Arrhythmias and Treatments

Question 1

Bradycardia

Answer 1

Rate below 60
Treat if symptomatic
discontinue offending medications
atropine
pacing
dopamine

Question 2

atrial kick

Answer 2

The electrical stimulation of the muscle cells of the atria causes them to contract. The structure of the AV node slows the electrical impulse, giving the atria time to contract and fill the ventricles with blood. This part of atrial contraction is frequently referred to as the atrial kick and accounts for nearly one third of the volume ejected during ventricular contraction

Question 3

Tachycardia

Answer 3

Rate over 100
Treat if symptomatic- underlying cause which could be a wide range of things
Beta blockers

Question 4

Supraventricular tachycardia

Answer 4

Vagal Maneuvers, Adenosine ( 6 mg then 12 mg fast)
Calcium Channel Blockers or beta blockers
Cardioversion if hemodynamically unstable

Question 5

hemodynamically unstable

Question 6

Adenosine Administration for SVT

Answer 6

slows cardiac conduction through the AV node and interrupts reentry pathways.
given by rapid IV bolus
6 mg over 1-3 seconds followed by a 20 mL NS bolus, followed by 12 mg dose

Question 7

What is the common side effect after the adenosine bolus?

Answer 7

Patient will briefly go into asystole

Question 8

Atrial fibrillation and atrial Flutter

Answer 8

Rate control
 Anticoagulation
 Rhythm conversion
 Meds
 Cardioversion
 Ablation

Question 9

Antiarrhythmics

Answer 9

• diltiazem
• digoxin
• amiodarone
• sotalol
• metoprolol)

Question 10

First degree heart blocks

Question 11

2nd degree type I

Answer 11

Commonly temporary,
may resolve on own.
• Less severe of the 2nd
degrees.
• Discontinue offending
medications.
• Treat symptomatic
bradycardia with atropine
and/or pacing

Question 12

2nd degree Type II

Answer 12

 Serious business » CHB or asystole
 Often 2° MI
 External pacing
 Transvenous pacing
 Permanent pacer
 Dopamine for symptomatic hypotension
 Atropine ineffective

Question 13

3rd Degree Heart Block

Answer 13

May lead to asystole, especially with wide
QRS’s.
• Pace it, permanently if not resolved

Question 14

Junctional arrhythmias

Answer 14

Often bradycardic
Atropine
Dopamine
Pacing
Underlying cause (dig toxicity,
hypoxia, inferior MI

Question 15

ventricular tachycardia (stable)

Answer 15

Amiodarone
bolus and drip
• Cardioversion

Question 16

Ventricular tachycardia (unstable w/pulse)

Answer 16

Unstable with pulse
• Cardiovert
• Amiodarone drip
• AICD
• Ablation
Underlying cause

Question 17

Torsades de pointes (TdP)

Answer 17

Polymorphic
ventricular
tachycardia
• Defibrillate
(synchronized cdv
often not possible)
• Underlying cause
• Magnesium
• Potassium

Question 18

Ventricular Fibrillation and Pulseless VTach

Answer 18

Defibrillation is the
immediate treatment goal

Follow defib with . . .
Epinephrine and
chest compressions
300mg amiodarone
push
Repeat as
necessary

Question 19

Pulseless electrical activity

Answer 19

Looks like a decent rhythm, isn’t.
Will degrade to asystole.
Chest compressions.
Epinephrine 1mg every 3-5 minutes.
Repeat.
Nothing to shock. Underlying cause

Question 20

Asystole

Answer 20

Treatment same as PEA: CPR, epi • Poor prognosis • Underlying cause

Question 21

Abnormal Potassium (K+) and ECG changes

Answer 21

Hypokalemia:
U waves (best seen in
precordial leads)
• Arrhythmias: PVCs,
polymorphic VT, VF
• Sx: muscle cramps,
weakness, leading to
paralysis

Question 22

Abnormal Potassium (K+) and ECG changes

Answer 22

Hyperkalemia:
Arrhythmias: bradycardia
and blocks
• Sx: heart palpitations, SOB,
chest pain, or N/V

Question 23

Synchronized Cardioversion

Answer 23

Typically start with lower energy
(despite what the video states,
although depends on HCP)
• Sedation
• Synchronized*
• Goal: reset the heart to NSR

Question 24

Defibrillatiion

Answer 24

Higher energy
• High quality CPR and ACLS meds
in between shocks
• Goal: Reset the heart to NSR
and return of spontaneous
circulation (ROSC)

Question 25

Pacing

Answer 25

Temporary pacing Transcutaneous Transvenous Epicardial Single chamber – common with temporary pacing Increase mA to ~10% beyond capture Set rate (often 80

Question 26

Permanent Pacemaker

Answer 26

Dual chamber – more common in permanent pacers

Question 27

Common Pacemaker Malfunctions

Answer 27

• Failure to capture • Failure to sense • Battery failure

Question 28

Postpacer/AICD Teaching

Answer 28

Keep arm below head for two weeks Avoid large magnets No TSA wands Monitor s/s infection Medical bracelet

Question 29

How can you tell a fib from Sinus Tach, junctional tach, SVT and Vtach, at a glance??

Answer 29

Atrial fibrillation is IRREGULAR

Question 30

Treatment of Afib and Aflutter

Answer 30

Is the patient symptomatic? What does that mean to you? Patient may c/o dizziness, feeling faint, SOB, low BP, High HR, mental status changes

Question 31

Atrial fibrillation with RVR…what does that mean?

Answer 31

Rapid ventricular response So the goal: rate control, anticoagulation, and rhythm control

Question 32

What is an important consideration for treatment of new onset afib and aflutter?

Answer 32

Time of onset, if greater than 48 hours or unknown, client will need to anticoagulated and/or TEE, in case there is a thrombus sitting in the atrium.

Question 33

Because what could happen if you cardiovert someone with a thrombus?

Answer 33

Could dislodge thrombus and cause emboli…already at high risk for stroke with a fib

Question 34

Let’s say you are working in the ed………….

Answer 34

You put a client on the monitor and without really examining the strip you can see the HR is 42 and patient is c/o being dizzy, slightly confused. What is a safe practice you could automatically do without an order? Apply transcutaneous pacer pads What drug may you anticipate being given and why? Atropine for sinus brady. Need to increase the heart rate.

Question 35

Second-degree HB, type II Why?

Answer 35

constant PRI, but there are dropped QRS. Concerned this might progress to CHB.

Question 36

Atropine

Answer 36

Increases heart rate Used for? sinus bradycardia, first-degree AV block, second-degree AV block, type 1 NOT with... second-degree block, type 2 and CHB

Question 37

Adenosine

Answer 37

Decreases heart rate Used for? stable SVT

Question 38

Synchronized Cardioversion

Answer 38

Start with lower energy Sedation Synchronized button* Goal: reset the heart to NSR Used for unstable afib, aflutter, vtach with a pulse *synchronized means shock delivered on specific point on QRS. Want to avoid T-wave (ventricular repolarization) because it can induce vfib

Question 39

Defibrillation

Answer 39

Higher energy High quality CPR and ACLS meds in between shocks Goal: Return of spontaneous circulation (ROSC) Used for pulseless vtach, vfib, torsades