The Electric Company
What is the pacemaker of the heart?
The SA node (sinoatrial node)
Regular, Rate less than 60, P Waves: uniform, normal; one for every QRS. QRS is less than 0.12 second, PR Interval: 0.12-0.20 second
Sinus Bradycardia
What rhythm produces progressively lengthening PR Intervals until a dropped QRS complex, then the cycle repeats?
Second Degree Type I (Mobitz 1, Wenkeback)
What is the term for early beats that occur within the patient's own rhythm and are caused by irritability? They are followed by a compensatory pause.
Ectopic Beats = Early Beats
Atropine 1 mg IV push
Pacing (Transcutaneous, then transvenous, permanent pacemaker)
What is the gatekeeper of the electrical system that is between the atria and ventricles?
The Atrioventricular (AV) Node
Regular rhythm, QRS complexes similar 0.12-0.20 second, PR Interval consistent, No pulse
Pulseless Electrical Activity (PEA)
In which rhythm do the PR intervals vary completely, as there is no association between the atria and the ventricles?
Third Degree Heart Block (complete heart block)
How do you document the patient's rhythm when you see sinus rhythm and then occasional early p waves?
Sinus with PACs (Premature Atrial Contractions)
My patient is in V Fib, what do I do?
Confirm it IS VF by check for a pulse. If no pulse present, immediately begin compressions and call a code 99. First line treatment for VF is early defibrillation, pads must be placed quickly and attached to Zoll Defibrillator. Follow ALS algorithm and providers orders (if provider present).
What is the name of the electrical pathway that wrap around the left and right ventricles?
The Purkinje Fibers
Irregularly Irregular. Rate varies with conduction: Less than 100 if controlled, greater than 100 if uncontrolled. No P waves, chaotic baseline, QRS is less than 0.12 second, PR Interval not discernable
Atrial Fibrillation (A Fib)
What rhythm is characterized by a prolonged delay in conduction at the AV node, recognized by a consistent PR Interval greater than 0.20 seconds.
First Degree AV Block
How would you refer to 7 fast wide QRSs that occur in a row? Bonus 100 points: If 2 beats of VT are a couplet, what are 3 beats called?
7 beats of Vtach
Bonus-2 beats are a couplet, 3 beats are a run of VT
The order of interventions for a patient in SVT who alert and oriented x 4, blood pressure is 131/79, and O2 sat is 96% on room air.
1. Vagal maneuvers
2. Adenosine 6mg IV push (can possibly do 2nd dose 12 mg if provider chooses)
3. Cardioversion
What does the T wave represent in terms of electricity passing through the heart?
Ventricular Repolarization
Irregular, rate not measurable, P Wave not discernable, QRS complex chaotic/not discernable, PR Interval not discernable
Ventricular Fibrillation
3rd degree heart block
If narrow complex Tachyarrhythmia does not convert with vagal maneuvers and medication conversion, what is the next step?
Cardioversion
Initiate code blue/start compressions
Defibrillate
How does the rhythm strip look different in a STEMI vs a NSTEMI?
STEMI- ST elevation
NSTEMI- T wave depression or inversion
Regular or irregular, Rate greater than 200 bpm, P wave not discernable, QRS complex > 0.12 second; variable in shape; twisting, PR Interval not discernable
Torsades de Pointes
or Multifocal V Tach
What is the rhythm that has a fixed PR Interval with set pattern of dropped QRS complexes?
Second Degree AV Block Type 2 (Mobitz 2)
What are the treatment goals for a person in Atrial Fibrillation/Flutter? Hint- there are 3 goals.
1. Rate Control 2. Rhythm control 3. Anticoagulation
During a code situation, the teams and providers are evaluating for cause of the event and they are thinking through the H's and T's. Can you name 3 potential H's and 3 potential T's?
Hs & Ts
Hypovolemia, Hypoxia, Hydrogen ion excess (acidosis), Hyper/hypokalemia, Hypothermia, Hyper/hypoglycemia
Toxins, Tamponade, Tension PTX, Thrombosis (PE), Thrombosis (MI)