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NurseFaith
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EKG differences for Ventricular Arrhythmias
T waves are always bigger and wider than P wave
P waves come from atrial muscle
QRS will tend to be wider when there is BBB
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When there is an irritable spot in the right ventricle, the ____ side will be stimulated first
Right
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The beat of a PVC goes in what direction?
- Opposite direction from a normal beat
- (wide, fat, ugly beat that interupts rhythm > premature ventricular contraction)
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No PR interval, Wide and bizarre QRS, Opposite direction of T wave
Premature Ventricular Contraction
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Pt assessment on someone that has a PVC (premature ventricular contraction)
- No pulse that you can feel-- NO cardiac output
- (people can feel these)
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What is unique about a beat after a PVC
- It comes right on (normal) time
- Compensatory Pause
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Most common cause of irritability of heart muscle
Hypoxia
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Number one treatment for patient with PVC (or any heart irratibility)
OXYGEN! (number one cause of irritability is hypoxia)
- *check oxygen nasal canula
- *tell pt to cough
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Unifocal PVCs
come from the same place in the heart
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Multifocal PVCs
Come from different points on the heart muscle (more dangerous than unifocal) > V Fib!
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Treament for Multifocal PVCs
- Oxygen is priority
- Amiodarone 150mg IV over 10-15 min
- Procainamide (Lidocaine/Novacaine) numbing
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effect of lidocaine/novacaine on the heart
Numbing agent and prolongs ventricular resting periods
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When two PVCs happen in a row, they are considered to
"Couplet"
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3 or more PVCs in a row (that have fired rapidly) =
Short Run of Ventricular Tachycardia
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Patterns of Irregular Beats:
Ventricular Bigeminy (one normal, one irregular...more serious) Trigeminy (normal, normal, PVC) or Quadrigeminy (normal, normal, normal, PVC)
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Normal PR interval
.12-.20
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Cause of Ventricular Tachycardia
Severe irritability of ventricular muscle (hypoxia) as well as acid-base imbalances (lactic acid released in response to blocked artery)
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If someone is in Ventricular Tachycardia, there are signs/symp of low cardiac output...what is treatment?
- Oxygen
- Cardiovert (synchronized)
- Push Amiodarone, Procainamide, Lidocaine, and Magnesium
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Warning about Treatment during Ventricular Tachycardia:
pt may become unresponsive and without breathing at any time! (don't treat monitors, ALWAYS assess your patient!)
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If person is in V tach with no s/s of life (no pulse) what is treatment?
CPR, Defibrilator/AED
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Rate of 150-250 bpm, No PRI, Wide Short and Fat QRS
Ventricular Tachycardia
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Complication of very low blood temperature
Ventricular Fibrillation
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Totally chaotic EKG with no discernible waves or complexes
Ventricular Fibrillation
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If pt has a "fine" V Fib EKG, giving what will help make it more "corse" and shockable?
IV epinephrine
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Treatment for unresponsive V Fib patient
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Treatment order for pt in V Fib with pulse
- Oxygen
- IV access
- Lidocaine 1 mg
- Lidocaine .5mg every 8 min (up to 3)
- Procainamide 20 mg (up to 1000 mg)
- Cardiovert as in unstable patients
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Straight line on EKG, absense of any electrical activity
Asystole
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Only treatment for Asystole
- Check pt before calling code
- CPR
- Epinephrine
- (shocking will not work because there is no electrical activity)
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Things that lead to Asystole
Pulseless Electrical Activity (PEA) -- assess your pt!
- Hypovolemia
- Hypoxia
- Hydrogen Ion Excess (Acidosis)
- Hypo/erkalemia
- Hypothermia
- Tension Pneumothorax, Tamponade, Toxins, Thrombosis Pulmonary
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