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CEN Cardiovascular Emergencies > Bradycardia > Flashcards

Bradycardia Flashcards

1
Q

If perfusion is adequate?

A

Monitor and observe

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2
Q

What if pt is symptomatic? Name some symptoms

A 
Dizzy
SOB
HTN
AMS
Chest pain
HF
Weak/Fatigue
Pulmonary Congestion 
Shock
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3
Q

If pt IS symptomatic what two treatments?

A

Atropine or Transcutaneous Pacing

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4
Q

Dosing of Atropine

A

3-5 mg PRN
ACLS: 0.5 mg q3 minutes for a total of 5mg

Do not give less than 0.5mg - Less can cause paradoxical bradycardia (meaning less than 90 systolic and less than 90 bpm)

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5
Q

When does atropine not work?

A

Heart transplant - Do not have the parasympathetic stimulation, drug blocks the parasympathetic so it has little affect

Heart Blocks - SA node is firing but the AV node is blocking the impulse, Atropine fires up the SA node so it’ll keep on firing but it will still be blocked at the AV node

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6
Q

What is a downside of Atropine regarding oxygen consumption

A

It can increase myocardial oxygen consumption

Caution with CAD and hypoxia

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7
Q

IF pacing is ineffective?

A

Epi or dopamine

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8
Q

Transcutaneous Pacing

A

Electricity leaves the RELEASE patch and goes to the GROUND patch : Heart needs to be sandwiched so the myocardial contracts ALONG W/ OTHER MUSCLES :))))

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9
Q

6 things to remember for Transcutaneous Pacing

A
  1. Keep 10cm away from implanted pacemaker or ICD
  2. Dry Skin
  3. Shave excess hair
  4. Avoid Medication patches
  5. Ensure TCP patches do not touch
  6. Place under breast of large breast
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10
Q

Rate for Transcutaneous Pacing

A

60 - 100

Usually started at 70 bmp

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11
Q

What to set the output for electricity delivered during TcP

A 
Output - electricity delivered 
Usually 40 - 80 mEa
Set to CAPTURE
Set 10% above capture
Check Pulse
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12
Q

What is capture

A

Enough electricity to cause the ventricle to contract

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13
Q

How do you know if it is captured?

A

Pacing spike gets higher and higher

You get an upside down QRS after each pacing spike

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14
Q

Which pulse to check for TP?

A

Femoral or Brach

NOT CAROTID - do not want central

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15
Q

During TP
What does pacing spike signify?
What does pulse signify?

A

Pacing Spike - Electrical capture

Pulse - Mechanical capture

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16
Q

Transvenous Pacing pro

A

The leads go directly to the myocardial muscle so they don’t contract a bunch of muscles

17
Q

Do you change the rate when you switch from transcutaneous - transvenous?

A

NO

18
Q

Do you change the output when you switch from transcutaneous - transvenous?

A

YES - way lower electricity needed due to the leads being directly in the heart
8-15 mEa

19
Q

Implanted Pacemaker problem solving? 4 Biggest malfunctions

A
  1. Failure to pace
  2. Failure to capture
  3. Undersensing
  4. Oversensing
20
Q

Undersensing

A

Not sensing if the pacing spike in or after the QRS, pacer is NOT sensing

21
Q

Failure to capture

A

No QRS after the pacing spike

22
Q

Failure to pace causes?

A

Battery Failure
Wire Fracture
Lead Displacement
Oversensing

23
Q

Failure to pace management

A

Medication to increase
Temporary Pacing
Contact Cardiology

24
Q

You can tell oversensing by

A

Artifact - sensing things that are not QRS but it thinks are QRS

25
Q

Common causes of oversensing

A
  1. Large P or T waves
  2. Skeletal Muscle Activity
  3. Electromagnetic interference
26
Q

How to fix oversensing

A

Remove from source of oversensing

Doughnut shaped magnet

27
Q

Failure to Capture and Undersensing Causes

A
  1. Electrode Displacement
  2. Lead Fracture
  3. Exit Block - Output of electrical activity is not high enough to cause a contraction
28
Q

What can cause Exit Block

A

Ischemia
Hyperkalemia
Class III antiarrhythmic such as amiodarone (because it is slowing the HR down)

29
Q

How to correct failure to capture and undersensing

A

Correct the ischemia (cath lab) or hyperkalemia

Wait for amiodarone to wear off

CEN Cardiovascular Emergencies (13 decks)

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