Basic Dysrhythmia Knowledge
What are the only two rhythms you should defibrillate?
V-fib and pulseless v-tach
What type of therapy is used for symptomatic bradycardia?
Transcutaneous Pacing
What is the first priority in V-Fib?
Begin CPR until a defibrillator is available.
How do you differentiate treatment for V-Tach based on pulse presence?
With a pulse: synchronized cardioversion or medications.
No pulse: defibrillation.
A patient with symptomatic bradycardia is deteriorating. What should you prepare to do?
Prepare for temporary transcutaneous pacing.
What is the first drug given for asystole or pulseless electrical activity?
Epinephrine 1 mg IV
What is the treatment for stable SVT?
Valsalva maneuver and Adenosine
In what order are doses of adenosine administered for SVT?
6 mg, then 12 mg, and 12 mg if necessary.
What is the priority for pulseless electrical activity (PEA)?
High-quality CPR and correcting reversible causes.
A patient in V-Fib is being treated. What should always accompany defibrillation efforts?
High-quality CPR.
What should you do first when you see asystole on the monitor?
Verify the rhythm in another lead
When is synchronized cardioversion used for ventricular tachycardia?
When the patient is unstable but has a pulse.
What is the fluid bolus range used in emergencies?
1 to 2 Liters.
What determines the use of synchronized cardioversion versus defibrillation?
Cardioversion is for rhythms with a pulse; defibrillation is for pulseless rhythms.
What are the reversible causes to consider in cardiac arrest (e.g., for PEA or asystole)?
H's and T's
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypokalemia, Hyperkalemia, Hypothermia
Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary)
Final Jeopardy
A patient presents with a wide QRS complex tachycardia at a rate of 160 bpm. The patient is hypotensive and showing signs of poor perfusion but still has a palpable pulse. What is the priority intervention, and why?
The priority intervention is synchronized cardioversion. This is indicated for unstable ventricular tachycardia (V-Tach) with a pulse, as it restores normal rhythm while avoiding delivery of the shock during the T wave, which could cause ventricular fibrillation.