Pt has no heart beat, no cardiac output, is clinically dead
Clinical picture of Ventricular fibrillation
NO BP, pulse or resp
unresponsive, cold, clammy, pale, and cyanotic
intervention defib 200, 300, 360then CPR
Bundle branch block
QRS 0.12 or greater
Can be left or right
watch for heart blocks
what is a bundle branch block
impulse reaches the ventricles at different times
Wide QRS pathways with 2 peaks
QRS .12 or greater
what is it, how to treat it?
no electrical activity, flat baseline
start with CPR, no electrical activity to shock
ischemia is represented by...
ST- depression and t-wave inversion
Injury is represented by...
ST-elevation, tombstone T-Waves
MI is represented by ...
what causes U-Wave?
tall peaked T-waves
which is more concerning, Hypokalemia or Hyperkalemia
Hyperkalemia = tall peaked T-Waves
Hypokalemia = U-Wave and systole
Defibrillation occurs when...
an electrical current is strong enough to depolarize a critical mass of cardiac fibers
The depolarization is followed by a spontaneous repolarization which will restore coordinated effective heart contraction by allowing the pacemaker in the atrium to resume dominence
each cardiac cycle has a vulnerable period which is essentially the ...
during this brief period, any electrical stimulus that occurs may induce Ventricular Fibrillation
synchronized is _____
by synchronizing the defib unit with pts heart rhythm it prevents the electrical shock from occurring during the T-Wave
unsynchronized is ______
electrical energy is delivered through the chest wall all myocardial cell halt and the SA node starts controlling the rhythm again
unstable V-Tach (unconscious)
Defib rapidly up to 3 times as nec, 200, 300, 360 checking the pulse between each shock
operator makes sure all personal are away fro the bed, and defib
only touch pt with paddles
operator should not be preforming CPR
do not discharge in the air
apply gel to pads
operator should be standing in a dry surface
remove all NTG sources
Turn pacer off
programs the machine to know the patients rhythm so that the shock is not given during the T-Wave (vulnerable period). usually shocks during the R-wave
when should cardioversion be used
uncontrolled atrial fibrillation
uncontrolled atrial flutter
ventricular arrhythmias (stable v tach)
can be temp or permant used to pace the heart when normal conduction tissue is unable to generate a normal adequate rhythm
they deliver electrical stimulation to myocardial muscle when normal conduction tissue of the heart fails to generate adequate BPM
what is the purpose of the pacemaker
to generate electrical stimulation when SA has failed and the AV and purkinjie fibers cannot provide adequate backup
To generate a HR that creates an adequate cardiac out put and stable blood pressurecan also be programmed to generate atrial contractility in lower generated pacer rhythms (improve ventricular rhythms)
To override (outpace) ectopic tachy rhythms
wire feed into the rt atrium but the end of the pacing catheter is on the outside and is attached t the external generator
used after open heart surgery, wires are placed on the epicardium rt atrium and rt ventricle and attached to external generator