dysrhythmia management

1. Dysrhythmia Management Tiffany Boyd BSN, RN, PCCN Staff Development Instructor Pinnacle Health

3. Pacing Spikes? Atrial: _Yes/ No / N/A_ Ventricular Yes / No / N/A�_ Capture? Atrial: Yes/ No / N/A_ Ventricular: _Yes / No / N/A Intrinsic Rate Atrial: ______ Ventricular: _________ Paced Rate Atrial: ____(N/A) Ventricular: __________(N/A) Intervals: AV _______(N/A) VA________________(N/A) Proper sensing? Atrial: _Yes/ No / Unable to assess/ N/A____ Ventricular: _Yes / No / Unable to assess/ N/A Is this pacemaker functioning appropriately for the settings given? Yes/No Explain why or why not: Pacing Spikes? Atrial: _Yes_ Ventricular Yes Capture? Atrial: Yes Ventricular: _Yes Intrinsic Rate Atrial: none Ventricular: _none______ Paced Rate Atrial: _60 (N/A) Ventricular: _60_____(N/A) Intervals: AV _160 ms__(N/A) VA__840 ms____(N/A) Proper sensing? Atrial: _Unable to assess (no intrinsic beats) Ventricular: Unable to assess (no intrinsic beats) Is this pacemaker functioning appropriately for the settings given? Yes Explain why or why not: Pacer spike before every p wave and q (QRS) Lower rate limit set at 60 bpm-atria pacing at 60 Good atrial & ventricular capture Pacing Spikes? Atrial: _Yes_ Ventricular Yes Capture? Atrial: Yes Ventricular: _Yes Intrinsic Rate Atrial: none Ventricular: _none______ Paced Rate Atrial: _60 (N/A) Ventricular: _60_____(N/A) Intervals: AV _160 ms__(N/A) VA__840 ms____(N/A) Proper sensing? Atrial: _Unable to assess (no intrinsic beats) Ventricular: Unable to assess (no intrinsic beats) Is this pacemaker functioning appropriately for the settings given? Yes Explain why or why not: Pacer spike before every p wave and q (QRS) Lower rate limit set at 60 bpm-atria pacing at 60 Good atrial & ventricular capture

4. Strip #2

5. PR= QRS= ST= elevated, depressed, isoelectric QT= HR= Rhythm= What would you do? PR N/A QRS 0.12-0.14 ST depressed QT 0.40 < HR=30 Idioventricular Assess pt-pacerPR N/A QRS 0.12-0.14 ST depressed QT 0.40 < HR=30 Idioventricular Assess pt-pacer

6. Strip #3

7. PR= QRS= ST= elevated, depressed, isoelectric QT= HR= Rhythm= What would you do? PR 0.16 QRS=0.16 ST=depressed QT=0.40 HR=60 SB w/ multifocal PVC�s Assess pt-IV, O2, atropinePR 0.16 QRS=0.16 ST=depressed QT=0.40 HR=60 SB w/ multifocal PVC�s Assess pt-IV, O2, atropine

8. Strip #4

9. PR= QRS= ST= elevated, depressed, isoelectric HR= Rhythm= What would you do? Loss of capture Increase MA Check battery ? Perm. Pacer if temp. pacer Loss of capture Increase MA Check battery ? Perm. Pacer if temp. pacer

10. Strip #5

11. PR= QRS= ST= elevated, depressed, isoelectric QT= HR= Rhythm= What would you do? Rate: 20-40 Rhythm: Regular, maybe irregular Pacer Site: Ventricles P Waves: absent PRI: No P, no PRI! QRS: Wide and bizarre IdioventricularRate: 20-40 Rhythm: Regular, maybe irregular Pacer Site: Ventricles P Waves: absent PRI: No P, no PRI! QRS: Wide and bizarre Idioventricular

12. Dopamine Your patient is ordered to receive a Dopamine infusion at 5 mcg/kg/min. The patient weighs 100 Kg. Dopamine is mixed 400 mg / 250 ml D5W. What rate would you set the pump for in ml/hr? 1.6 mg/ml concentration 500mcg/min dose 18.75 ml/hr1.6 mg/ml concentration 500mcg/min dose 18.75 ml/hr

13. Nitroglycerin You are assessing your 70 Kg patient. A Nitroglycerine drip of 50 mg in 250ml of D5W is infusing at 45 ml/hr. What dose is infusing per minute? Be sure to express the dosage appropriately for this drug. 200mcg/ml-concentration 10mcg/min=3ml/hr 45/3=15x10mcg/min=150mcg/min200mcg/ml-concentration 10mcg/min=3ml/hr 45/3=15x10mcg/min=150mcg/min

14. Dobutamine Your 68 Kg patient is receiving 20ml/hr of a Dobutamine drip. The Dobutamine is mixed 500mg/250ml. What dose is the patient receiving? Be sure to express the dosage appropriately for this drug. 2000 mcg/ml-concentration 20ml/hr=40000mcg/hr 40000mcg/hr / 60 min=667 mcg/min 667 mcg/min / 68 kg= 9.8 mcg/kg/min2000 mcg/ml-concentration 20ml/hr=40000mcg/hr 40000mcg/hr / 60 min=667 mcg/min 667 mcg/min / 68 kg= 9.8 mcg/kg/min

15. Amiodarone An Amiodarone infusion has been ordered for your patient in NSVT. It is ordered as a bolus infusion over 10 min and an infusion to be delivered at 1mg/min x 6hr and then decreased to 0.5 mg/min x 18hr. It is prepared as 150mg/100ml D5W for the bolus and 450mg/250ml D5W for the infusion. What would you set the rates at for the bolus and then the infusion? Bolus: 150mg/100ml x 60 min/hr= 600ml/hr Infusion: 450mg/250ml = 1.8 mg/ml 1mg/min= 34 ml/hr 0.5mg/min= 17 ml/hrBolus: 150mg/100ml x 60 min/hr= 600ml/hr Infusion: 450mg/250ml = 1.8 mg/ml 1mg/min= 34 ml/hr 0.5mg/min= 17 ml/hr

16. Cardene Your patient is ordered a Cardene infusion. It comes prepared as 50mg/250ml of D5W. It is ordered to be delivered at a rate of 5mg/hr. What would you set the infusion pump to run at? Also, what would you anticipate if the medication is infusing through a peripheral IV? 1mg/5ml=final concentration 5mg/hr x 5ml/mg= 25 ml/hr IV site needs changed every 12 hours if not a central line. 1mg/5ml=final concentration 5mg/hr x 5ml/mg= 25 ml/hr IV site needs changed every 12 hours if not a central line.

17. Labetalol Your patient has been ordered a Labetalol infusion for high blood pressure. It is prepared as 200mg/250ml of D5W. It is ordered to infuse at 2mg/min. What would you set the infusion pump rate at? 0.8 mg/ml = final concentration 2mg/min x 60min/hr x ml/0.8mg= 150 ml/hr0.8 mg/ml = final concentration 2mg/min x 60min/hr x ml/0.8mg= 150 ml/hr