Lecture 2 for N176
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Causes of sinus tachy
- volume loss
How do you treat sinus tachy?
Consider the cause 1st, then treat from there...ie-low blood volume will cause the heart to race, start an IV of NS, scope for GI bleed etc...
Symptoms of sinus brady
- may be asymptomatic....or
- anginal pain
What causes sinus brady?
- increased vagal tone
- athletic heart
- drugs-BB and Dig
Drugs that cause bradycardia
digoxin and beta blockers
If a patient has symptomatic bradycardia and you have given Atropine, Dopamine and Epi...what's your next step?
How do you know a persons in acute heart failure?
- crackles in the lungs
- decreased O2 sats
PAC's can be a prelude to
- A fib
- A flutter
- Paroxysmal artial tachycardia
What causes Paroxysmal Atrial Tachycardia
How do you treat PAC's?
- Usually asymptomatic and no interventions needed....
- but if have more than 6/min they will be symptomatic and need
- stop drinking alcohol and coffee
- no smoking
ventricular contractions are btwn 150-250, but are regular
What's a paroxsymal SVT (PSVT)
SVT that starts abruptly after a PAC and it ends suddenly without intervention
Treatment for SVT
Eliminated identified cause in healthy person
- admin O2
- Calcium channel blockers
- Beta Blockers
Block AV node
Immediate intervention for SVT
- #1...vagal maneuver to try and decrease HR
- anitidysrhytmic agents like:
- Beta Blockers
- Calcium Channel Blockers
Another medication to give for Bradycardia
Zofran....if they are experiencing nausea. Decreases vagal tone
#1 medication to give for SVT? How?
- 6 mg slammed followed by a NS flush
- repeat after 1-2 min
- **this will cause asystole for 6-8 seconds
Describe Atrial Flutter
atria arent contracting and the rate is at 250-350
P wave looks like a sawtooth pattern....there are QRS complexes that are normal
What's the result of atrial flutter?
ineffective atrial contraction and emptying causes a loss of atrial kick which makes the person at risk for clots and emboli
What do I need to ask about the persons Atrial Flutter?
How long has it been going on....cuz they may already have clots and we dont want to convert them and throw the clots.
If it has been for longer than 48 hours give them medication to slow the HR first
Medication that slows the HR
Describe Atrial Fibrillation
quivering of the atria
P waves are absent or indistinguishable
- atria rate is at 350-600...cant count
- ventricle rate is at 100-160
What is the result of Atrial Fibrillation?
Poor atrial emptying, so danger of clot and embolism
What do you do for a patient with A Fib
- check apical and radial pulse for perfusion...risk of cardiovascular instability
What causes PVC's?
If a person comes in and EKG shows PVC's what do I check first?
Labs for potassium level and ask if they are on any diuretics
PVC's can be...
- in pairs called couplets
- every other beat called bigemeny
- every third beat called trigemeny
If you have more than 3 PVC's in a row it is called
- V Tach
- seen in people who take stimulants
Describe Ventricular Tachycardia
100-250 beats per minute
cant see a p wave
V Tach oftenly turns in to....
V fib....cuz of the decrease in CO
Looks like big mountains next to each other in a row
Describe Ventricular Fibrillation
the rate is rapid and not measurable...no atrial activity
cant see any P waves and QRS complex looks like fibrillatory waves
Describe a person in V Fib
person will lose consciousness, become pulseless and apneic
Result of V Fib
death will occur if it is allowed to persist for more than 4-6 minutes
What could happen for asystole to show up on the ECG rhythm
lead fell off
What is Pulseless Electrical Activity?
1st level...there is a rhythm on the monitor, but no detectable pulse
2nd level....it is often due to a reversible cause like H&T
List H's that cause PEA
- Hydrogen ion loss-acidosis
List T's that cause PEA
- Tablets or Toxins...drug OD
- Tamponade-cardiac (after surgery)
- Tension Pneumothorax
What will the EKG look like if they have PEA
The energy is transmitted during the up strok of the R wave....so you have to have an organized rhythm to do this
Describe Adult BLS
- Unresponsive/not breathing or not normal breathing
- activate emergency response system
- get AED
- check pulse....no pulse=
- 30 to 2
- After AED is on check to see if shockable rhythm
- If yes, give 1 shock and resume CPR
- If no, resume CPR
Ask yourself these questions when a patient has persistent Bradyarrhymia or Tacchyrhythmia
- Is it causing....
- acutely altered mental status
- any signs of shock
- ischemic discomfort
- acute heart failure
If no....monitor and observe
If a person is experiencing bradycardia and has signs of hypotension, altered LOC, signs of shock, chest pain or signs of acute heart failure what do I do?
Give- #1 Atropine, then Dopamine or Epi
Possible transcutaneous pacing then Transvenous pacing if necessary
If person is tachy and is showing signs of hypotension, altered LOC, signs of shock, chest pain or acute heart failure....what do I do?
Synchronized cardioversion....but only if the patients BP isnt too low and their RR is WNL
may want to sedate patient
What if a person is having a tachy rhythm, is asymptomatic and has a wide QRS complex....what do I do?
- IV access
- 12 lead EKG
- Adenosine, BB or CCB
IV drug given as a push for tachycardia
Adult having cardiac arrest do 3 things first...
- shout for help
- press emergency response
- start cpr
For what conditions do we shock a patient?
V Fib and Pulseless Ventricular Tachycardia
What conditions do we not shock the patient? What do we do?
- Asystole and PEA
- CPR for 2 minutes then check for a shockable rhythm
- and Epinephrine every 3-5 minutes
What is the pattern for treatment of Vfib and Vtach that is pulseless?
- cpr and amioderone as an anti-arrhythmic
First line of medications for patients with V fib or pulseless Vtach
- epi, vasopressin, epi
- or vasopressin, epi, epi
When a person is coding how quickly does the endotracheal tube need to be inserted?
Common treatments for patients who have had a MI
- decrease their core temperature to 89.6-93.2 for 12-24 hours post arrest.
Done with ice packs, cold iv infusion
How soon after a persons MI can you tell their prognosis?
72 hours after
Why hypothermia after an MI?
- to minimize ischemia to heart
- to diminish reperfusion injury
- to decrease the patients metabolic needs
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