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Recommended you watch: Life-Threatening Arrhythmias: Foundational Concepts

Recommended you watch: Life-Threatening Arrhythmias: Foundational Concepts. 80712/32612. Before watching this program.

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Recommended you watch: Life-Threatening Arrhythmias: Foundational Concepts

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  1. Recommended you watch: Life-Threatening Arrhythmias: Foundational Concepts 80712/32612 Before watching this program

  2. This PowerPoint file is a supplement to the video presentation.  Some of the educational content of this program is not available solely through the PowerPoint file.  Participants should use all materials to enhance the value of this continuing education program.

  3. EMS/Nursing 80812/ 34812 Life-Threatening Arrhythmias: Events

  4. EMS/Nursing 80812/ 34812 Elizabeth J. Tombs, RN, MSN, IBCLC, RLC, Assistant Professor, Anita Thigpen Perry School of Nursing, TTUHSC Lubbock, Texas

  5. EMS/Nursing 80812/ 34812 Carol A. Strahan, RN, MSN, CCRN, CEN, Assistant Faculty Retention Counselor Anita Thigpen Perry School of Nursing, TTUHSC Lubbock, Texas

  6. EMS/Nursing 80812/ 34812 Objectives Recognize the electrical process of the heart.

  7. EMS/Nursing 80812/ 34812 Objectives Identify patterns and causes of atrial fibrillation and ventricular tachycardia.

  8. EMS/Nursing 80812/ 34812 Objectives Identify patterns and treatment of asystole and pulseless electrical activity (PEA).

  9. Heart Rhythms • Always life-threatening • ventricular fibrillation • asystole • pulseless electrical activity (PEA) • Can become life-threatening • sinus bradycardia/tachycardia • Mobitz 1 and 2 • complete heart block • atrial fibrillation (A-fib) • atrial flutter (A-flutter)

  10. Heart Rhythms • paroxysmal atrial tachycardia (PAT) or supraventricular tachycardia (SVT) • ventricular tachycardia

  11. P P P P P P P P P wave Complete Heart Block

  12. PR Interval Complete Heart Block

  13. PR Interval: varies Regular Rhythm: Regular P to P and Regular R to R Rate: Atrial usually 60-100 Ventricular usually 20-60 QRS Interval: normal or wide Complete Heart Block

  14. Causes • MI (myocardial infarction) • Medication side effect • Hypoxia • Conduction system lesion

  15. Treatment • May try pacemaker • Consider atropine or epinephrine • May need dopamine to sustain cardiac output

  16. Rate: >100 – 160 (upper limit) Regular Rhythm: Yes – generally PR Interval: .12 - .20 secs QRS Interval: >.12 secs Rate: 100 Sinus Tachycardia

  17. Causes • Fever • Hypoxia • Medication side effect (ex. Beta adrenergic) • Pathologic underlying condition (thyroid storm)

  18. Treatment • If stable, treat underlying cause (i.e., decrease fever) • If unstable: • consider medications (ex. beta blocker) • consider starting O2

  19. Regular Rhythm: mostly regular and visually identifiable pattern Rate: generally >150 for SVT and >160 – 250 for PAT PR Interval: no identifiable P waves at such a rapid pace QRS Interval: narrow complexes PAT/SVT

  20. PAT/SVT Symptoms • Distress • Anxious • Impending doom

  21. Causes • Likely premature atrial complex (PAC) triggered • Stimulants (caffeine, medications) • Anxiety • Damage to myocardial tissue

  22. Treatment • If stable, treat underlying cause • vagal maneuvers • carotid massage • may give adenosine • also consider: calcium channel blocker, digitalis, beta blocker • If unstable: • cardioversion

  23. R Cardioversion: needs to be synched on the R waves PAT/SVT

  24. Rhythm: irregular Rate: atrial = 350 – 700 (ventricular = >150 uncontrolled A-fib) PR Interval: no P waves QRS Interval: narrow complexes Atrial Fibrillation

  25. Causes • MI damage • Pulmonary heart disease • Valvular heart disease • Hyperthyroidism

  26. Treatment • If less than 48 hours: • convert back to sinus rhythm (SR) • consider: digitalis, calcium channel blockers, beta blockers, amiodarone, or cardioversion • If greater than 48 hours: control heart rate (HR) and give anticoagulant to prevent blood clots • If unstable: cardioversion

  27. PR Interval: P wave is saw-tooth Regular Rhythm: mostly regular and visually identifiable pattern Rate: Atrial = 250 – 350 (ventricular rate depends on the conduction ratio) QRS Interval: narrow complexes Atrial Flutter

  28. Causes • Heart disease • Valvular heart disease • Lung disease

  29. Treatment • If stable, treat underlying cause • consider: calcium channel blocker, digitalis, beta blocker • may use adenosine for A-flutter • If unstable: cardioversion

  30. Regular Rhythm: mostly regular and visually identifiable pattern Rate: >100 (generally >150) PR Interval: no P waves QRS Interval: wide and bizarre complexes Ventricular Tachycardia

  31. Causes • Premature ventricular complexes (PVCs) • PVC causes: • hypokalemia • hypoxia • heart disease • Low magnesium • Stimulants

  32. Treatment • Treat the patient, not the monitor • Check pulse • if pulse: • amiodarone • O2 started • if no pulse: • cardiopulmonary resuscitation (CPR) • defibrillate

  33. Treatment • Medications: epinephrine, amiodarone, and O2 (follow advanced cardiac life support [ACLS] protocol)

  34. Bizarre and chaotic rhythm; no detectible P or QRS (looks like static) Ventricular Fibrillation

  35. Causes • PVCs • R on T phenomena • Heart disease • Hypokalemia • Hypoxia • Low magnesium • Stimulants

  36. Treatment • CPR • Immediate defibrillation • ACLS protocol • Medication: epinephrine, amiodarone, O2

  37. Regular Rhythm: no Rate: 0 PR Interval: 0 QRS Interval: 0 Asystole: A-none systole-contractions Asystole

  38. Causes • Massive MI • Profound hypoxia • Heart disease • 5 Hs • hypothermia • hypothermia • hypokalemia • hypoxia • hydrogen ion acidosis • hypovolemia

  39. Causes • 5 Ts • toxic/tablets • thrombosis (coronary) • thrombosis (pulmonary embolism) • tension pneumothorax • tamponade

  40. Treatment • CPR • Medications: epinephrine, may consider atropine • Consider transcutaneous pacing • ACLS protocol

  41. Any organized electrical rhythm where patient does not have a pulse Pulseless Electrical Activity (PEA)

  42. Causes • Inability to cause systole • Either the current is too weak or the muscle is not able to contract • 5 Hs • 5 Ts

  43. Treatment • CPR • Identify and reverse cause • Medications: epinephrine • ACLS protocol • Treat the patient not the monitor

  44. After the Event • Continue to provide supportive measures • Provide education to family and patient: • cardiac arrhythmia • treatment • prevention • Provide support to family and patient: • resources • holistic aspects (spiritual, cultural, etc.)

  45. EMS/Nursing 80812/ 34812 Life-Threatening Arrhythmias: Etiology/Treatment If you have any questions about the program you have just watched, you may call us at: (800) 424-4888 or fax (806) 743-2233. Direct your inquiries to Customer Service. Be sure to include the program number, title and speaker.

  46. EMS/Nursing 80812/ 34812 Release Date: 02/01/2012 The accreditation for this program can be found by signing in to www.ttuhsc.edu/health.edu

  47. EMS 80812 This continuing education activity is approved by the Continuing Education Coordinating Board for Emergency Medical Services for 1.5 Basic CEH. You have participated in a continuing education program that has received CECBEMS approval for continuing education credit. If you have any comments regarding the quality of this program and/or your satisfaction with it, please contact CECBEMS at: CECBEMS -12200 Ford Road, Suite 478 Dallas, TX  75234 Phone:  972-247-4442 -lsibley@cecbems.com

  48. Nursing 34812 The Texas Tech University Health Sciences Center Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Provider approved by California Board of Registered Nursing, Provider #CEP11800, for the designated number of contact hours for each program. Provider approved by Florida Department of Health Board of Nursing, Provider #FBN2060. Provider approved by West Virginia Board of Examiners for Registered Professional Nurses, Provider #WV1998-0262RN. Iowa Board of Nursing approved provider #325. Accepted by the North Carolina Board of Nursing. Reminder to all PARTICIPANTS, certificates should be retained for a period of four (4) years. Health.edu reports Florida Continuing Education (Contact Hours) to CE Broker. This activity provides 1.5 contact hours.

  49. Nursing 34812 This activity is presented for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of nursing. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

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