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Warren Shared "Cardiac + Dysrhythmias" - 22 Picmonics

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Cardiac + Dysrhythmias

EKG Findings - Treatments
Atrial Fibrilation
Rate Control (Beta-blockers, Ca-Blockers or Digoxin)
Warfarin before Cardioversion
Atrial Flutter
Tx same as A-Fib
Multifocal Atrial Tachycardia
Verapamil
SVT
Vagal Maneuvers
Adenosine (Adenocard)
Ventricular Tachycardia
Amiodarone or Lidocaine
Ventricular Fibrilation
Cardioversion then Epinephrine
Torsades de Pointes
Magnesium
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Parts of an ECG
PQRST
P Wave
Atrial Depolarization
QRS Complex
Ventricular Depolarization
T Wave
Ventricular Repolarization
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2 mins
ECG Interpretation
Rate
Rhythm
P Waves
Upright, Rounded, Before Every QRS
PR Interval (< 0.20 seconds)
Normal QRS (< 0.12 seconds)
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2 mins
ECG: Sinus Bradycardia
Rate
< 60 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Atropine
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1 min
ECG: Sinus Tachycardia
Rate
> 100 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Treat Underlying Cause
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2 mins
ECG: Atrial Flutter
Rate
Variable
Rhythm
Regular or Irregular
P Wave
Saw Tooth, Multiple Before Every QRS
PR Interval
Non-measurable
QRS Interval
< 0.12 seconds
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2 mins
ECG: Atrial Fibrillation
Rate
Variable Rate
Rhythm
Irregular Rhythm
P Wave
No P Wave
PR Interval
No PR Interval
QRS Interval
QRS < 0.12 Seconds
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1 min
Atrial Fibrillation/Flutter Pharmacologic Treatment (USD SSOM)
Acute Rhythm Control
Cardioversion
Anticoagulants
Ibutilide
Chronic Rhythm Control
Sotalol
Amiodarone
Dronedarone
Acute & Chronic Rhythm Control
Dofetilide
Flecainide
Propafenone
Acute & Chronic Rate Control
Verapamil
Diltiazem
Beta Blockers
Amiodarone
Digoxin
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8 mins
AV Block Types
1st Degree
1st degree
The PR interval is prolonged (> 200 msec)
Benign and asymptomatic. No treatment required
Slow conduction of AV Node
2nd degree
Mobitz type I (Wenckebach)
Mobitz type I (Wenckebach)
Progressive lengthening of PR interval until a beat is “dropped” (a P wave not followed by a QRS complex)
Usually asymptomatic
Variable RR interval with a pattern (regularly irregular)
Slow conduction of AV Node
Mobitz type II
Mobitz type II
Dropped beats that are not preceded by a change in the length of the PR interval (as in type I)
PR interval normal because problem is in Bundle of His, not AV node
May progress to 3rd-degree block.
Often treated with pacemaker
3RD DEGREE (COMPLETE)
3rd degree (complete)
The atria and ventricles beat independently of each other.
P waves and QRS complexes not rhythmically associated.
Atrial rate > ventricular rate.
Usually treated with pacemaker.
Can be caused by Lyme disease.
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Atrioventricular Block Types
First Degree
First Degree
PR Interval > 200ms
No Treatment Needed
Second Degree
Second Degree
Mobitz I (Wenckebach)
Progressive PR Interval Lengthening with Nonconducted QRS Complex
Mobitz II
Constant PR Interval with Nonconducted QRS Complex
Third Degree
Third Degree
Atrioventricular Dissociation
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3 mins
Amiodarone
Blocks K channels
Blocks Na Channels
Weak Calcium Channel Blocking
Peripheral Vasodilation
Oral and IV
Hepatic Metabolism
Levels Detected over Long Period
CYP Induction
Life-threatening Antiarrythmic
Hospitalize for First Dose
Adverse Effects
Drug Deposits
Photodermatitis
Corneal Microdeposits
Bradycardia and AV Block with IV
Pulmonary Toxicity
Hepatotoxicity
Proarrythmic
Pregnancy Risk Factor D
Hypo or Hyperthyroidism
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Ventricular Fibrillation (V-fib)
Causes
Myocardial Infarction
Ischemia
Disease States
Cardiac Catheterization
Pacemaker
Symptoms
Unresponsive
Pulseless
Apnea
Treatment
CPR/ACLS
Defibrillation
Drugs (epinephrine & vasopressin)
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2 mins
Ventricular Fibrillation / Pulseless Ventricular Tachycardia Treatment (USD SSOM)
Termination
Cardioversion
Amiodarone
Procainamide
Lidocaine
Magnesium
Prophylaxis
Implantable Cardioverter Defibrillator
Beta Blockers
Amiodarone
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6 mins
Nitroglycerin
Mechanism of Action
Decreases Preload
Indications
Angina
Up to 3 doses q 5 mins
Side Effects
Headache
Hypotension
Contraindications
Viagra (Sildenafil)
Nursing Considerations
Assess Blood Pressure
Protect From Light
Use Glass Bottle and Special Tubing
Gloves for Applying Topically
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2 mins
Myocardial Infarction Interventions
MONA
Morphine
Oxygen
Nitrates
Aspirin
Thrombolytics (tPA)
Invasive Procedures
Cardiac Catheterization
Stent Placement
Angioplasty
Coronary Artery Bypass Grafting (CABG)
Considerations
Decrease Modifiable Risk Factors
Resuming Activity (Physical, Sexual)
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2 mins
Coronary Artery Bypass Grafting (CABG)
Indications
ST-Segment Elevation Myocardial Infarction (STEMI)
Cardiovascular Disease (CAD)
Uncontrolled Angina
Considerations
Internal Mammary Artery
Saphenous (Leg) Vein
Transient Limb Edema
Closely Monitor Patients
Venous Thromboembolism (VTE) Prophylaxis
Incentive Spirometer
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2 mins
Cardiac Tamponade
Mechanism
Fluid in the Pericardial Sac
Pericarditis
Decreased Cardiac Output
Signs/Symptoms
Beck's Triad
Hypotension
Jugular Venous Distention (JVD)
Distant Heart Sounds
Pulsus Paradoxus
Electrical Alternans
Treatment
Pericardiocentesis
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1 min
Heparin (Unfractionated)
Mechanism of Action
Suppresses Coagulation
Indications
Deep Vein Thrombosis (DVT)
Pulmonary Embolism
Side Effects
Hemorrhage
Heparin-Induced Thrombocytopenia (HIT)
Considerations
Monitor aPTT
Preferred (Safe) During Pregnancy
Antidote
Protamine Sulfate
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2 mins
Digoxin (Lanoxin)
Mechanism of Action
Increases Inotropy
Indications
Heart Failure
Atrial Fibrillation
Side Effects
Bradycardia
Fatigue
Contraindications
Heart Block
Nursing Considerations
Heart Rate Below 60
Hypokalemia
Monitor for Toxicity and Visual Changes
Digibind
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2 mins
Acute Digoxin Toxicity
Clinical Symptoms
Hyperkalemia
Cholinergic (Nausea, Vomiting, Diarrhea)
Blurry Yellow Green Vision with Halo of Light
Arrhythmia
Bradycardia
EKG Changes
Prolonged PR interval
Decreased QT
Scooping on EKG
T Wave Inversion
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2 mins

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