All Cardiac Arrhythmais

Question 1

What are the rules for a wandering pacemaker?

Answer 1

Regularity: slightly irregular
Rate: 60-100
P wave: morphology changes from one complex to the next

PRI: less than .20 second
QRS: less than .12 second

Question 2

What are the rules for ectopic PAC’s?

Answer 2

Regularity: depends on the underlying rhythm; regularity will be interrupted by the PAC

Rate: depends on underlying rhythm
P wave: p wave of early beat differs from the sinus p waves; can be flattened or notched. May be lost in preceding t wave

PRI: 0.12-0.20 seconds
QRS: less than 0.12 second

Question 3

What are the rules for atrial tachycardia?

Answer 3

Regularity: regular
Rate: 150-250 bpm
P wave: atrial p wave, can be lost in T wave
PRI: 0.12-0.20
QRS: less than 0.12

Question 4

What are the rules for atrial flutter?

Answer 4

Regularity: atrial rhythm is regular, ventricular rhythm is usually regular but can be irregular if there is a variable block

Rate: atrial rate 250-350, ventricular varies
P wave: sawtooth pattern
PRI: Unable to determine
QRS: less than 0.12 second

Question 5

What are the rules for atrial fibrillation?

Answer 5

Regularity: grossly irregular
Rate: atrial rate greater than 350, ventricular varies

P wave: no discernible p waves; atrial activity is referred to as fibrillatory waves

PRI: unable to measure
QRS: less than 0.12 second

Question 6

What do you do for stable vtach with a pulse (wide QRS)

Answer 6

Drug therapy, amiodarone or lidocaine

Question 7

What do you do for unstable vtach with a pulse?

Answer 7

Synchronized cardiovert - 100 joules

Question 8

What do you do for witnessed v-fib?

Answer 8

Chest compressions then defibrillate at 360 joules when ready

Question 9

What do you do for unwitnessed vfib?

Answer 9

Chest compressions for 2 min before defibrillating

Question 10

What do you do for stable sinus bradycardia?

Answer 10

Drug therapy - atropine 0.5 mg every 3-5 min

Question 11

What do you do for unstable sinus bradycardia?

Answer 11

Pace on monitor at 70 bpm and increase milliamps until shows QRS, then check for pulse

Question 12

What is a normal sinus rhythm with no pulse?

Answer 12

PEA

Question 13

What do you do for stable SVT?

Answer 13

Attempt vagual maneuver (have patient blow on their thumb like they are trying to blow up a ballon) drug therapy = adenosine

Question 14

What do you do for unstable SVT?

Answer 14

Cardiovert

Question 15

What are the characteristics of SVT?

Answer 15

Over 160 bpm, tight QRS complex

Question 16

What is the first drug you give for clinical death?

Answer 16

Epi 1:10,000 @ 1mg every 3-5 min

Question 17

What are the rules for atrial tachycardia?

Answer 17

Regularity: regular
Rate: 150-250 bpm
P wave: atrial p wave, can be lost in T wave
PRI: 0.12-0.20
QRS: less than 0.12

Question 18

What are the rules for atrial flutter?

Answer 18

Regularity: atrial rhythm is regular, ventricular rhythm is usually regular but can be irregular if there is a variable block

Rate: atrial rate 250-350, ventricular varies
P wave: sawtooth pattern
PRI: Unable to determine
QRS: less than 0.12 second

Question 19

What are the rules for atrial fibrillation?

Answer 19

Regularity: grossly irregular
Rate: atrial rate greater than 350, ventricular varies

P wave: no discernible p waves; atrial activity is referred to as fibrillatory waves

PRI: unable to measure
QRS: less than 0.12 second

Question 20

What do you do for stable vtach with a pulse (wide QRS)

Answer 20

Drug therapy, amiodarone or lidocaine

Question 21

What do you do for unstable vtach with a pulse?

Answer 21

Synchronized cardiovert - 100 joules

Question 22

What do you do for witnessed v-fib?

Answer 22

Chest compressions then defibrillate at 360 joules when ready

Question 23

What do you do for unwitnessed vfib?

Answer 23

Chest compressions for 2 min before defibrillating

Question 24

What do you do for stable sinus bradycardia?

Answer 24

Drug therapy - atropine 0.5 mg every 3-5 min

Question 25

What do you do for unstable sinus bradycardia?

Answer 25

Pace on monitor at 70 bpm and increase milliamps until shows QRS, then check for pulse

Question 26

What is a normal sinus rhythm with no pulse?

Answer 26

PEA

Question 27

What do you do for stable SVT?

Answer 27

Attempt vagual maneuver (have patient blow on their thumb like they are trying to blow up a ballon) drug therapy = adenosine

Question 28

What do you do for unstable SVT?

Answer 28

Cardiovert

Question 29

What are the characteristics of SVT?

Answer 29

Over 160 bpm, tight QRS complex

Question 30

What is the first drug you give for clinical death?

Answer 30

Epi 1:10,000 @ 1mg every 3-5 min

Question 31

What do leads 2,3, and AVF look at?

Answer 31

Left ventricle (inferior wall MI)

Question 32

What do leads v-1 and v-2 look at?

Answer 32

Septum

Question 33

What do leads v-3 and v-4 look at?

Answer 33

Anterior

Question 34

What do leads v-5 and v-6 look at?

Answer 34

Lateral

Question 35

What does ST elevation indicate?

Answer 35

Heart injury

Question 36

What does ST depression indicate?

Answer 36

Heart ischemia

Question 37

What is your treatment for a right sided MI?

Answer 37

Fluid

Question 38

What is your treatment for a left sided MI?

Answer 38

Nitro

Question 39

What does the right coronary artery feed?

Answer 39

SA node (60-100)

Question 40

Why do heart blocks occur?

Answer 40

Result of conduction disturbances in the av node

Question 41

What is a first degree heart block?

Answer 41

Not a true block, delay at the AV node but each impulse is eventually conducted through to the ventricles. Characterized by a PRI longer than .20 and constant. This will be the only abnormality in the arrhythmia.

Question 42

What is a key feature of second degree heart blocks?

Answer 42

Not every P wave is followed by a QRS complex

Question 43

What is the difference between wenckebach and type II second degree block?

Answer 43

The pattern in which the P waves are blocked, concentrate on the PR intervals

Question 44

What rate is a type II second degree heart block usually?

Answer 44

Bradycardia

Question 45

What is a key characteristic of type II second degree heart blocks?

Answer 45

Will always have more P waves than QRS complexes. It will be regular or irregular depending on the conduction ratio.

Question 46

What is a key characteristic of wenckebach second degree heart block?

Answer 46

Increasing long PRI's followed by a blocked p wave