2017 RN HESI Critical Care Cardiac Exam.docx

External defib strong current indicated for pulseless

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External Defib Strong Current Indicated for Pulseless Rhythms Procedure 1. Paddle or defibrillation pad placement 2. Good contact with skin (protect from burns) 3. Charge defibrillator to desired setting 4. “I’m clear, you’re clear, everyone clear, oxygen clear”. Make sure no one is touching pt or pts bed. 5. Adequate pressure with paddles 6. Shock 7. Continue CPR 2 minutes, then assess rhythm 3 main difference btwn cardioversion & defib: 1. Cardioversion is for pts with a pulse. Defib is for pts without a pulse. 2. You cardiovert pt at lower joules (lower energy; 50-100 J). You use highest amt of joules we can for defib (up to 360). 3. Cardioversion have to synchronize shock with QRS; we want to make sure the shock is delivered at right time in cardiac cycle bc if not, we can put pt into lethal rhythm. Ex. If you shock pt while ventricles are depolarizing, you can put them in V-Tach. Study strips separately from treatments & causes & rhythms themselves. Too Slow: speed up
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HESI EXAM RN Critical Care Exam 1 (10) SB / AVB (2-3) Atropine, epinephrine, dopamine, Pacemaker Too Fast: slow it down Sinus Tachy: treat cause SVT/AT: adenosine (short half-life, push fast, stop heart, given 3 times). Afib-Aflutter: Cardizem (diltiazem). Afib is always irregular. A flutter can be regular or irregular. Cardioversion: echo first with afib & aflutter to check for clots. Too Ugly : defib Unstable V-tach / Vfib: defib, CPR, epinephrine Atrial Dysrhythmia: problem with P wave Ventricular Dysrhythmia: problem with QRS Sinus Dysrhythmia: problem with rate. Too fast or too slow heartrate. AV blocks: problem with PR interval. Google EKG skill state free EKG skill stat
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