Critical Exam 2 -EKG Arrhythmia interpretation, causes, tx (10pts)

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Critical Exam 2 -EKG Arrhythmia interpretation, causes, tx (10pts)
2013-09-27 17:44:30
Critical Exam EKG Arrhythmia interpretation causes tx 10pts

Critical Exam 2 -EKG Arrhythmia interpretation, causes, tx (10pts)
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  1. Sinus arrhythmia
    • Irregular rhythm
    • Coincides with phases of resperation
    • Common in kids and athletes
  2. Sinus Tachycardia
    • Rate= 100-160
    • Tx=none unless symptomatic - tx cause; carotid sinus massage (allows you to see Pwaves); Drugs= adenosine, verapamil, digoxin
  3. Sinus Bradycardia
    • Rate=<60
    • Tx: if pt is symptomatic tx cause; Drug of choice is Atropine IVP (.5-1mg); Transcutaneous pacing
  4. First Degree Heart Block (A-V block)
    • PR intv= >.20 
    • Cause: impulse delayed in atria - MI, digoxin toxicity, ischemia, BB, CCB, CAD, hyperkalemia, rheumatic fever
    • Tx: Monitor, correct underlying cause
  5. Third degree Heart Block- Complete Heart Block (CHB)
    • Atrial rate exceed Ventricular rate; QRS wide and bizzare ; PR variable
    • Cause: digoxin, inderal, CAD, increase vagal tone, inferior MI, acute myocarditis, electrolyte imbalance
    • Tx: Pacemaker; Atropine IVP or Isuprel drip
  6. Atrial Flutter
    • Rate=240-360 (usually 300)
    • P wave= abnormal with saw-tooth appearance 
    • Cause: rheumatic or ischemic disease, HF, AV valve disease, pre-excitation syndrome, septal defects, pulmonary emboli, thyrotoxicosis, alcoholism, pericarditis
    • Tx: Admin 02; Digoxin, amiodarone, cardizem to slow rapid vent response, anticoag
  7. Atrial fibrillation
    • Rhythm= grossly irregular
    • Rate=400-600
    • Pwave= NONE, fibrillatory waves 
    • Cause: HTN, DM, male, CHF, valve disease, alcohol, cardiac surgery, MI, pericarditis, myocarditis, pulm embolism
    • Tx: Antidysrhythmic (CCB-cardizem, amiodarone); Anticoag (Lovanox, Coumadin); Cardioversion
    • **Observe for clot formation
  8. Premature Atrial Contraction (PAC)
    • Rhythym= reg except PAC
    • P wave= may be hidden in preceding T wave
    • (looks like beat comes too soon)
    • Cause: rheumatic heart disease, mitral stenosis, early sign of CHF, MI, stimualants
    • Tx: Usually none. Pronestyl or Quinidine to increase refractoriness of atrium
  9. Premature Ventricular Contraction (PVC)
    • Rhythym=irregular d/t premature beat
    • QRS= wide and bizzare!
    • MCLI best lead to see
    • Cause: hypoxia, hypokalemia, ischemia, mi, stimulants, proarrhytmic meds
    • Tx: when seen with bradycardia as escape beats/ >6bpm, multifocal, couplet or R on T- lidocaine (bolus 1-1.5mg/kg repeat in 30 mins w 1/2 as much); lidocaine drip (1-4mg/min); Pronestyl and amiodarone
  10. Ventricular Tachycardia (V-tach)
    • Rate= >100
    • QRS = >.12 +bizarre
    • Cause: same as PVC+cardiomyopathy, vent aneurysm
    • Tx: unconcious- electrically cardioverted, defib, pacemaker, amiodarone 150mg over 10 min, lidocaine, pronestyl
  11. Ventricular fibrillation
    • Rhythym= chaotic electrical activity
    • Rate, Pwave, PR, QRS= NONE
    • Cause: same as PVC
    • Tx: CPR/Defibrillation-200,300,360; epinephrine 1mg ivp Q3-5min or Vasopressin 40 units IVP x1; defibrillate again
  12. Asystole
    • AKA Standstill
    • Absence of rhythym may see little p waves
    • Cause: adv cardiac disease, electrical cardioversion, defibrillation, antiarrhythmic meds
    • Tx: cpr and acls protocol DO NOT SHOCK- check ABCs, check leads, transcutaneous pacing, epi 1 mg ivp Q3-5min, atropine 1mg ivp