waves PRI: Non existent QRS: Narrow, <0.10 sec |
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Causes of Atrial Flutter |
Advanced rheumatic heart disease Preexcitation syndrome Hypoxia Cor pulmonale CHF Enhanced automaticity or reentry |
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Field Treatment of Atrial Flutter |
Diltiazem (0.25 mg/kg slow IVP, 0.35 mg/kg slow IVP) Synchronized cardioversion |
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Atrial Fibrillation |
Rate: Varies Rhythm: Irregularly irregular P waves: Non-existent, f (fibrillation waves) PRI: Non-existent QRS: Narrow, <0.10 sec |
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Causes of Atrial Fibrillation |
Advanced rheumatic heart disease Hypertensive or coronary heart disease Cardiomyopathy Preexcitation syndrome Excessive ingestion of caffeine Commonly associated with CHF Enhanced automaticity or reentry |
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Field Treatment of Atrial Fibrillation |
Diltiazem (0.25 mg/kg slow IVP, 0.35 mg/kg slow IVP) Synchronized cardioversion |
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Wandering Atrial Pacemaker |
Rate: Usually 60-100 Rhythm: Irregular P waves: At least 3 different P wave morphologies PRI: Varies QRS: Narrow, <0.10 sec (If rate exceeds 100 it is classified as multifocal atrial tachycardia)(No field treatment) |
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Premature Junctional Complexes |
Rate: Depends on underlying rhythm Rhythm: Regularly irregular, irregularly irregular P waves: inverted if visible, may be before during or after QRS PRI: if apparent <0.12 sec QRS: Normal <0.12 sec |
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Causes of PJCs |
Anxiety Catecholamines Stimulants Hypoxia Ischemia Drug toxicity Ideopathic (No field treatment other than correcting causes) |
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Junctional Escape Rhythm |
Rate: 40-60 bpm Rhythm: Regular P waves: Inverted if visible, may be before, during or after QRS PRI: If apparent, <0.12 sec QRS: Normal, <0.12 sec |
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Causes of Junctional Escape Rhythm |
SA node failure Increased vagal tone Hypoxia Drug toxicity |
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Field Treatment of Junctional Escape Rhythm |
Asymptomatic: Monitor Symptomatic: Atropine (0.5 mg up to 3 mg) If refractory: dopamine (2-10 mcg/kg/min) Epi or TCP |
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Accelerated Junctional Rhythm |
Rate: 60-100 Rhythm: Regular P waves: Inverted if visible, may be before, during or after QRS PRI: If apparent, <0.12 sec QRS: Normal, <0.12 |
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Causes of Accelerated Junctional Rhythm |
Increased AV automaticity Ischemia Hypoxia Dig toxicity Inferior wall MI Rheumatic fever |
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Field Treatment of Accelerated Junctional Rhythm |
Supportive Correct cause, if possible |
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Junctional Tachycardia |
Rate: 100-180 Rhythm: Regular P waves: Inverted if visible, may be before, during or after QRS PRI: If apparent, <0.12 sec QRS: Normal, <0.12 |
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Causes of Junctional Tachycardia |
Increased AV automaticity Ischemia Stimulants Hypoxia Drug toxicity Rheumatic fever |
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Field Treatment of Junctional Tachycardia |
Asymptomatic: Vagal maneuvers, Adenosine (6 mg, 12 mg, 12 mg), Cardizem (0.25 mg/kg), Expert consultation Symptomatic: Synchronized cardioversion |
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Premature Ventricular Complexes |
Rate:Dependent on underlying rhythm Rhythm: Irregular due to ectopic P waves: None PRI: None QRS: Wide, bizarre, >0.12 sec ST segment and T wave usually in opposite direction of QRS |
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R-on-T Phenomenon |
When a PVC falls on the T wave during the relative refractory period of the preceding normal QRS. May precipitate V-Tach, V-Flutter or V-fib |
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Causes of PVCs |
Increased catecholamines and sympathetic tone Stimulants High levels of digitalis preparations Sympathomimetics Hypoxia Acidosis Hypokalemia CHF Irritable focus or reentry phenomenon |
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Field Management of PVCs |
High flow Oxygen Ventricular antiarrhythmic |
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Ideoventricular Rhythm |
Rate: 20-40 bpm Rhythm: R-R usually regular P Waves: Usually not present, if present, no relation to ventricular complexes PRI: None QRS: Wide, morphology may vary >0.12 sec |
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Causes of Ideoventricular Rhythm |
AMI Failure of SA node and AV junction pacemaker sites Sinus arrest SA exit block Complete AV block |
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Treatment of Ideoventricular Rhythm |
Atropine (0.5 mg up to 3 mg total) Dopamine or Epi infusion TCP |
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Agonal Rhythm |
Rate: <20 bpm Rhythm: regular or irregular P waves: not present PRI: none QRS: very wide |
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Ventricular Tachycardia |
Rate: 100-250 bpm Rhythm: Usually regular P waves:Usually not present PRI: None QRS: Wide and bizarre, >0.12 sec ST segment and T wave usually in opposite direction of QRS complex |
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Causes of V-Tach |
AMI with hypoxia or acidosis Significant cardiac disease, cardiomyopathy, CHF, mitral valve prolapse, CAD Dig toxicity Use of drugs that prolong QT interval Severe brady-arrhythmias Electrolyte Imbalances (hypokalemia) CNS disorders PVCs |
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Treatment of V-Tach (with a pulse) |
Stable: high flow O2, 12-lead, vagal maneuvers, adenosine if monomorphic, amiodarone infusion (150 mg /100 mL over 10 min) Unstable: SCV 100j |
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Torsades de Pointes |
Polymorphic V-Tach Twisting of the points Looks like a twisted ribbon |
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Causes of Torsades de Pointes |
Multiple ventricular ectopic foci Hypomagnesemia CVD Drugs that prolong QT interval |
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Management of Torsades de Pointes |
Stable: Magnesium sulfate (1-2 g in 50-100 mL D5W over 5-60 min) Unstable: Defibrillation |
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Ventricular Fibrillation |
Rate: No heart rate Rhythm: Completely chaotic P waves: None PRI: None QRS: None |
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Causes of V-Fib |
AMI Myocardial ischemia Myocardial Trauma Dig, quinidine, procainamide toxicity Acidosis, hypoxia, electrolyte imbalance Electrocution R-on-T PVCs VT or V-flutter |
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Treatment of V-Fib |
CPR until defibrillator is available Immediate unsynchronized defibrillation (120-200j biphasic, 360j monophasic) CPR for 5 cycles, IV access at earliest opportunity Defibrillate CPR 5 cycles 1 mg Epi 1:10000 CPR 5 cycles Defibrillate Amiodarone (300 mg IVP) or Lido (1-1.5 mg/kg) |
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Asystole |
Rate: None Rhythm: Flat Line P waves: None PRI: None QRS: None |
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Causes of Asystole |
H's and T's |
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Management of Asystole |
1 mg Epi 1:10000 every 3-5 min If possible V-fib, assess in another lead, if still unsure, treat as V-fib |
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Ventricular Standstill |
Rate: none Rhythm: none P waves: non-conducted P waves PRI: none QRS: none |
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Causes of Ventricular Standstill |
H's and T's |
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Treatment of Ventricular Standstill |
Same as asystole |
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H's and T's |
H: Hypoxia, hypo/hyperkalemia, hydrogen ion acidosis, hypothermia, hypovolemia T: Tamponade (cardiac), Thrombosis (pulmonary), Thrombosis (cardiac), Tension pneumothorax, toxins |
