It all starts with your foundation
Intrinsic rate of the SA, AV and purkinje fibers
SA- 60-100
AV- 40-60
Purkinje- 20-40
Steps to rhythm interpretation
1. Identify P waves and appearance
2. Identify QRS and width
3. Ps for Qs and Qs for Ps?
4. Identify PRI (normal/abnormal)
5. Regular or Irregular R to Rs
6. Rate
What makes a tachycardia unstable?
Chest pain
Altered mentation
Shortness of breath with Pulmonary Edema
Hypotension or other signs of shock
Stable vs Unstable Angina
Stable: predictable, follows a pattern, usually brought on with exertion, improved with rest/nitro
Unstable: unpredictable, can change suddenly, usually starts at rest, longer lasting usually, usually not relieved by rest or standard meds,
Features of cardiogenic shock
hypotensive, tachycardic, pulmonary edema, signs of hypoxia
Bonus: common medication treatment?
What does the LAD feed?
Anterior wall and interventricular septum
smooth up right P waves, narrow qrs, PRI between 0.12-0.20 consistently, regular r to r intervals, rate above 100
Sinus Tach
Treatment for unstable narrow complex tachycardia
Synchronized cardioversion
Standard ACS treatment
Fentanyl/Morphine
Oxygen to maintain at 94%
Nitro 0.4mg SL
Aspirin 162-324mg PO
How does nitro work?
Decreases preload, and causes coronary vasodilation
Layers of the artery from inner most to outer
tunica intima
tunica media
tunica externa
Accelerated idioventricular
3 main treatments of PEA/Asystole
1. High quality CPR
2. Epi 1mg 1:10,000
3. Hs and Ts
Cardiac arrest
Left vs right sided heart failure
experiences fatigue, chronic cough, and DIB
Right- backs up into the body, usually caused by lung disease/increased pulm pressures or left sided heart failure
experiences pedal edema, abdominal swelling, jvd
3 Layers of the heart from inner to outer and the sac around the heart
Bonus: Can you tell me the purpose of each layer?
Endocardium-smooth lining of heart chambers and valves
Myocardium-muscle wall of heart
Epicardium- thin outer lining and houses coronary arteries
Pericardium-fluid filled sac proving protection, reducing friction, prevents overfilling (overstretch), and stability
Inverted or missing P waves, narrow QRS, regular R to R intervals, rate 40-60
Junctional Rhythm or Junctional Escape
Explain of to perform TCP
place pads on patient, explain procedure to patient, turn on pacer, set rate to 60-80, adjust mA to obtain electrical capture and mechanical capture, if needed adjust rate to improve Cardiac output. When appropriate give pain management/sedation.
Describe signs/symptoms of an emergent aortic aneurysm
tearing chest or back pain, unequal blood pressures, shortness of breath, lethal dysrhythmias, signs of stroke
Name three conditions that mimic angina pectoris
Gallbladder stones/infection, AAA, GERD, costochondritis, panic attacks, PEs, hernias, muscle strains
As sodium channels shut off, what do potassium channels do during repolarization?
Open to allow outflow of potassium so the cell repolarizes.
smooth up right P waves, typical QRS complex is narrow but can be wide (all QRS's will be consistent in appearance), some P waves do not have a QRS complex, the PRIs for the married P and Qs is consistent and (0.12 to 0.20), Irregular R to R, rate can vary but typically bradycardic
Mobitz 2 or 2nd degree type 2
Complication of atropine if underdosed or given too slow
paradoxical bradycardia
Field treatments for hypertensive emergencies
Rapid transport, supportive care
2 hospital treatments for infarctions
cardiac cath and thrombolytics