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Telemetry / Arrythmias

Telemetry / Arrythmias. Dan Crouch Kristi Kuhn Kate Lindley Ben Voss. Unresponsive patient in ED. Junctional tachycardia. Regular Narrow complex No P waves. Surgical consult for arrhythmia. Paroxysmal SVT (PAT). Benign rhythm If sustained: Vagal maneuvers Adenosine DCCV.

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Telemetry / Arrythmias

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  1. Telemetry / Arrythmias Dan Crouch Kristi Kuhn Kate Lindley Ben Voss

  2. Unresponsive patient in ED

  3. Junctional tachycardia • Regular • Narrow complex • No P waves

  4. Surgical consult for arrhythmia

  5. Paroxysmal SVT (PAT) • Benign rhythm • If sustained: • Vagal maneuvers • Adenosine • DCCV

  6. 70 yo AAF with palpitations

  7. Premature ventricular complexes • Abnormal but usually benign • Concerns: very frequent, history of ischemia • Ask about symptoms (palpitations, “skipping a beat”) • Beta-blockers for symptomatic patients

  8. Called to see sleeping patient

  9. NSVT • ICM or NICM • Usually not an indication for ICD • Ask about symptoms • Use more beta-blockers

  10. Patient with L-sided weakness

  11. Atrial fibrillation • Irregular • No coordinated atrial activity (no P waves) • Rate control • Anticoagulation

  12. Lung transplant pt with SOB

  13. Atrial flutter (2:1) • Regular rhythm • Flutter circuit rate: 300 bpm • Re-entrant circuit • Diagnostic maneuvers: vagal stimulation, adenosine

  14. Typical atrial flutter • “Sawtooth” pattern

  15. Atrial flutter (variable block) • Regular flutter waves @ 300 bpm • Irregular ventricular response • Usually seen with AV nodal blockade • May be difficult to distinguish from coarse Afib

  16. Nursing student asks for help

  17. Mobitz I (Wenkebach) • Regular P waves • Lengthening P-R interval • Shortening R-R interval • Predictably dropped beats (grouped beats)

  18. Patient with syncope

  19. Mobitz II • Randomly dropped beats • Frequently progresses to 3rd degree AVB or complete heart block • Can be indication for pacemaker

  20. 27 yo WM with syncope at work

  21. Complete Heart Block • Normal sinus node activity (P waves) • No ventricular response • Pt presented with syncope while driving forklift

  22. Patient with chest pain

  23. Ventricular tachycardia • Wide complex tachycardias • VT until proven otherwise for patients with ischemia • Brugada criteria: only AV dissociation useful on tele • GET AN EKG!! • Non-malignant rhythm with aberrancy also possible

  24. Pt missed dialysis

  25. Hyperkalemia • QRS widening • Peaked T waves • Treatment: • Calcium first • Insulin/glucose, albuterol, glucagon, NaHCO3, IVF/Lasix • Kayexalate last

  26. 18 yo WF postpartum

  27. Torsades de pointes • Polymorphic ventricular tachycardia • Life-threatening with degeneration to VF • Usually precipitated by PVC in setting of long QT • Often associated with QT-prolonging drugs • Check for electrolyte disturbances (especially Mg)

  28. Regardless of the telemetry…

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