Week 8: Cardiac Emergencies and Life Saving Interventions: Part 1 Flashcards Preview

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Flashcards in Week 8: Cardiac Emergencies and Life Saving Interventions: Part 1 Deck (56):
1

Pacemaker Cells

ability to initiate an electrical impulse within themselves (automaticity)

-SA node, AV node, Junction, Purkinje fibers

-SA: originates electrical impulse.  Allows working cells to react

2

excitability

ability of all cells to react to electrical impulse

3

Isometric Line

-Resting membrane potential of cardiac cells
-There is a lack of movement of ions 

 

4

As potassium is moved outside of the cells the intracellular potential becomes?

increasingly negative

 

5

cardiac conduction pathway

SA node-->AV node--> Bundle of Hiss---> left and right bundle branches--> purkinje fibers.  

6

SA node

Sinus node.  Dominant pacemaker of the heart.  Upper posterior wall location of the right atrium. Results in the depolarization of the heart.

7

AV node

-located in posterior wall of R atrium below tricuspid valve.  Allows atrial conduction to move into ventricular portion of the heart allowing ventricular contraction

8

lead normally used in ecg monitoring

lead 2.  Looking through the heart at the patient's right side of the heart and up into the heart watching the electrical impulse that's being generated.

9

p wave

arterial depolarization

10

pq and pr segments

conduction through AV node and AV bundle

11

ST segment

ventricles contract

12

t wave

ventricular repolarization

13

rule of 300

Divide 300 by the number of boxes between each QRS = rate

14

6 second method

distance between the number of boxes until you get to the initiation of the second beat.  Multiply how many complete complexes you have within 6 seconds, times 10 gets you a heart rate/minute.

15

normal PR, QRS, and QT

PR
0.20 sec (less than one large box)


QRS
0.08 – 0.10 sec (1-2 small boxes)


QT
Half the R-R interval with normal HR
0.38-0.42 seconds

16

type of rhythm?

Originating from SA node
P wave before every QRS
P wave in same direction as QRS
PR 0.12- 0.20
QRS less than 0.12

Sinus:

 

17

type of rhythm?

-Regular rhythm, rate less than 60
-P waves present before each QRS and between 0.12-.020
-QRS less than 0.12

sinus bradycardia

18

Treatments of Sinus Bradycardia

Atropine
-0.5mg IV bolus
-Repeat every 5 min
-Max dose 3 mg
-Side effects: Dry mouth, Blurred vision, Urinary retention,
Less than 0.5 mg, Slowed heart rate

 

 

19

type of rhythm?

-Rhythm regular, rate greater 100
-P Waves present before each QRS, PR interval .12- .20
-QRS less than 0.12

sinus tachycardia

20

treatment of sinus tachycardia?

ID cause and tx
Pain
Anxiety
Infection
CHF
MI

21

Characterized by:

-Varied rate with periods of bradycardia and tachycardia

-Caused by dysfunction of SA node without escape mechanisms

-Seen in elderly

-QRS narrow

-R to R irregular

Q image thumb

sick sinus syndrome

22

treatment of sick sinus syndrome

symptomatic tx:

ex: If too brady, give atropine and 02

23

-Rapid rate usually above 150 to 250 bpm
-P waves hidden behind t waves
-QRS  complex narrow
-R to R regular 

Q image thumb

supraventricular tachycardia

24

treatment of SVT

Oxygen

Adenosine
-6mg IV push fast
-Repeat with 12mg if needed
-Causes asystole
-run a continuous strip

 

 

25

  • Rapid depolarization of the AV node
  • Usually a regular rhythm
  • Narrow QRS
  • Atrial rate can be up to 350 bpm

Q image thumb

atrial flutter

26

treatment of atrial flutter

Adenosine
Calcium Channel Blockers (Diltiazem)
-Slow conduction
-15-20 mg IVP slow
Beta Blockers
-Decrease HR
-Decrease BP
-Slow IVP

27

  • no effective atrial contraction
  • Narrow QRS
  • Rhythm irregular
  • Rapid ventricular rate 100-160 bpm

atrial fibrillation

28

treatment of A-fib

  • Previous interventions
  • Warfarin INR 2-3

29

  • AV node or Bundle of His
  • Replace the SA node  P wave may be inverted or buried
  • Rate 40-60 Junctional escape
  • Rate 60+ junctional tachycardia
  • QRS regular and narrow

Q image thumb

junctional rhythm

30

treatment of junctional rhythm

tx only if underlying problem

31

  • Just an early beat that originates from the AV node
  • Rhythm regular except early beat
  • One P wave for each QRS
  • QRS narrow

Q image thumb

premature atrial contraction

32

treatment of PAC

tx only if underlying problem

33

  • Early beat with wide QRS complex
  • No p wave with beat

Q image thumb

premature ventricular contraction

34

treatment of PVC

  • Check electrolytes
  • Treat if symptomatic

35

  • QRS greater than 0.12 usually regular
  • Sustained vs. Nonsustained
  • Usually no p wave

Q image thumb

ventricular tachycardia

36

treatment of ventricular tachycardia

Lidociane
1-1.5mg/kg IV then a maintenance drip 1-3 mg/kg/min
Magnesium
For long QT induced V-tak
1-2mg in 10ml of D5W over 10-20 min

 

 

37

  • Undeterminable
  • Looks like squiggly lines

Q image thumb

ventricular fibrillation

38

treament of vfib

  • CPR
  • ACLS

 

 

39

what meds can cause junctional rhythm

digoxin, beta blockers

40

  • Polymorphic V-tak
  • Usually underlying long QT interval

Q image thumb

torsades de pointes

41

treatment of torsades

  • Magnesium
  • Treat underlying cause

 


 

42

  • A conduction delay
  • Regular rhythm
  • PR interval long greater than 0.20
  • QRS normal

Q image thumb

first degree block

43

treatment of first degree heart block

treat underlying cause

44

wide bizar formation of the qrs is indicative of what kind of premature contraction?

premature ventricular contraction

45

  • Regularly irregular
  • Progressivly longer PRI until dropped QRS
  • QRS narrow

Q image thumb

second degree heart block/ Mobitz 1/ Wenckebach

46

treatments of second degree heart block

  • Tx if symptomatic
  • Pacing
  • Atropine

47

  • PR interval fixed,
  • QRS dropped intermittently
  • Rapidly progresses

 

 

Q image thumb

second degree block/Mobitz 2

48

Treatment of second degree HB/mobitz 2

  • pacing
  • atropine

49

Atrial and ventricle disassociated 

Q image thumb

third degree complete block

50

treatment for third degree complete block

PACE

51

  • Short PR interval <0.12 sec
  • Prolonged QRS >0.10 sec
  • Delta wave
  • Can simulate ventricular hypertrophy, BBB and previous MI

Q image thumb

WPW block

52

  • prolonged QT greater than 0.42
  • increased chance of going into a ventricular arrhythmia, most often torsades
  • most often congenital in pts with families who had sudden cardiac death under age 50
  • treatment=prevention (have you had any syncope, seizures, felt dizzy when you ran)

prolonged QT syndrom

53

Synchronized shock
-Delivered on R wave
-Pediatric cardioversion gets 0.5-1 J/kg first shock
         -Additional cardioversion shocks are at 2 J/kg.
-Adult cardioversion
          -Cardioversion for atrial rhythms is 50-100-200-300-360 J
-Need pain and sedation medication

cardioversion

54

Unsynchronized
-Pediatric: use a dose of 2 J/kg for the first attempt and 4 J/kg for subsequent attempts.
-Adults: Physio‐Control Biphasic
                -200 joules – 1stshock
                -300 joules – 2nd shock
                -360 joules – all following shocks
-Monophasic: 360 joules – all shocks

defibrillation

55

  • implanted
  • delivers shock as needed

implantable cardioverter/defibrillator

56