Think Link

ECG NOTES
What is your Nursing Management? Assess the patient. What is the Drug of choice? Atropine Sulfate Pulmonary Embolism

Electrical System of the Heart

Atrial Fibrillation

Sinus Tachycardia at 129 beats/min

Causes:

Atrial Rate of 400 600 beats per minute No identifiable P Wave Underlying heart disease Alcoholism Infection Stress

Causes: Exercise, pain, fever, hypotension Myocardial Ischemia, CHF, Anemia Hyperthyroidism, Theophylline , Epinephrine, Caffeine

What is its significance? Embolus formation High risk for? Pulmonary Embolism What are the Treatments? Cardioversion- synchronizes electric cardioversion IV ibutilide (corvert)- chemical cardioverion Catheter ablation

Basic ECG Interpretation and NursingManagement

Normal Sinus Rhythm at 70 beats/min

What is your Nursing Management? Find First the cause What is the Drug of Choice? Beta Blockers

Atrial Flutter
All the measurement are within the normal range Understanding your Normal Rhythm is very Important. Doing a quick Count, The rhythm of the Patient is 70 beats/ min

What are the drugs to be given?

Sinus Bradycardia at 55 beats/ min

Causes: Parasympathomimetic drug Increase Intracranial pressure Myocardial Infarction (inferior) Normal with trained athletes P-R Interval 0.12- 0.20 sec. QRS - Less than 0.10 sec. Q-T interval Under 38 sec. Significance: Decrease Cardiac Output Decrease Blood Pressure Angina Change Level of consciousness Saw-tooth flutter waves Atrial rate of 240 400 beats per minute No identifiable P wave

Verapamil,( vasodilation, prolonged AV node conduction time) Diltiazem,( slows AV node, Decrease contractility) Digoxin, (Slows AV node conduction) Heparin, (warfarin) blood thinner

What if the PRI is prolonged? Heart Block. A- V Block

Answer. Coronary artery disease, Hypertension, Mitral valve disorder Cardiomyopathy Cor Pulmonale Pulmonary heart disease Can occur as a results of structural changes in the conduction system. Prolonged PR interval Normal PR interval ( 0.12 - 0.20 Sec. )

What are the causes of atrial flutter?

Causes:
Tumors Myocardial Infarction Coronary Artery Disease, Infections of the heart

What is its significance? Embolus formation High risk for?

Think Link: My Self Review Guide For Nurses

www.thinklink.weebly.com

Think Link
Toxic effect of Digitalis

ECG NOTES
o o transmission of impulse fails Irregular heart beat Asymptomatic There is no response after a spike ( impulse given by the pacemaker)

Digitalis Toxicity
Associated with heart blocks Check Pulse Rate (Toxicity Rate) < 60 bpm for adult < 80 bpm for child < 100 bpm for neonatal Evaluation of Digitalis Level

2nd degree block (2:1) Wenckebach

Treatment of choice for 2nd and 3rd degree AV block Pacemaker ( Spike ) Atrial pacing

Failure to Discharge Battery Failure, dislodge leads, wire fracture

During the Exam

Spike is the term use and can be seen at the ECG For the use of Pacemaker

Therapeutic level 0.9-1.2 ng/mL Toxic level 2.0 ng/mL

What are the symptoms of digitalis toxicity? Nausea, vomiting and seeing Halos around eyes (yellowGreen), Diplopia, Blurred Vision Photophobia, Headache Drowsiness

(2:1) 2 Pwave for every 1 set of QRS

Life Threatening Dysrhythmias Premature Ventricular Contraction

2nd degree block (2:1, 3:1) 100% Ventricular-paced rhythm

(2:1 , 3:1) more than 2 Pwaves for every 1 set of QRS Second degree AV- Block is a block in which impulse reach the ventricles but others do not An increased irritability of the ventricles Early ventricular Complexes

Life threatening PVCs

If there are more than 6 PVCs in one full minute Multiform / multifocal PVC R on T phenomena Couplet ( Two Consecutive PVC ) Triplet ( Three consecutive PVC ) Chest Pain with increased Frequency of PVC

Bullets
Check potassium level (3.5 5.5 meq/L) Hypokalemia can cause Digitalis toxicity Give Potassium I.V or orally Give Isuprel and Atropine Increase Heart Rate High Fiber Diet ( constipation contributes to digitalis toxicity )

3rd degree Complete Block (unidentifiable)

The results of this heart block

Hypotension Siezure Cerebral ischemia Cardiac arrest ( unidentifiable ) The P wave has no correlation with the QRS ) Third Degree Heart Block( Complete Heart Block ) erratic heart rates where SA and AV are beating independently

1st degree block (1:1)

Pacemakers P: Patients identification, Medic Alert Card A: Aware your dentist C: Check for signs of hiccups E: Electric Machine are avoided M: MRI are avoided A: Avoid driving for the first 6 months K: Keep a record of Pulse Rate. E: Educate the patient in taking Pulse Rate 1 full
minute.

What is the first thing you need to do? Notify the Physician. What Electrolyte you need to check? Potassium ( hypokalemia can cause PVC ). What do you need to prepare for Wide and Chaotic PVC? Prepare Lidocaine. What if it is a Narrow PVC (hypoxic PVC)? Give Oxygen.

(1:1) 1 P wave for every 1 set of QRS First degree AV-Block

R: Report signs of dizziness, faintness fever, Redness, swelling, soreness, blackouts or Increase Pulse Rate S- Stand Clear

Failure to Sense The rate set by the pacemaker has not reacted. Failure to Capture

SA continues to function but the

Think Link: My Self Review Guide For Nurses

www.thinklink.weebly.com

Think Link

ECG NOTES
Answer. Assess the patients responsiveness before checking the machine Are you allowed to defibrillate the patient? Answer. No! You cannot shock a shocked heart What is the drug of choice? Answer. Epinephrine

Ventricular Tachycardia

Ventricular Fibrillation (Course)

Electrical therapy Cardioversion

( elective procedure ) Awake/ Alert/ oriented Informed Consent Synchronized 10- 200 joules Biphasic50- 100 joules Monophasic 100- 200

Common Interpretation that is being ask in examination: Prominent U wave: Flat or inverted T wave: Peak T Wave: Widened QRS: Prolong ST interval: Shortened ST segment: Wide and Chaotic QRS: Prolong PRI: Shortened PRI: Hypokalemia Hypokalemia Hyperkalemia Hyperkalemia Hypocalcemia Hypercalcemia PVC AV Block Junctional

Ventricular Fibrillation (Fine)

It is a repititve Firing of an irritable Ventricular Ectopy. 140 250 beats / minute or greater Prepare for this question.. Is there a Pulse? Yes Prepare oxygen, antidysrhythic drugs and prepare for a synchronized cardioversion Is there a Pulse? No Prepare for Defibrillation and CPR no discernible waves or complexes to measure the heart is fibrillating no cardiac output

You can use cardioversion with:

Atrial Tachycardia, A.Flutter, A.Fibrillation, Ventricular Tachy. With pulse PSVT, WPW

What are your interventions? Answer. Assess the patient Activate the EMS Perform continues CPR Defibrillation Give Adrenalin and Antidysrhythmic Therapy What is the drug of choice for ventricular fibrillation? Answer. Epinephrine

Defibrillation
Emergency procedure Unconscious Check for DNR Asynchronized 300j CPR Assess rhythm360j CPR Assess rhythm360j CPR- Assess rhythm-

Torsades de Pointes

Asystole

Inverted T wave: Hypoxia Presence of Q wave: Necrosis S-T elevation: Myocardial Injury

You can use defibrillation with:

Another type of ventricular tachycardia Irregular rhythm with fast heart beat. Cardiac Arrest No cardiac movement No rhythm Ventricular Fibrillation Ventricular Tachycardia (pulseless ) Pulses Electrical Activity

What is the main reason of Torsades de Pointes? Answer. Hypomagnesaemia What is the expected drug to be given? Answer. Magnesium Sulfate

Thank You for visiting: www.thinklink.weebly.com For Online group review discussion Log on:
http://xat.com/ThinkLinkRevieweeCommunity

What is your first intervention?

Think Link: My Self Review Guide For Nurses

www.thinklink.weebly.com

Think Link

ECG NOTES

Emir Kahn R. Bautista R.N. (Review Specialist)

Think Link: My Self Review Guide For Nurses

www.thinklink.weebly.com