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EKG day 2

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by

Taffy Anders

on 4 February 2013

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Transcript of EKG day 2

The AV node is overwhelmed by the rapid Atrial impulses and only conducts some impulses to the ventricles.
The AV node blocks at least half of these impulses to protect the ventricles. Atrial Flutter Atrial Flutter Paroxysmal – Sudden onset
You must SEE the onset to call it Paroxysmal. Paroxysmal Atrial Tachycardia (PAT) aka Paroxysmal Supraventricular Tachycardia (PSVT) Supraventricular – general term used to describe arrhythmias that originate in sites above the bundle branches, such as the sinus node, atria and atrioventricular junction. Supraventricular Tachycardia (SVT)
AKA Atrial Tachycardia Vagal maneuvers
Adenosine
Calcium channel blocker (Diltiazem)
Beta blocker (Metoprolol)
Amiodarone
Sedation
Cardioversion (50 J) Atrial Tachycardia Treatment Rhythm is regular
Rate 140-250
P waves – abnormal, commonly pointed
PR interval – usually not measurable
QRS – normal (0.10 seconds or less) Atrial Tachycardia
AKA Supraventricular Tachycardia PAC Underlying rhythm is usually regular
The P wave associated with the PAC is premature and abnormal in size, shape, and direction
The P wave is often small, upright, pointed, and may even be inverted.
An abnormal p wave may be found hidden in the preceding T wave
Compensatory pause after the PAC PACs PACs Premature Atrial Contractions Pages 87-92 in your book

Early beat from ectopic site within the atria

Ectopic site discharges an impulse before the next sinus node impulse is discharged

PACs can originate from one ectopic site or multiple sites within the atria. Premature Atrial Contractions (PACs) PAC Pages 52-58
(strip 6-1 through strip 6-20) Practice R to R interval does not resume on time / P to P interval does not resume on time Sinus Arrest This is a 6 second strip, what is the approximate heart rate? Sinus Arrhythmia This is a 6 second strip, what is the rate? Sinus tachycardia begins and ends gradually.
Conditions associated with ST include excitement, exertion, exercise, fever, infection, sepsis Sinus Tachycardia Pages 51-52 Rhythm is regular
Rate is 100 to 180
P wave before every QRS
PR is normal (0.12 to 0.20 Seconds)
QRS: Normal (0.10 seconds or less) Sinus Tachycardia Must be administered correctly
Given too slowly or in doses of less that 0.5 mg can actually slow the heart rate further Atropine If SB does not resolve with Atropine a temporary pacemaker may be needed.
All medications that cause a decrease in heart rate should be reviewed and discontinued if indicated.
For chronic bradycardia, permanent pacing may be indicated. Sinus Bradycardia Treatment Basic treatment – maintain airway, oxygen, monitor ECG, establish IV access.

Cough – this can decrease vagal tone and might be tried to increase the heart rate.

Persistent SB – atropine 0.5 mg to 1.0 mg. May repeat up to maximum dose of 3 mg. Sinus Bradycardia Treatment Vomiting
Drugs such as: Digitalis, morphine, sedatives, calcium channel blockers, beta blockers.
MI (Reperfusion Rhythm)
Vagal Stimulation & Vasovagal reactions
Sleep apnea
Hypothyroidism, Hypothermia, and hyperkalemia
Increased Intracranial Pressure
Degenerative diseases as SSS Causes of Sinus Bradycardia Can be normal for athletes or when sleeping.

Does not require treatment unless patient shows signs of poor cardiac output. Sinus Bradycardia Rhythm is regular (follows normal conduction pathway)
Rate is 40 to 60
Upright P wave before every QRS
PR interval is normal (0.12 - 0.20 seconds)
QRS is normal (0.12 seconds or less) Sinus Bradycardia This is a 6 second strip, what is the rate? Describe basic underlying rhythm first
Then add additional information.
Example:

Sinus rhythm with premature atrial contraction Irregular This is a 3 second strip. How fast is the rhythm? Sinus Rhythm QRS is wide (greater than 0.12 seconds) Ventricular Rhythm QRS is narrow (0.10 seconds or less)
AKA: Supraventricular Atrial Rhythm Atrial vs. Ventricular Analyzing a Rhythm Strip Calipers work best

When calipers are not available, use a blank piece of paper and pencil. Practice Determine regularity (rhythm)
Calculate the rate
Examine P waves
Measure the PRI
Measure the QRS Analyzing Rhythm Strips Determine regularity (rhythm)
Calculate the rate
Examine P waves
Measure the PRI
Measure the QRS Interpreting the Rhythm QRS Complexes
Are all QRS complexes present?
Do all QRS complexes look alike?
Is there a QRS for every P wave?
Are the R to R intervals equal?
Are all QRS complexes within normal range (less than .12 seconds)? Interpreting the Rhythm PR Intervals
Are PRIs present?
Are all PRIs equal?
Are all PRIs within the normal range of 0.12 - 0.20 Interpreting the Rhythm P Wave – examine each for:
Are all P waves present?
Are they all upright?
Do they all look alike?
Is there a P wave before every QRS?
Are the P to P intervals equal? Interpreting the Rhythm If the QRS is narrow (< .12) the rhythm is atrial in origin

If the QRS is wide (> .12) the rhythm is ventricular Interpreting the arrhythmia
Where is it originating from? Normal ECG Page 95-98 Originates in an ectopic pacemaker site in the atria, depolarizing at a rate of 250-400 beats per minute.
The resulting waveform often looks “sawtooth” and are called Flutter waves or F waves. Atrial Flutter Non-conducted PACs will have an abnormal P wave and will occur prematurely. Refer to pages 92-93 for strips.

The ectopic atrial focus (origin of the PAC) is so early that the AV node is refractory and the impulse cannot be sent to the ventricles. Non-conducted PAC Pages 48-50 in your workbook Compare length of R-R intervals to determine if it is arrest or block Basic rhythm is regular with a sudden pause.
Block = SA initiated impulse, but was blocked (R-R resumes on time). Sinus Block Basic rhythm is regular with a sudden pause.
Arrest = failure of SA
(R-R does not resume on time) Sinus Arrest Sinus Arrest vs. Sinus Block Page 47 in your book Originates in SA node, but delivers impulse irregularly.
Very common
Does not require treatment unless it is causing bradycardia with symptoms of hemodynamic compromise. Sinus Arrhythmia Pages 41-51 Originates in the SA node (narrow QRS)
Normal response to body’s increased demand for blood flow. Sinus Tachycardia This is a 3 second strip, what is the rate? Signs of poor cardiac output (patient is not tolerating rhythm):
Pale, cool, clammy skin, cyanosis
Dyspnea
Confusion, disorientation, dizziness
Chest Pain
Unresponsiveness Sinus Bradycardia Rhythm is regular
Rate of 60 to 100 beats per minute
P wave before every QRS
PR interval between 0.12 and 0.20 seconds
QRS is 0.12 seconds or less Sinus Rhythm
Normal Rhythm – requires no treatment Practice Irregular rhythm; R-R intervals vary by 0.32 second. Regular rhythm; R-R intervals do not vary Determine rhythm regularity EKG Interpretation presented by Taffy Anders RN, MSN, CCRN Today's Objectives Review Sinus Rhythms: SR, SB, ST, SVT
Identify PJCs and PVCs
Identify atrial rhythms: Atrial Fibrillation, Atrial Flutter
Treatment of A-Fib/A-Flutter
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