Complex Mod 1 - Dysrhythmias

Normal Sinus Rhythm

Rate: 60; Regular; P wave present; P:QRS ratio 1:1; PR interval 0.20; QRS width 0.06

Sinus Arrhythmia

Causes: Regular respiration, sleep apnea, sick sinus syndrome. Rate 80; P wave present, P:QRS ratio 1:1; PR interval 0.14; QRS width 0.06

Sinus Bradycardia

Causes: Hypoxia, hypothermia, meds, sleep, normal in athletes. Rate 40, Regular P wave present, P:QRS ratio 1:1; PR interval 0.14, QRS width 0.06

Sinus Bradycardia Treatment

If symptomatic: Syncope, chest pain, hypotension, shortness of breath, diaphoresis; give atropine 0.5 mg IVP

Sinus Tachycardia

Causes: Fever, anemia, hypovolemia, hypotension, PE, MI. Rate 130; Regular, P wave present; P:QRS ratio 1:1; PR interval 0.16; QRS width 0.04

Sinus tachycardia treatment

If symptomatic, treat the cause

Atrial Fibrillation

Atrial Flutter

Supraventricular Tachycardia

Junctional Rhythm

Normal sinus rhythm with 2 PVCs

Ventricular contraction because much wider than QRS complexes. Wide ventricular contractions compared to a regular QRS

Multiple foci/multifocal PVCs

2 PVCs originating from different parts of ventricle. More than one area of hyper excitability

Couplet

2 PVCs in a row

Triplet

3 PVCs in a row

Bigeminy

A PVC for every other beat

Trigeminy

A PVC for every third beat

Ventricular Tachycardia

Polymorphic Ventricular Tachycardia (Torsade's de Pointes)

Ventricular Fibrillation

Idioventricular Rhythm

Pulseless Electrical Activity (PEA)

H's

� Hypovolemia
� Hypoxia
� Hydrogen ion (Acidosis)
� Hypo/hyperkalemia
� Hypothermia

T's

� Tension pneumothorax
� Tamponade(cardiac)
� Toxins
� Thrombosis,pulmonary
� Thrombosis,cardia

Asystole (Ventricular standstill)

Defibrillation

� Not synchronized
- Delivered anytime in cardiac cycle
R on T phenomenon could occur and be dangerous in someone with a pulse; won't happen if pulseless.
� Higher energy (electricity)

Defibrillation indications

- Ventricular fibrillation
- Ventricular tachycardia without a pulse

Cardioversion

� Synchronized: machine reads patient's rhythm and cardioversion is delivered on R wave to lower risk of R on T phenomenon. Sedated first, controlled envrionment.
� Delivered on the R wave
� Lower energy (electricity)

Cardioversion indications

? Atrial fibrillation (after anticoagulation!)
? Unstable tachyarrhythmias