Dysrhythmias Study Guide (2).docx - Dysrhythmias Sinus Dysrhythmias Sinus Tachycardia >100 bpm Sinus Bradycardia <60 bpm Causes o Vagal

Dysrhythmias Study Guide (2).docx - Dysrhythmias Sinus...

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Dysrhythmias Sinus Dysrhythmias Sinus Tachycardia >100 bpm Causes: o Exercise o Caffeinated beverages o Hyperthyroidism o Acute MI o Infection, fever, pain o Compensatory -Dehydration, hypovolemia, hypoxia, heart failure, shock, pulmonary embolism o Drugs -cocaine, cannabis, ecstasy, nicotine o Sympathetic stimulation- stress, fear, anxiety o Meds- epinephrine, dopamine, atropine Assessment/Sx: o Palpitations o Restlessness, anxiety o Pale, cool skin Interventions: 1. Treat underlying cause (oxygen, fluids, reduce fever, treat pain, etc) 2. If symptomatic a. Synchronized cardioversion b. Adenosine ( 1 st dose-6 mg rapid IVP follow w/flush; 2 nd dose- 12 mg if required) i. SE: nausea, vomiting, bradycardia ii. Restarts the heart! Have defibrillator available! 3. If asymptomatic a. IV access, 12 lead ECG, pulse ox, VS b. Vagal stimulation c. Adenosine (if regular rate & rhythm) d. Beta blocker, Ca channel blocker Permanent Pacemaker Used for conduction disorders that are not permanent (complete heart block) Placed surgically under conscious sedation Average life-span of 10 years Types: o Single or Dual Chamber Pacemaker o Atrial Pacer -Spike followed by P wave o Ventricular Pacer -Spike followed by QRS o AV Pacer -Spike followed by P wave & QRS o Synchronous (demand) or Asynchronous (fixed- rate) o Implantable Cardioverter Defibrillator ( ICD)- able to perform cardioversion, defibrillation, and pacing of the heart Indication: pt has hx of spontaneous VT/VF not caused by an MI Complications: bleeding & cardiac tamponade Sinus Bradycardia <60 bpm Causes: o Vagal stimulation (carotid massage, straining, vomiting, coughing, Valsalva maneuver, breath holding, cold stimulus to face) o Hypothyroidism, Hypothermia, Hypoxia, Hypo/Hyperkalemia o Meds -Beta blockers, Ca Channel blockers, Amiodarone, digitalis, Sotalol o Posterior/Inferior MI o Increased ICP o Post heart transplant o Obstructive sleep apnea o Diseased SA node Assessment/Sx: o Syncope o Dizziness, weakness o Confusion o SOB Interventions: 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 TCP 3. Or Dopamine 2-20 mcg/kg/min (2 nd line drug) 4. Or Epinephrine 2-10 mcg/min (alternative to dopamine) Temporary Pacing Nonsurgical, provides electrical stimulation/impulse to the heart Uses o TX for bradydysrhythmias and asystole o EMERGENCY measure used temporarily until a permanent pacer can be placed o Prophylactically during procedures/transportation for pts at risk for bradydysrhythmias Single-Chamber Pacemaker-impulse sent to R atrium or R ventricle Dual-Chamber Pacemaker- impulse sent to both R atrium & R ventricle Two modes of pacing… o Synchronous: only paces on demand when pt’s HR is lower than the set rate; when pacing not needed the pacer inhibits itself from firing o Asynchronous: fixed-rate pacing Transcutaneous Pacing o two electrodes placed externally, the generator transmits an electrical impulse to stimulate ventricular depolarization when the pt’s HR is slower than the rate set on the pacemaker
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