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MED SURG III

Exam #2 - Dysrhythmias, Heart Block, Pacemakers, Cardioverison & Defibrillation

QuestionAnswer
Ventricular Dysrhythmias Originate…. From the foci of the ventricles
Premature Ventricular Complexes Impulse that starts in the ventricle and is conducted through the ventricles before the next normal sinus impulse. Can occur in healthy people, especially in those with intake of caffeine, nicotine, or alcohol. May be caused by cardiac ischemia, HF, hypoxia, digitalis toxicity, hypoxia, acidosis, or hypokalemia.
Ventricular Tachycardia Defined as three or more PVCs in a row, occurring at a rate exceeding 100 bpm. Patients with larger MIs or lower ejection fractions are at a high right of ventricular tachycardia. Medical emergency as it almost always results in a patient being unresponsive and pulseless. Symptoms depend on duration and vary from none, to palpitations, to hemodynamic collapse and death.
Treatment of Premature Ventricular Complexes Treatment is only needed if frequent and persistent and include: Amiodarone, Beta Blockers
Treatment of Ventricular Tachycardia If stable, continue monitoring, obtain 12 lead ECG. If unstable, unconscious, or without a pulse, treat as ventricular fibrillation with immediate defibrillation. If there IS A PULSE - synchronized cardioversion. If PULSELESS - defibrillation, CPR. MEDICATIONS include Procainamide, Amiodarone, Sotalol, and Lidocaine
Ventricular Fibrillation Most common type in patients with cardiac arrest. Rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Results in the inability of the heart to pump any blood to the body. Which will result in death. No atrial activity is seen on the ECG. Most common cause is coronary artery disease, and resulting acute MI. Symptoms include loss of consciousness, absent pulse, no heart sounds, BP drops to 0/0
Treatment of Ventricular Fibrillation CPR & DEFIBRILLATION. Medications include Amiodarone and Epinephrine
Idioventricular Rhythm Also called a ventricular Escape Rhythm. Occurs when the impulse starts in the conduction system below the AV node. When the sinus node fails to create an impulse or when the impulse is created but cannot be conducted through the AV node (due to a complete AV block). the Purkinje Fibers automatically discharge an impulse
Treatment of Idioventricular Rhythm Initiating Emergency Transcutaneous Pacing. MEDICATIONS include epinephrine, atropine, and vasopressors.
Ventricular Asystole Commonly called flatline, ventricular asystole is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal.
First Degree Heart Block Occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal.
Second Degree Heart Block, Type I (Wenckebach) Occurs when there is a repeating pattern in which all but one of a series of atrial impulses are conducted through the AV node into the ventricles (every 4 of 5 atrial impulses are conducted). Each impulse takes a longer time for conduction than the one before, until one impulse is fully blocked.
Second Degree Heart Block, Type II Occurs when only some of the atrial impulses are conducted through the AV node into the ventricles.
Third Degree Heart Block Occurs when no atrial impulse is conducted through the AV node into the ventricles. P waves may be seen, but the atrial electrical activity is not conducted down into the ventricles to initiate the QRS complex, the ventricular electrical activity. Having two impulses stimulate the heart results in a condition referred to as AV dissociation which may also occur during VT.
Bundle Branch Block Abnormal conduction through the bundle branches will cause a depolarization delay through the ventricular muscle, resulting in a widened QRS complex
Right Bundle Branch Block (RBBB) Indicates problems in the right side of the heart
Left Bundle Branch Block (LBBB) Indicates heart disease.
Bigeminy Every other complex is a PVC
Trigeminy Every 3rd complex is a PVC
Quadrigeminy Every 4th complex is a PVC
Medical Management of Conduction Abnormalities Based on the cause of the AV block and the stability of the patient, treatment is directed toward increasing the heart rate to maintain a normal cardiac output. If the patient is stable and has no symptoms, no treatment may be indicated or it may simply consist of decreasing or eliminating the cause (e.g., withholding the medication or treatment).
Treatment of AV Heart Blocks Usually requires a pacemaker
Junctional Dysrhythmias Originate the AV node
Premature Junctional Complexes Impulse that starts in the AV node before the next normal sinus impulse reaches the AV node. Causes Include: Digitalis toxicity, HF, CAD
Non-Paroxysmal Junctional Tachycardia Enhances automaticity in the junctional area, resulting in a rhythm similar to junctional rhythm, except at a rate of 70-120 bpm. Does not normally have any detrimental hemodynamic effect. BUT it may indicate a serious underlying condition such as: Digitalis toxicity, Myocardial Ischemia, Hypokalemia, COPD
Atrioventricular Nodal Reentry Tachycardia (AVNRT) Common arrythmia that occurs when an impulse is conducted to an area in the AV that causes the impulse to be rerouted back into the same area over and over again at a very fast rate. Typically abrupt in onset, and abrupt cessation. Causes Include: Caffeine, Nicotine, Hypoxemia, Stress, Cardiomyopathy
Cardioversion Delivery of energy that is synchronized to the QRS complex. Used in the treatment of persistent unstable tachyarrhythmias in patients without a loss of pulse.
Defibrillation Asynchronized delivery of a shock randomly during the cardiac cycle. Indicated in any patient with pulseless ventricular tachycardia or ventricular fibrillation where cardioversion is not possible
Automated External Defibrillators (AEDs) Useful, does not require special medical training. Found in public places. Analyze the heart rhythm and then charge and deliver shock if appropriate. Cannot be overridden manually and can take 10-20 seconds to determine arrhythmias.
Major Difference Between Cardioversion & Defibrillation The timing of the delivery of the electrical current
Semi-Automated AEDs Can be overridden and usually have an ECG display. Tend to be used by paramedics. Also have the ability to pace.
Implantable Cardioverter Defibrillation (ICD) Small battery-powered device placed in the chest to monitor the heart rhythm and detect irregular heartbeats. Can deliver electric shocks via one or more wires connected to the heart to fix an abnormal rhythm
Pacemaker Electronic device that provides electrical stimuli to the heart muscle. Usually used when a patient has a permanent or temporary slower-than-normal impulse formation, or a symptomatic AV or ventricular conduction disturbance.
On-Demand Pacemaker Set to sense and respond to patients HR activity
Fixed or Synchronous Pacemakers Set to fixed rate. Not set to sense. Does not know when the patients HR is beating
Sense Pacemakers Can Sense, but should not fire if it is above the preset rate
Capture Pacemakers Able to stimulate the myocardium to contract
Pacemaker Discharge Education Signs of Infection, Need for follow-up care. TEACH FAMILY CPR. No MRIs, Avoid High Output Generators. No Contact Sports. Notify TSA of pacemaker when traveling WAND CANNOT GO DIRECTLY OVER IT. Get a card, and keep it with at all times. MONITOR HR. Objects with batteries should not go over pacemakers. Don't go by antitheft systems. Know when battery should be changed. Follow-up care is available for some remotely.
Monophasic Defibrillators Current travels in one direction, from one paddle to the other
Biphasic Defibrillators Current travels towards the positive paddle and then reverses and goes back, occurring several times. Associated with fewer burns and less myocardial damage
Associated with fewer burns and less myocardial damage
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