Recommended you watch: Life-Threatening Arrhythmias: Foundational Concepts

1. Recommended you watch: Life-Threatening Arrhythmias: Foundational Concepts 80712/32612 Before watching this program

2. This PowerPoint file is a supplement to the video presentation.  Some of the educational content of this program is not available solely through the PowerPoint file.  Participants should use all materials to enhance the value of this continuing education program.

4. EMS/Nursing 80812/ 34812 Life-Threatening Arrhythmias: Events

5. EMS/Nursing 80812/ 34812 Elizabeth J. Tombs, RN, MSN, IBCLC, RLC, Assistant Professor, Anita Thigpen Perry School of Nursing, TTUHSC Lubbock, Texas

6. EMS/Nursing 80812/ 34812 Carol A. Strahan, RN, MSN, CCRN, CEN, Assistant Faculty Retention Counselor Anita Thigpen Perry School of Nursing, TTUHSC Lubbock, Texas

7. EMS/Nursing 80812/ 34812 Objectives Recognize the electrical process of the heart.

8. EMS/Nursing 80812/ 34812 Objectives Identify patterns and causes of atrial fibrillation and ventricular tachycardia.

9. EMS/Nursing 80812/ 34812 Objectives Identify patterns and treatment of asystole and pulseless electrical activity (PEA).

10. Heart Rhythms • Always life-threatening • ventricular fibrillation • asystole • pulseless electrical activity (PEA) • Can become life-threatening • sinus bradycardia/tachycardia • Mobitz 1 and 2 • complete heart block • atrial fibrillation (A-fib) • atrial flutter (A-flutter)

11. Heart Rhythms • paroxysmal atrial tachycardia (PAT) or supraventricular tachycardia (SVT) • ventricular tachycardia

12. P P P P P P P P P wave Complete Heart Block

13. PR Interval Complete Heart Block

14. PR Interval: varies Regular Rhythm: Regular P to P and Regular R to R Rate: Atrial usually 60-100 Ventricular usually 20-60 QRS Interval: normal or wide Complete Heart Block

15. Causes • MI (myocardial infarction) • Medication side effect • Hypoxia • Conduction system lesion

16. Treatment • May try pacemaker • Consider atropine or epinephrine • May need dopamine to sustain cardiac output

17. Rate: >100 – 160 (upper limit) Regular Rhythm: Yes – generally PR Interval: .12 - .20 secs QRS Interval: >.12 secs Rate: 100 Sinus Tachycardia

18. Causes • Fever • Hypoxia • Medication side effect (ex. Beta adrenergic) • Pathologic underlying condition (thyroid storm)

19. Treatment • If stable, treat underlying cause (i.e., decrease fever) • If unstable: • consider medications (ex. beta blocker) • consider starting O2

20. Regular Rhythm: mostly regular and visually identifiable pattern Rate: generally >150 for SVT and >160 – 250 for PAT PR Interval: no identifiable P waves at such a rapid pace QRS Interval: narrow complexes PAT/SVT

21. PAT/SVT Symptoms • Distress • Anxious • Impending doom

22. Causes • Likely premature atrial complex (PAC) triggered • Stimulants (caffeine, medications) • Anxiety • Damage to myocardial tissue

23. Treatment • If stable, treat underlying cause • vagal maneuvers • carotid massage • may give adenosine • also consider: calcium channel blocker, digitalis, beta blocker • If unstable: • cardioversion

24. R Cardioversion: needs to be synched on the R waves PAT/SVT

25. Rhythm: irregular Rate: atrial = 350 – 700 (ventricular = >150 uncontrolled A-fib) PR Interval: no P waves QRS Interval: narrow complexes Atrial Fibrillation

26. Causes • MI damage • Pulmonary heart disease • Valvular heart disease • Hyperthyroidism

27. Treatment • If less than 48 hours: • convert back to sinus rhythm (SR) • consider: digitalis, calcium channel blockers, beta blockers, amiodarone, or cardioversion • If greater than 48 hours: control heart rate (HR) and give anticoagulant to prevent blood clots • If unstable: cardioversion

28. PR Interval: P wave is saw-tooth Regular Rhythm: mostly regular and visually identifiable pattern Rate: Atrial = 250 – 350 (ventricular rate depends on the conduction ratio) QRS Interval: narrow complexes Atrial Flutter

29. Causes • Heart disease • Valvular heart disease • Lung disease

30. Treatment • If stable, treat underlying cause • consider: calcium channel blocker, digitalis, beta blocker • may use adenosine for A-flutter • If unstable: cardioversion

31. Regular Rhythm: mostly regular and visually identifiable pattern Rate: >100 (generally >150) PR Interval: no P waves QRS Interval: wide and bizarre complexes Ventricular Tachycardia

32. Causes • Premature ventricular complexes (PVCs) • PVC causes: • hypokalemia • hypoxia • heart disease • Low magnesium • Stimulants

33. Treatment • Treat the patient, not the monitor • Check pulse • if pulse: • amiodarone • O2 started • if no pulse: • cardiopulmonary resuscitation (CPR) • defibrillate

34. Treatment • Medications: epinephrine, amiodarone, and O2 (follow advanced cardiac life support [ACLS] protocol)

35. Bizarre and chaotic rhythm; no detectible P or QRS (looks like static) Ventricular Fibrillation

36. Causes • PVCs • R on T phenomena • Heart disease • Hypokalemia • Hypoxia • Low magnesium • Stimulants

37. Treatment • CPR • Immediate defibrillation • ACLS protocol • Medication: epinephrine, amiodarone, O2

38. Regular Rhythm: no Rate: 0 PR Interval: 0 QRS Interval: 0 Asystole: A-none systole-contractions Asystole

39. Causes • Massive MI • Profound hypoxia • Heart disease • 5 Hs • hypothermia • hypothermia • hypokalemia • hypoxia • hydrogen ion acidosis • hypovolemia

40. Causes • 5 Ts • toxic/tablets • thrombosis (coronary) • thrombosis (pulmonary embolism) • tension pneumothorax • tamponade

41. Treatment • CPR • Medications: epinephrine, may consider atropine • Consider transcutaneous pacing • ACLS protocol

42. Any organized electrical rhythm where patient does not have a pulse Pulseless Electrical Activity (PEA)

43. Causes • Inability to cause systole • Either the current is too weak or the muscle is not able to contract • 5 Hs • 5 Ts

44. Treatment • CPR • Identify and reverse cause • Medications: epinephrine • ACLS protocol • Treat the patient not the monitor

45. After the Event • Continue to provide supportive measures • Provide education to family and patient: • cardiac arrhythmia • treatment • prevention • Provide support to family and patient: • resources • holistic aspects (spiritual, cultural, etc.)

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