Cardiovascular Monitoring Cardiac Dysrhythmia

1. Cardiovascular MonitoringCardiac Dysrhythmia Dr.nohaelsayed

2. Sinoatrial Node (Sinus) Dysrhythmias Sinus bradycardia: the SA node fires electrical impulses at a rate that is slower than normal (that is, less than 60 impulses per minute) Sinus tachycardia: the SA node fires electrical impulses at a rate that is faster than normal (that is, greater than 100 impulses per minute)

3. Sinus Bradycardia - SB Regularity – regular Rate – less than 60 / min P waves – 1:1 PRI - .12 - .20 QRS - .12 or less

4. Sinus Tachycardia - ST Regularity – regular Rate - > 100 / min P waves = 1:1 PRI = .12 - .20 QRS = .12 or <

5. Sinus Arrhythmia - SA Caused by a variety of factors: anxiety, stimulants, fever, exercise, medical conditions Regularity – irregular Rate – anything; freq. in normal rate of 60 – 100 / min P waves – 1:1 PRI - .12 - .20 QRS - .12 or <

6. Sinus Rhythms

7. Atrial Dysrhythmias Atrial flutter: Atrial contraction (represented by the P waves on the ECG) is regular but faster than normal (250 to 400 times per minute) Atrial fibrillation: is caused by rapid, uncoordinated twitching of the myocardium of the atria; in atrial fibrillation, the P waves are irregular and small, and they occur at a rapid rate all along the ECG

8. Atrial Fibrillation : A Fib

9. Atrial Flutter : A Flutter

10. Atrioventricular Junction Dysrhythmias • Junctional rhythm: occurs if the SA node fails to fire and send an electrical impulse through to the AV node or if the SA node fires the impulse too slowly

11. Junctional rhythms

12. P wave after QRS - junctional

13. Ventricular Dysrhythmias Premature ventricular contraction Ventricular tachycardia Ventricular fibrillation

14. Premature Ventricular Contraction: PVC Ectopic beat – dangerous if occurs often Regularity – may interrupt the regularity of underlying rhythm Rate – depends on underlying rhythm P wave – will not be one before ectopic beat PRI – none in ectopic beat – measure underlying rhythm QRS – ectopic beat – wide and bizarre, also look at underlying rhythm

16. Ventricular Tachycardia - VT Medical Emergency – most pts will be unconscious & can’t feel pulse Regularity – usually regular, can be slightly irregular Rate – 150 – 250 / min P waves – none PRI – none QRS - >.12

18. Ventricular Fibrillation - VF Start CPR!! Regularity – baseline totally chaotic Rate – can’t determine P waves - ? PRI - ? QRS - ?

20. Asystole No electrical activity Start CPR

21. Cheat Sheet – Ventricular Dysrhythmias

22. Atrioventricular Blocks • First-degree atrioventricular block • Second-degree atrioventricular block * Type I - Wenckebach rhythm * Type II - Mobitz type I rhythm • Third-degree atrioventricular block (Mobitz type II rhythm)

23. Observations to Report to the Nurse Immediately • The PR interval is longer than earlier • The QRS complex changed shape or widened • The ECG shows a new dysrhythmia that was not there before • C/O chest pain or discomfort • C/O shortness of breath • C/O dizziness • Person unconscious

24. Artifacts Can Be Caused by: Electrical interference from other electrical equipment (such as an electric razor) or monitoring devices in the area Loose electrodes, especially if the person is diaphoretic (sweating) or recently repositioned Electrodes dried out Electrodes placed over an excessively hairy area Defective monitor or lead wires Patient movement (for example, from shivering or brushing the teeth)

25. Artifact:

26. 12 Lead EKG: • Prepare equipment • Bed at comfortable working height • Adjust patient’s clothing to expose chest; provide privacy • Determine correct position for each electrode • If excessive hair, remove with shaver • Clean with alcohol pad to remove oils if needed • Ask patient to lay still and obtain tracing

28. 12-Lead Tracing: