EKG Rhythms

Question 1

what is the causes of normal sinus rythym

Answer 1

good functioning heart

good sv, CO, preload, after load and good perfusion

Question 2

what is important to do for a pt who appears to be in sinus rhythm

Answer 2

make sure they are asymptomatic and that they are not in PEA (pulsless electrical activity) pt will not have a pulse and be unresponsive
*do not shock for PEA

Question 3

what is it called if pt is in normal sinus rhythm but has an elongated PR interval (> 0.20)

Answer 3

AV block and if it is consistent then its called 1st degree heart block
*people can live with this rhythm

Question 4

what are causes of 1st degree heart block

Answer 4

hx of infarct
BB, CCB, dig
myocarditis
age related heart changes

Question 5

what is the treatment for 1st degree heart block

Answer 5

monitor pt, pt can live with this

*check cap refill, skin color, pulses to see if they occur with monitor

Question 6

HR of less than 60 bpm

must have upright P wave

Answer 6

sinus bradycardia

Question 7

what are the causes of sinus bradycardia

Answer 7

hypoglycemia
hypothermia
hypothyroidism
hypovolemia
toxic exposure
meds
infarctions
*most healthy athletes

Question 8

what are the different variations with sinus bradycardia

Answer 8

elevated T wave- caused by hypokalemia

ST depression- caused by injury or untreated hypovolemia

Question 9

what would the treatment be for sinus bradycardia

Answer 9

treated only if the client is experiencing symptoms

IV atropine, fluid challenge, or pacemaker

Question 10

if the pt who has sinus bradycardia perfusing

Answer 10

decreased perfusion

Question 11

HR >100

Answer 11

sinus tachycardia

Question 12

what are the causes of sinus tachycardia

Answer 12

initial hypovolemia
HTN
fever
stress
caffeine
smoking
hyperthyroidism
excess alcohol
cocaine abusers
pain

Question 13

what is the tx for sinus tachycardia

Answer 13

(tx the cause)
NS fluid challenge
maybe BB to slow heart rate

Question 14

is the sinus tachycardia pt perfusing well

Answer 14

check pulses and color, if rate is consistent the perfusion will decrease
*due to loss of atrial kick and too fast to allow filling times

Question 15

if the sinus tachycardia pt has an ST depression variation what should be done

Answer 15

fluid challenge, O2, call doc

Question 16

umbrella term for unidentifiable rhythms
P waves often not identifiable
PR interval not measured
150-200bpm

Answer 16

supraventricular tachycardia (SVT)

Question 17

what are S/S of SVT

Answer 17

chest pain, SOB, lightheadedness/dizziness, confused, syncope

Question 18

what is the treatment for SVT

Answer 18

vagal maneuver
slow heart rate with meds 
oxygen (if pt is stable)
adenosine (chem cardioverter if stable)
*if pt is UNSTABLE electrically cardiovert (synchronized)

Question 19

does the pt who has SVT have perfusion

Answer 19

no because theres no atrial kick

Question 20

atrium quivering, irregular, excess P waves but not true P waves

Answer 20

atrial fibrillation

Question 21

what are S/S of A fib

Answer 21

dizzy/lightheadedness, syncope, confusion, fatigue, SOB, bird flopping feeling

Question 22

what is the tx of A fib

Answer 22

if the HR is too fast slow it with meds
*make sure pt is on anticoags to reduce risk of clot formation
must get a TEE to r/o clots before cardioversion
the tx of choice is cardioversion

Question 23

what are risks of A fib

Answer 23

develop clots in the heart
stroke
PE
low BP and decreased CO

Question 24

sawtooth appearance

Answer 24

A flutter

Question 25

what are S/S of A flutter

Answer 25

SOB, anxiety, weakness, angina, syncope

Question 26

what is the treatment for A flutter

Answer 26

same as A fib- slow heart rate, anticoags, TEE before cardioversion **can pace someone out of A fib- turn on pacemaker, dial up to what HR says, leave for a few sec, start turning down

Question 27

greater than 100 bpm P waves unidentifiable QRS wide and bizarre shape

Answer 27

V tach

Question 28

what are S/S of V tach

Answer 28

lightheadedness, dizzy, angina, syncope, SOB, absent or rapid pulse, LOC, hypotension

Question 29

what is the tx for V tach

Answer 29

O2, lidocaine drip, and shock quickly (shock out of chaotic rhythm) NO cardioversion there is no perfusion

Question 30

HR is undetermined, no PR interval, no P waves

Answer 30

v fib | *if v tach is untreated it goes to V fib

Question 31

how do you treat V fib (worse than v tach)

Answer 31

CPR, Defib (NO cardioversion) | theres no perfusion

Question 32

"flat line"

Answer 32

asystole

Question 33

if you see asystole what should you do first

Answer 33

assess leads are on, assess pt, check pulse

Question 34

how is systole treated

Answer 34

CPR- NO defib and theres not any perfusion