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Dysrhthmias

Maladaptive Ventricular Rhythms

Wide QRS Measures>.12 seconds
T wave is which way from QRS Opposite
Normal people may have PVCs that cause no problem True
PVCs are dangerous for who? Pt who has had MI
PVC premature contraction originating from an irritable vocus in the ventricle
Most common ventricular dysrhythimia PVC
Most common of all dysrhymias PVC
Determining factor in PVC Wide QRS
Shape of QRS Abnormal
R-R interval from normal QRS before PVC to normal QRS after PVC Equal but not always 2 R-R intervals
Compensatory phase delay after a PVC
Ventricular Irritability usually indicates PVC
Isolated, infrequent PVCs dangerous? Unsually are not
PVCs dangerous 6 or more in a minute
Ventricle Bigeminy every other peat is a PVC / is considered dangerous
Ventricle Bigeminy Every other beat is a PVC
Ventricle Bigeminy dangerous? True
R on the T Pattern PVC falling on T wave of the preceding QRS and is particularly dangerous
Multi-focal PVC's originating from more than one ectopic focus
How can you tell PVCs are multi-focal? look different from each other
Multi-focal are more/less dangerous than uni-focal? More
Couplets 2 consecutive PVC's; especially dangerous
Interpolated PVC's PVCs that come so early that they activate the ventricle and repolarize before the next normal contraction
Primary drug for PVCs Lidocaine
Usual dosage of Lidocaine for PVC 50-100 mg (1 mg/kg)
Overdose of Lidocaine will cause what? convulsions
Ventricular tachycardia 3 or more PVCs in a row (also called short run)
Ventricle tachycardia is often forerunner for what? Ventricle Fibrillation
V-tach may occur in short runs or bursts True
Rate of Ventricular Tachycardia 140-250 per minute
Ventricular Tachycardia sustained, what is cardiac output like lowered or inadequate
Ventricular Tachycardia is treated w/ what drug? Lidocaine
Initial treatment for Ventricular Tachycardia 100 mg Lidocaine, followed by IV infusion
If Ventricular Tachycardia continues after giving drug, what is next step? pre-cardial shock
Series of PVCs, slower than VT, 50-100 bpm Accelerated idioventricle rhythm
VT starts and stops abruptly
Accelerated idioventricular rhythm starts and stops gradually
Inherent pacing rate of ventricular tissue 20-40 bpm
Accelerated ventricular rate 50-100 bpm
Dying heart or Agonal Accelerated Ventricle rate seen following defib of VF, before a higher focus takes over and ventricular impulses are sporadic
Agonal pulses not palpable
Torsades de Pointes polarity of wide QRS complexes rhythmically change between positive and neagtive
Vetricular Tachycardia shape uniform in shape
Torsades de Pointes shape Waxing and waning
Treatment for Torsades de Pointes Magnesium
Ventricular fibrillation muscles quiver or twitch; do not contract
Pulse in Ventricular fib? no pulse
Primary ventricular fibrillation can develop in pt who is doing well
Secondary ventricular fibrillation ventricular fibrillation develps in pt w/ advanced left vetricular failure
Treatment for ventricular fibrillation CPR
What acidosis does pt w/ vfib develop? lactic or metabolic
Lidocaine or Amiodorone as continuous infusion after successful defibrillation
Primary reasons for pacemakers Tachy-arrhythmia, blocks - 2nd, inferior MI, 3rd HB, Prophilactic in 2nd degree HB going to surg (temp pacemaker)
Name types of temporary pacemakers external/cutaneous, Internal, transthoracic
Which pacemaker can be initiated the quickest external/cutaneous
Pacemaker most comfortable to pt while operational internal transverse or transthoracic
Generator for temp. intravenous pacemaker is where? outside the pt.
Where is the end of the intravenous pacing electrode placed? Right ventricle
How can you tell electrode is "seeded" or "seated" correctly? floroscopy or artifact/EKG strip
Why is demand pacemaker preferred over fixed mode? fixed will fire on schedule, demand works c pt or on heart and fires when needed.
Usual venous site for temporary pacemaker IJ (jugular), Subclavian, Femoral
Where should the tip of the electrode be to pace effectively endocardium/wall of the ventrical
Loss of capture pacemaker is firing bu the heart isn't contracting in response to it
If loss of capture occurs, what must be done? Dr must reposition catheter
Loss of capture, what can nurse do? have pt change position or cough
No pacing blips on monitor mean what? Pacemaker is not working correctly
Why would pacemaker not be firing? Pt's heart is firing on it's own, batteries need to be changed
Twitching during pacing means...? electrodes have punctured the ventricle wall
Hiccups or singultus can result from what? electrodes puncturing the ventricle wall
If perforation occurs, what must happen? Dr will have to reposition the catheter
What are fusion beats in relation to artificial pacemakers? WHen pt's own intrisic beat coincides with pacemaker's beat, will have characteristics of both
What is used to terminate V-fib Debirillation
Cardioversion can be used to terminate what? Atrial and ventricular arrhythmias
Cardioversion is elective therapeutic measure True
Cardioversion/Defibrillation Cardioversion is synchronized on the R wave, Defibrillation is not synchronized.
Where are paddles placed? either both anteriorly or one anterior and posterior
Why is conductive paste or saline pads used? to prevent electrical arc or surface burn
Precardial shock striking on T wave can cause what? ventricular fibrilllation
Refractory period nonvulnerable period
Refractory period is when? QRS is in it
Bifasic goes down and comes back - 2 chances to convert
Synchronized shcok is delivered wen? in the refractory period
How does defibrillator know when to shock Recognizes the QRS (R wave) complexes and firing at that time (switch must be on for it to recognize)
If the synchronizer switch is on what can be treated? Atrial fib, cannot treat ventricular fib
If synchroizer is off, what can happen if pt is in atrial fib? can throw them into V-fib
Elective shock synchronized
Nonsynchronized defibrillation
cardioversion synchronized
anesthesia synchronized
ventricular fibrillation defibrillation
Permit required synchronized
minimum energy synchronized
emergency defibrillation
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