Ventricular Dysrythmias

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Ventricular Dysrythmias
2011-09-26 23:37:44
Ventricular Dysrythmias

Vent. Dysrythmias
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  1. What causes PVCs?
    • Some part of the ventricle fires because tissues become irritable
    • Electrolyte imbalances, hypoxia, not gettings blood, etc.
  2. Ventricular Dysrythmia causes of decreased CO
    Sustained VT, VF, and 6-10 PVCs in one minute
  3. R on T phenomenon
    • PVCs are firing close to T waves; can send someone into VF
    • Can be precursor to VT and VF (decreased CO)
  4. PVC Characteristics
    • QRS greater or equal to 0.12sec
    • Contraction is premature
    • The QRS complex and T waves deflect in opposite directions
    • Need K+ levels to be 4.0 or greater
  5. Multifocal PVCs
    multiple positive and negative deflected QRS complexes; different directions
  6. Unifocal PVCs
    PVCs are both in same direction
  7. PVCs: Bygiminal, Trigiminal, Couplet, and VT
    • Bygiminal: PVCs every other beat
    • Trygiminal: PVCs every third beat
    • Couplet: 2 PVCs together
    • VT: 3 or more PVCs together
  8. Ventricular Tachycardia (VT)
    • Wide QRS (greater than 0.12)
    • Rate greater than 100bpm
    • P wave may be absent (buried in QRS complex)
    • Pulse may be absent
    • Magnesium can contribute to this
  9. Ventricular Fibrillation (VF)
    • Can not see usual complexes
    • No pulse, cannot determine rate, chaotic waveform
    • No consciousness, no CO
    • Smaller peaks: fine VF
    • Bigger peaks: coarse VF
    • Most common cause of sudden death
  10. Asystole
    • Straight line
    • No electrical impulses
  11. PVC Treatment
    • No treatment is asymptomatic
    • Reduce caffeine, ETOH, and stress
    • Amiodarone (suppresses PVCs)
  12. VT Treatment
    • Amiodarone
    • Magnesium
    • Cardioversion
    • If no pulse, same treatment as VF
  13. VF Treatment
    • CPR
    • Defibrillation
    • Epinephrine
    • Vasopression
    • Amiodarone
    • Lidocaine
    • Once has pulse and converted, start continuous infusion of last drug used to convert to rythm
  14. Amiodarone hydrochloride
    • Antiarrhythmic agent, depresses conduction, raises threshold for VF
    • PO or IV (central line preferred)
    • IV loading dose: 150mg over first 10minutes (dilute 150mg in 100ml D5W), then 360mg over next 6hrs, followed by 540mg over next 18hrs
    • Adverse effects: H/A, dizziness, hypotension, bradycardia, blue-gray skin color