Telemetry/EKG/Pacers

1. Telemetry/EKG/Pacers MCC NURSING DIANA BLUM MSN

2. A dysrhythmia is a disturbance of the rhythm of the heart caused by a problem in the conduction system. • Categorized by site of origin: atrial , AV nodal, ventricular • Blocks are interruptions in impulse conduction: 1st, 2nd type 1&2, 3rd or complete heart block

6. P wave Measures: 0.12-0.20

7. QRS WAVE Measures: 0.06-0.12

8. QT Wave Measures approx0.34-0.43 secs

9. Calculating Heart Rate • Quick Estimate: The 6-second Method • - count the # of QRS complexes in a 6 sec. • length of strip & multiply by 10 • (the second mark is = to 5 large boxes) • This can be used is rhythm is reg or unreg.

11. To map= to determine if regular or irregular Each small box measures 0.04 1 big box (5 small boxes) is equal to a HR of 300 2 big boxes is hr of 150 3 big boxes is hr of 100 4 big boxes is hr of 75 5 big boxes is hr of 60 6 big boxes is hr of 50 7 big boxes is hr of 43 8 big boxes is hr of 38

12. Large box estimate of heart rate works with regular rhythms

13. Count small boxes between two R waves. Divide into1500 Gives BPM

14. Atrial arrythmias • Normal sinus rhythm • Sinus tachycardia • Sinus bradycardia • Premature atrial contraction (PAC) • Supraventricular tachycardia • Atrial flutter • Atrial fibrillation

15. Ventricular arrythmias • Junctional rhythm • AV blocks • Premature junctional rhythm • Premature ventricular contraction (PVC) • Ventricular Tachycardia (V-tach) • Ventricular Fibrillation (V-Fib) • Torsade de Pointes (TdP) • Pulseless electrical activity (PEA) • Asystole

16. ARTIFACT

17. NSR

18. Sinus arrhythmia Hr= 60-100 bpm On strip it looks regular but does not map out PR interval= 0.12-0.20

19. Junctional escape rhythm HR 40-60 bpm <60 bpm is accelerated Rhythm is regular Pwaves not always present

20. Junctional Rhythm

21. SB

22. ST

23. Supraventricular Tachycardia

24. SVT converted with Adenosinegiven rapid IV Push stimulates vagal response. S/E: flushing,bronchospasm,AVblock

25. AV Blocks • First degree block • Second degree block Type I (Wenchebach) • Second degree block Type II (Mobitz II) • Third degree block • Bundle branch block

26. First degree heart block Rate is usually WNL Rhythm is regular Pwaves are normal in size and shape The PR interval is prolonged (>0.20 sec) but constant

27. Second degree heart block type 1 Pwaves are normal in size and shape; Some pwaves are not followed by QRS PR interval: lengthens with each cycle until it appears without QRS Complex then the cycle starts over QRS is usually narrow

28. http://www.youtube.com/watch?v=GVxJJ2DBPiQ&feature=related

29. Second degree heart block type 2 Ventricular rate is usually slow Rhythm is irregular Pwaves are normal in size and shape (more pwaves than QRS) PR interval is within normal limits QRS is usually wide

30. 3rd degree heart block of complete heart block Ventricular rate is regular but there is no correlation between pwaves and QRS Pwaves are normal in size and shape No true PR interval

31. Atrial Fibrillation Erratic wavy base Pr is not measurable QRS 0.10 sec or less usually http://www.youtube.com/watch?v=VKxQgjj2yVU&feature=related

32. Afib causes : • Chocolate large amounts: contains theobromine, a mild cardiac stimulant. • - sleep apnea • - athletes more prone (enlarged heart) • - tall athletes (esp basketball players) • - aging heart • - men more than women • - sleeping on left side or stomach • etc.

33. A-fib treatment: • ASA not as effective as Coumadin in preventing strokes. • ASA less likely to cause abnorm bleeding • **since hemorrhagic stroke increases with age & is also increased by taking Coumadin, some Drs. may switch older pts from Coumadin to ASA.

34. A Fib electrical cardioversion: • High risk of forming clots & causing stroke • Anticoagulants taken before treatment and 3-4 weeks post treatment • If life-threatening, may need Heparin IV before cardioversion • Best time: recent A fib

35. Atrial flutter Atrial rate of 250-450 bpm ventricular rate varies Atrial rhythm is regular ventricular rate is irregular No identifiable p waves P wave is not measurable Qrs: 0.10 or less usually

36. Atrial fib/flutter

37. Paced beat Pacer spike should fall before the P wave unless a dual Chamber pacemaker; if it does not there could be a problem

38. PAC

39. Premature ventricular conduction (PVC) Extra beat Types uniform=go the same direction multifocal= go in different direction R on T=when the pvc fall on the preceding twave couplet= 2 pvcs together bigeminy= pvc every other beat trigeminy=pvc every third beat

40. PVCs (unifocal)

41. PVCs (multifocal)

42. Ventricular tachycardia Monomorphic: beats are same size and shape Polymorphic: different size and shape

43. Torsades de pointe This is a polymorphic VT Usually electrical imbalance in nature r/t NA+ or K+

46. Ventricular Fibrillation Rate can not be determined because of no identifiable waves Rapid chaotic rhythm with no pattern No p waves No PR interval No QRS

47. Vtach/Vfib • Both can be life threatening • VT= V HR 100-250 bpm • Causes: AMI, CAD, hypokalemia, dig toxic • S/S: palpitations, dizzy, angina, <LOC • Treatment: assess for pulse, if none, defib • VF=Rate undeterminable Cause: same • Treatment: CPR

48. Asystole

49. Asystole and PEA • CPROxygen • Epinephrine 1 mg IV/IO (repeat 3-5 minutes) • May give Vasopressin 40U IV/IO to replace • 1st or 2nd dose of epinephrine • Consider Atropine 1 mg IV/IO Repeat every 3 to 5 min (up to 3 doses)

50. http://videos.reinolla.tv/winners/pe/