dr.noha elsayed cardiovascular monitoring cardiac dysrhythmia
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DR.NOHA ELSAYED
Cardiovascular Monitoring
Cardiac Dysrhythmia
Sinoatrial Node (Sinus) Dysrhythmias
Sinus bradycardia: the SA node fires electrical impulses at a rate that is slower than normal (that is, less than 60 impulses per minute)
Sinus tachycardia: the SA node fires electrical impulses at a rate that is faster than normal (that is, greater than 100 impulses per minute)
Sinus Bradycardia - SB
Regularity – regularRate – less than 60 / minP waves – 1:1PRI - .12 - .20QRS - .12 or less
Sinus Tachycardia - ST
Regularity – regularRate - > 100 / minP waves = 1:1PRI = .12 - .20QRS = .12 or <
Sinus Arrhythmia - SA
Caused by a variety of factors: anxiety, stimulants, fever, exercise, medical conditions
Regularity – irregularRate – anything; freq. in normal rate of 60 –
100 / minP waves – 1:1PRI - .12 - .20QRS - .12 or <
Sinus Rhythms
Interpretation SR SB ST SA
Regularity Regular Regular Regular Irregular
Rate 60 – 100/ min < 60 min > 100 min Could be any rate, usually between 60 - 100
P waves 1:1 1:1 1:1 1:1
PRI .12 - .20 .12 - .20 .12 - .20 .12 - .20
QRS .12 or < .12 or < .12 or < .12 or <
Atrial Dysrhythmias
Atrial flutter: Atrial contraction (represented by the P waves on the ECG) is regular but faster than normal (250 to 400 times per minute)
Atrial fibrillation: is caused by rapid, uncoordinated twitching of the myocardium of the atria; in atrial fibrillation, the P waves are irregular and small, and they occur at a rapid rate all along the ECG
Atrial Fibrillation : A Fib
Atrial Flutter : A Flutter
Atrioventricular Junction Dysrhythmias
Junctional rhythm: occurs if the SA node fails to fire and send an electrical impulse through to the AV node or if the SA node fires the impulse too slowly
Junctional rhythms
P wave after QRS - junctional
Ventricular Dysrhythmias
Premature ventricular contractionVentricular tachycardia Ventricular fibrillation
Premature Ventricular Contraction: PVC
Ectopic beat – dangerous if occurs oftenRegularity – may interrupt the regularity of
underlying rhythmRate – depends on underlying rhythmP wave – will not be one before ectopic beatPRI – none in ectopic beat – measure underlying
rhythmQRS – ectopic beat – wide and bizarre, also look
at underlying rhythm
Ventricular Tachycardia - VT
Medical Emergency – most pts will be unconscious & can’t feel pulse
Regularity – usually regular, can be slightly irregular
Rate – 150 – 250 / minP waves – nonePRI – noneQRS - >.12
Ventricular Fibrillation - VF
Start CPR!!Regularity – baseline totally chaoticRate – can’t determineP waves - ?PRI - ?QRS - ?
Asystole
No electrical activityStart CPR
Cheat Sheet – Ventricular Dysrhythmias
Interpretation PVC – premature ventricular contraction
VT – Ventricular Tachycardia
VF – Ventricular Fibrillation
Asystole
Regularity The underlying rhythm can be regular or irregular
Usually regular, can be irregular
Baseline totally chaotic
No electrical activity, only a flat line
Rate Determined by underlying rhythm
150 – 250Per min.
Can’t be determined
P waves Ectopic not preceded by a P wave
none No discernible P waves
PRI Ectopic comes from lower focus, no PRI
none none
QRS Wide and bizarre >.12
Wide and bizarre >.12
No discernible QRS complex
Atrioventricular Blocks
First-degree atrioventricular block Second-degree atrioventricular block * Type I - Wenckebach rhythm
* Type II - Mobitz type I rhythm
Third-degree atrioventricular block (Mobitz type II rhythm)
Observations to Report to the Nurse Immediately
The PR interval is longer than earlierThe QRS complex changed shape or
widenedThe ECG shows a new dysrhythmia that
was not there beforeC/O chest pain or discomfortC/O shortness of breathC/O dizziness Person unconscious
Artifacts Can Be Caused by:
Electrical interference from other electrical equipment (such as an electric razor) or monitoring devices in the area
Loose electrodes, especially if the person is diaphoretic (sweating) or recently repositioned
Electrodes dried outElectrodes placed over an excessively
hairy areaDefective monitor or lead wiresPatient movement (for example, from
shivering or brushing the teeth)
Artifact:
12 Lead EKG:
Prepare equipmentBed at comfortable working heightAdjust patient’s clothing to expose chest;
provide privacyDetermine correct position for each
electrode If excessive hair, remove with shaver Clean with alcohol pad to remove oils if needed Ask patient to lay still and obtain tracing
12-Lead Tracing:
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