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DysrhythmiasSinus Dysrhythmias Sinus Tachycardia >100 bpmCauses:oExercise oCaffeinated beveragesoHyperthyroidism oAcute MIoInfection, fever, pain oCompensatory-Dehydration, hypovolemia, hypoxia, heart failure, shock, pulmonary embolism oDrugs-cocaine, cannabis, ecstasy, nicotineoSympathetic stimulation-stress, fear, anxiety oMeds-epinephrine, dopamine, atropine Assessment/Sx:oPalpitations oRestlessness, anxietyoPale, cool skin Interventions:1.Treat underlying cause (oxygen, fluids, reduce fever, treat pain, etc)2.If symptomatica.Synchronized cardioversionb.Adenosine (1stdose-6 mgrapid IVP follow w/flush; 2nddose- 12 mg if required)i.SE:nausea, vomiting, bradycardiaii.Restarts the heart! Have defibrillatoravailable!3.If asymptomatic a.IV access, 12 lead ECG, pulse ox, VSb.Vagal stimulation c.Adenosine (if regular rate & rhythm)d.Beta blocker, Ca channel blocker Permanent PacemakerUsed for conduction disorders that are not permanent (complete heart block) Placed surgically under conscious sedation Average life-span of 10 yearsTypes:oSingle or Dual ChamberPacemaker oAtrial Pacer-Spike followed by P wave oVentricular Pacer-Spike followed by QRS oAV Pacer-Spike followed by P wave & QRS oSynchronous (demand) or Asynchronous(fixed-rate) oImplantable Cardioverter Defibrillator(ICD)- able to perform cardioversion, defibrillation, and pacing of the heartIndication:pt has hx of spontaneous VT/VF not caused by an MIComplications: bleeding & cardiac tamponadeSinus Bradycardia <60 bpmCauses:oVagal stimulation (carotid massage, straining, vomiting, coughing, Valsalva maneuver, breath holding, cold stimulus to face)oHypothyroidism, Hypothermia, Hypoxia, Hypo/HyperkalemiaoMeds-Beta blockers, Ca Channel blockers, Amiodarone, digitalis, Sotalol oPosterior/Inferior MIoIncreased ICPoPost heart transplant oObstructive sleep apneaoDiseased SA node Assessment/Sx:oSyncopeoDizziness, weaknessoConfusion oSOBInterventions:1. Atropine 0.5mg IV (repeat Q3-5 minutes, max 3mg.) along w/…IVF, O2, d/c meds that may be causing the bradycardia 2.If Atropine ineffective TCP3.Or Dopamine 2-20 mcg/kg/min (2ndline drug)4.Or Epinephrine 2-10 mcg/min (alternative to dopamine) Temporary PacingNonsurgical, provides electrical stimulation/impulse to the heartUses…oTX for bradydysrhythmias and asystole oEMERGENCY measure used temporarily until a permanent pacer can be placed oProphylactically during procedures/transportation for pts atrisk for bradydysrhythmiasSingle-Chamber Pacemaker-impulse sent to R atrium or R ventricleDual-Chamber Pacemaker- impulse sent to both R atrium & R ventricle Two modes of pacing…oSynchronous: only paces on demandwhen pt’s HR is lowerthan the set rate; when pacing not needed the pacer inhibits itself from firing oAsynchronous: fixed-rate pacing Transcutaneous Pacing otwo electrodes placed externally, the generator transmits anelectrical impulse to stimulate ventricular depolarization when the pt’s HR is slower than the rate set on the pacemaker