Ventricular Dysrhythmias Flashcards
(103 cards)
1
Q
What are ventricular dysrhythmias?
A
Slow, abnormal, non-simultaneous depolarization of ventricles at a rapid rate
2
Q
What does the QRS of a ventricular dysrhythmia look like?
A
Large, wide QRS
3
Q
Where is the p wave in a ventricular dysrhythmia?
A
Usually hidden in the QRS
4
Q
What are the 3 H’s (causes) of ventricular dysrhythmias?
A
Heart disease
Hypoxia
Hypokalemia
5
Q
What does a decreased CO lead to a loss of?
A
Atrial kick
6
Q
What are the 12 reversible causes of ventricular dysrhythmias called?
A
Hs and Ts
7
Q
What are the Hs of the Hs&Ts?
A
Hypovolemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia
8
Q
What are the Ts of the Hs and Ts?
A
Tension pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (PE)
Thrombosis (MI)
9
Q
What does the QRS look like during a PVC?
A
Wide
10
Q
What are types of PVCs?
A
unifocal, multifocal, bigeminy, trigeminy
11
Q
List 4 types of ventricular dysrhythmias
A
PVCs
V tach
V fib
Torsades de Pointes
12
Q
What is the definition of a PVC?
A
Ectopic impulses that originate in the ventricle that discharge before the next sinus is due
13
Q
There is no __ wave associated with PVCs
A
P wave
14
Q
How long in seconds is the qrs of a PVC?
A
> 0.12 seconds
15
Q
What does the HR look like in someone having PVCs?
A
Regular except for when premature beat interrupts
16
Q
What is the r to r interval for a PVC?
A
It’s equal
17
Q
What are unifocal PVCs?
A
All originate from the same ventricular location, so their configuration looks identifcal
18
Q
List 5 types of PVCs
A
Unifocal
Couplets
Multifocal
Bigeminy or bigeminal
Trigeminy or trigeminal
19
Q
What is a couplet PVC?
A
Two PVCs originating from the same ventricular location that occurs togethers
20
Q
What is a multifocal PVC?
A
A PVC that originates at two or more ventricular locations and therefore have different configurations
21
Q
What is a bigeminy PVC?
A
Repeated pattern of one normal SA node-initiated beat followed by one PVC
22
Q
Bigeminy PVCs occur at…
A
every other beat
23
Q
Trigeminy PVCs occur at…
A
every two beats
24
Q
What is a trigeminy PVC?
A
Repeated pattern of two normal beats followed by one PVC
25
If the PVCs look the same they are...
unifocal
25
If the PVCs look the same they are...
unifocal
26
PVCs that look uniform =
unifocal
27
What type of dysrhythmia is this?
Unifocal PVC
28
What type of dysrhythmia is this?
Couplet PVC
29
Two PVCs that occur together are called...
Couplet
30
What type of dysrhythmia is this?
Multifocal PVC
31
Multifocal PVCs can have many forms such as...
One flipped on positive axis
One flipped on negative axis
32
Which is worse, multi, couplet or unifocal PVCs?
Multifocal PVCs because multiple places in the ventricle are firing
33
What type of dysrhythmia is this?
Bigeminy PVC
34
What type of PVC occurs every other beat?
Bigeminy
35
How frequent to bigeminy PVCs occur?
Every 2nd beat
36
What PVC can be characterized as having "bunny ears"?
Bigeminy PVC
37
How can you differentiate between a bigeminy PVC and a couplet PVC?
Bigeminy PVCs occur at every other beat
38
What type of dysrhythmia is this?
Trigeminy PVC
39
Is it normal to occasionally have a PVC?
Yes, many people will occasionally have a pVC
40
What are common causes of a PVC?
Hypokalemia
Hypomagesemia
Hypoxia/hypoxemia
Caffeine
Tobacco
Stress
Reperfusion after lysis of a clot (Acute MI)
41
How do you treat PVCs?
Treat the cause!
42
If someone is having a PVC, what amount is criteria for a concern?
More than 6 per minute or three in a row
43
What types of PVCs are a cause for concern?
Couplet PVCs
More than 3 ina row
Multifocal
PVC occurring in R on T
44
What does a multifocal PVC indicate?
Ventricular irritability
45
What does a PVC occurring in R on T mean?
Down stroke of the t-wave during relative refractory or vulnerable period
46
What type of dysrhythmia is this?
PVC occurring in R on T
47
What causes a R-on-T phenomenon?
a ventricular depolarization superimposing on the previous beat's repolarization
48
What is the danger of a R-on-T phenomenon?
It can cause someone to go into cardiac arrest
49
What type of dysrhythmia is this?
Ventricular tachycardia
50
Where are the p-waves in ventricular tachycardia?
You cannot see them, usually absent
51
What is the R-R interval like in ventricular tachycardia?
Usually regular
52
What does the QRS look like in ventricular tachycardia?
Wide and bizarre
53
What the the heart rate of someone experiencing ventricular tachycardia?
100-250 bmp
54
What are common causes of ventricular tachycardia?
Poor oxygenation/decreased CO
Increase in catecholamines
Electrolyte imbalances
MI/ischemia
Acute heart failure
Drugs
Etc
55
What two catecholamines are a potential cause of ventricular tachycardia?
Epinephrine
Norepinephrine
56
What two electrolyte imbalances are potential causes of ventricular tachycardia?
Potassium and/or magnesium
57
What is a slow ventricular tachycardia?
Heart rate of 100-150
58
What is a fast ventricular tachycardia?
Heart rate greater than 150
59
If someone is experiencing ventricular tachycardia, what two things must you always check?
LOC and pulse
60
What is important concerning pulse checks and ventricular tachycardia?
You can have pulse and pulseless ventricular tachycardia
61
If someone is experiencing a SLOW ventricular tachycardia, initially the may...
Have compensated CO but will deteriorate quickly
62
Does someone with fast ventricular tachycardia have CO compensation?
No, there is not enough filling time and the patient will decompensate quickly
63
What is the main function of amiodarone?
Antiarrhythmic
64
How does amiodarone work?
Blocks potassium channels thereby delaying repolarization and prolonging refractory period
Also affects sodium and calcium with alpha and beta blocking properties
65
What is another name for the refractory period on an EKG?
QT interval
66
Amiodarone works by prolonging...
QT interval
67
Amiodarone works by delaying...
repolarization
68
Amiodarone is used as a first line agent for which dysrhythmias?
Ventricular tachycardia
Ventricular fibrillation
Uncontrolled atrial fibrillation
69
What is the IV loading dose of amiodarone?
150mg over the first 10 minutes
70
How is the IV loading dose of amiodarone diluted?
Dilute 150 mg in 100 ml of D5W
71
After the IV loading dose of amiodarone, what is the next dose?
After 10 minutes, 360mg over the next 6 hours (1mg/min)
72
After the IV loading dose of amiodarone, and the next maintenance dose, what is the remaining dose for amiodarone?
540mg over next 18 hrs (0.5mg/min)
73
After a patient is stabilized, how is amiodarone given?
PO to bridge the gap after IV is tapered off
74
What are the side effects of amiodarone?
Headache
Dizziness
Hypotension
Bradycardia
Blue-gray skin color
75
What are symptoms that a patient is not tolerating amiodarone well?
Hypotension and bradycardia
76
What are two types of defibrillators?
Monophasic
Biphasic
77
What is a monophasic defibrillator?
Energy goes in one direction, requires more energy
78
What type of current does a monophasic Lifepak defibrillator have?
Fixed current to deliver 200-360 joules
79
What type of defibrillator is a biphasic zoll?
Delivers energy in two different directions, uses less energy
80
What type of current is the biphasic zoll?
Can manually or automatically adjust strength of current to deliver 120-200 joules
81
What is the advantage of a biphasic zoll over a monophasic lifepak?
Less tissue damage due to less current
82
What can an elective cardioversion cause?
It can cause an R-to-T phenomenon which can put patient into a life threatening dysrhythmia
83
What is an elective cardioversion?
Form of shock that delivers an electrical current that is synchronized with the patient's heart rhythm
84
When is an elective cardioversion typically used?
For SVT, Afib, a flutter, V tach, and unresponsive to meds
85
What must you do before an elective cardioversion?
Must "sync" prior to shocking
86
What should you do if an initial cardioversion is unsuccessful?
Repeat using higher voltage
87
Defibrillation is an __ procedure
emergency
88
When is defibrillation used?
Pulseless ventricular tachycardia
Ventricular fibrillation
Torsades de pointes
89
What is defibrillation?
Unsynchronized electrical shock that administers large amount of joules
90
What must the nurse do before administering the shock during defibrillation?
Announce "all clear"
91
What is this dysrhythmia?
An example of synchronized cardioversion
92
How many joules is given during synchronized cardioversion?
100 joules, up to 200 joules
93
What should the nurse say to the patient before elective cardioversion?
Obtain consent
Educate patient regarding cardioversion and what to expect during procedure
94
What does the nurse want IV wise for a patient undergoing an elective cardioversion?
At least two good working IVs, large bore greater than 20g
95
If a patient is hemodynamically stable, what should the nurse administer before cardioversion?
Light sedation
96
When is light sedation before a cardioversion contraindicated?
If the patient is hemodynamically unstable
97
What should the nurse make sure is done before starting an elective cardioversion?
Ensure optimal pad placement
Make sure Oxygen/Ambu bag in place
Ensure BP is cycling every 2-3 minutes
98
What is the exception to making sure a patient has blood pressure readings taken every 2-3 minutes during a cardioversion?
If the patient has an arterial line
99
What should be obtained both before and after an elective cardioversion?
EKG strip for documentation
100
Who should assist the nurse with an elective cardioversion?
RT, physician or APP at bedside
101
What is the difference between pulseless ventricular tachycardia and pulseless electrical activity?
PEA has a normal rhythm
Pulseless VT has a disorganized rhythm
102
Why is there no pulse in pulseless cardiac output?
The heart is not contracting effectively enough to generate a pulse, which means no cardiac output
