ACLS Review Made Incredibly Easy

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No Expire eBook. Abebooks Marketplace Used. Amazon Marketplace New. Amazon Marketplace Used. Abebooks Marketplace New. Amazon New. BiggerBooks New. PDF Drive investigated dozens of problems and listed the biggest global issues facing the world today. Let's Change The World Together.

Pdfdrive:hope Give books away. Get books you want. Ask yourself: Should I live with no regrets, or learn from my mistakes? Report Close Quick Download Go to remote file. Documents can only be sent to your Kindle devices from e-mail accounts that you added to your Approved Personal Document E-mail List. Provide two rescue ventilations with each breath delivered in 1 second. If his chest doesnt rise with rescue ventilations, reposition the airway and reattempt ventilation.

Defi- brillation must occur as soon as possible. For example, a person in VF has almost no chance of survival if defibrillation doesnt occur within 10 minutes of collapse. That means you must move swiftly and efficiently through the CAB portion of the survey in order to proceed quickly to defibrillation. AEDs are computerized, low-maintenance defibrillators emergency care. If the AED detects a shockable rhythm, it that!

All AEDs operate using four steps:. AnalysisPlace the AED into analyze mode to detect a shockable rhythm. ShockPress the shock button when indicated. If an AED isnt available, follow steps for using a manual defibrillator. It includes: CirculationGain I. AirwayInsert an advanced airway. BreathingAssess bilateral chest movement and ventilation. Differential diagnosisSearch for, find, and treat reversible causes of the arrest.

Circulation Key points The circulation component of the secondary CABD survey Progressive CABD involves several interventions ultimately designed to identify steps arrhythmias and determine and deliver appropriate medication CPerform interven- to the patient.

As one person obtains I. Then determine the need for other treatments, such AReassess the air- as cardioversion restoring normal heart rhythm using shock or way; intubate as soon as defibrillation. BCheck for breath sounds; confirm tube Airway placement. Reassess the airway to make sure that its still open. If a bag- DDetermine what valve mask device is providing adequate airway management, caused the event. An ET tube should be inserted as quickly as possible. Keep in mind that Breathing an ET tube should be inserted as After insertion of an ET tube, confirm oxygenation and moni- quickly as possible!

Also assess for equal chest move- ment during ventilation. Auscultate for bilateral breath sounds using a five-point technique left and right anterior chest, left and right midaxillary points, and over the stomach. Make any necessary adjustments to ensure that the patient is breathing adequately, including removing the tube, if necessary, and starting over. When youre confident that the ET tube is in place, secure it to prevent dislodgment. Confirm its placement using waveform capnography or an exhaled esophageal detector device. A chest X-ray and arterial blood gas levels help to accurately evaluate adequate ventilation.

Differential diagnosis You need to consider potentially reversible causes of the cardio- pulmonary emergency, such as hypovolemia, hypoxia, acidosis,. Even if you succeed in establishing a perfusing rhythm, cardiac arrest can recur if the underlying cause isnt identified and appropriately treated. Simi- larly, an organized team approach provides an overall structure for managing the emergency response team and guides the team through all phases of an emergency, from preparation to post- emergency evaluation. An organized team approach has components that may slight- ly overlap in an actual emergency: anticipation entry resuscitation maintenance family notification transfer debriefing.

Anticipation The anticipation component involves the rescuers preparations as they move to the scene of a possible cardiac arrest or wait for the arrival of a patient with possible cardiac arrest. Steps in this component include gathering the team, agreeing on a leader, delin- eating duties, preparing and checking equipment, and positioning the rescuers. Entry In the entry component, the team makes first contact with the patient. Steps to perform during this component include obtain- ing entry vital signs, transferring the patient in an orderly manner from BLS personnel to the ACLS team if applicable , gathering a concise history, and repeating vital sign assessment.

Resuscitation During resusci- During the resuscitation component, the team leader needs tation, the team to keep the team focused on the basics of circulation, airway, leader needs to keep the team focused on and breathing. Effective communication is crucial, and team the basics of circu- members should state vital signs every 5 minutes or in response lation, airway, and to any change in the patients condition.

Team members should breathing. Maintenance The maintenance component begins when vital signs have stabilized.

During this time, team members need to maintain the patients condition by focusing on the CABs and staying ready for any new or renewed problems. Family notification This component directs members of the team to inform the family of the patients condition. Whether youre bearing good or bad news, this notification must be done promptly, hon- estly, and with sensitivity.

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If family members are present, they may wish to watch the resuscitation efforts because these may be the final moments for the patient. If the family does observe, a practitioner should remain with them to answer questions, explain procedures, and direct them where to stand. The practitioner can also watch for signs of major discomfort or distress in the family members and end the observation, if necessary.

Transfer The transfer component occurs when the resuscitation team transfers the patient to another team. When transferring the patient and all relevant information, you should be concise, complete, and well organized. Debriefing Every emergency situation should finish with a debriefing of the event. This debriefing exercise should occur away from the crisis situation. It allows for self-assessment, identification of areas. Algorithms are flowcharts that can serve as memory tools for carrying out the steps involved in different emergency situations.

Its important to remember that real-life patient care rarely corresponds exactly to any particular algorithm. Therefore, algorithms provide a useful guide but cant replace a flexible, thorough under- standing of patient care. For specific algorithms, see Chapter 8, Emergency cardiac care. Quick quiz Key points 1. The link in the chain of survival thats most likely to improve Summary points the patients survival rate is: Immediate recognition A. When performed correctly, rapid defibrillation is the Early cardiopulmonary link in the chain of survival thats the most important to patient resuscitation CPR using survival because its ultimately the only way to reverse cardiac CAB circulation, air- arrest resulting from VF.

However, all links in the chain are way, breathing important for successful resuscitation. Rapid defibrillation Minimization of inter- 2. When confronted with a possible cardiac arrest, which ruptions in CPR to per- action is important to perform prior to beginning the initial CABD form advanced coronary steps? Call for help and activate the EMS. Incorporation of a mul- B. Clear the area. Notify the family.

Call the practitioner. Steps that are important to take prior to the initial ous circulation CABD steps include assessing unresponsiveness, calling for help. ACLS treatment algorithms are: A. ACLS educational tools. Answer: C. Treatment algorithms are flowcharts that guide ACLS treatment. Theyre designed to be a memory tool; how- ever, they arent absolute because every patient needs to be as- sessed according to their response to treatment and individual circumstances. Determining a differential diagnosis is part of the: A. Effective communication among team members is key during which component of the organized team approach?

Entry B. Maintenance C. Resuscitation D. Transfer Answer: C. Effective communication is key during the resuscitation component. The team members should state vital signs every 5 minutes or in response to any change in the moni- tored parameters. Team members should also state when proce- dures and medication administration are complete.

After establishing unresponsiveness and assessing ineffec- tive breathing, compressions begin: A. Scoring If you answered all six questions correctly, outstanding! Your chain of survival is strong. If you answered four or five questions correctly, great job! Youre primarily on the right track. If you answered fewer than four questions correctly, good effort! The importance of interpretation An essential component of advanced cardiac life support ACLS An essential is the rapid recognition of cardiac arrhythmias. Frequently, iden- component of ACLS tification of an arrhythmia is what triggers an ACLS response, is rapid recognition especially in the hospital setting.

Accurate interpretation of a of cardiac cardiac arrhythmia guides appropriate treatment and may help arrhythmias. Understanding cardiac conduction The cardiovascular system contains specialized pacemaker cells that enable the heart to generate a precise rhythm. These cells have four unique characteristics: automaticitythe ability to spontaneously initiate an electrical impulse conductivitythe ability to transmit the impulse to the next cell contractilitythe ability to shorten the fibers in the heart when receiving the impulse excitabilitythe ability to respond to an electrical stimulus.

Cardiac conduction system In normal conduction, each electrical impulse travels from the sinoatrial SA node through the atria along the internodal and interatrial tracts. The impulse slows momentarily as it passes through the atrioventricular AV junction to the bundle of His. Then it descends the left and right bundle branches and finally down the Purkinje fibers. Interatrial tract Bachmanns bundle SA node. Right and left bundle branches Interventricular septum Purkinje fibers. Cardiac conduction begins in the sinoatrial SA node and proceeds through the cardiac conduction system.

Its located on the endocardial surface of the right atrium near the superior vena pacemaker cava. When the SA node fires, it sends an impulse throughout the AV nodeimpulse right and left atria that results in an atrial contraction. Normally, conduction. AV node will generate impulse if SA node fails. Situated low in the septal wall of the right. Then it travels to the distal portions of the bundle branches called the Purkinje fibers.

These fibers fan across the surface of the ventricles from the endocardium to the myocardium. As the impulse spreads, it signals the blood-filled ventricles to contract. Safety mechanisms The conduction system has two built-in safety mechanisms. Abnormal impulses Abnormal impulse conduction results from disturbances in automaticity, conduction, or both. Its automatic Automaticity can increase or decrease. For example, increased automaticity of pacemaker cells below the SA node commonly causes tachycardia.

Likewise, decreased automaticity of cells in the SA node can cause bradycardia or an escape rhythm. Atrial tachycardia with a block is an example of a combined automaticity and conduction disturbance. Monitoring cardiac rhythms An electrocardiogram ECG is used to monitor the precise sequence of electrical events in the cardiac cycle.


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There are two types of ECG recordings: the lead and the single lead, commonly known as a rhythm strip. Youll want to get this complex An ECG complex reflects the electrical events occurring in one cardiac cycle. Each complex consists of five waveforms, labeled. See ECG waveform components. Typically, you identify cardiac arrhythmias by recognizing their effects on the ECG waveform.

However, ECG interpretation doesnt replace the need for keen assessment skills. Always remember that ECG findings should correlate with the patients physical condition. P wave and the first negative deflec- PR interval tion after the R wave. The PR end of the QRS complex interval represents and also indicates the the time it takes an beginning of the ST seg- impulse to travel ment. The ST segment from the atria represents part of ven- through the atrio- tricular repolarization; ventricular nodes its measured from the and the bundle of end of the S wave to the His.

The PR interval beginning of the T wave. The U The QRS complex wave follows the T wave; represents ven- however, because the U tricular depolariza- wave signifies a problem, it isnt seen in most patients. QT interval The Q wave appears as the first negative deflection in The QT interval represents ventricular depolarization and the QRS complex; the R wave as the first positive deflection.

It extends from the beginning of the QRS The S wave appears as the second negative deflection or complex to the end of the T wave. Applying monitoring devices An ECG monitor is a tool that provides continuous information about the hearts electrical activity. Electrodes applied to the patients chest pick up the hearts electrical activity and display it on the monitor. You may use a three-, four-, or five-electrode sys- tem for cardiac monitoring. See Using a five-leadwire system. Technique matters To ensure accurate lead monitoring, you must apply the electrodes correctly.

Follow these steps for accurate lead placement: Clip dense hair at each site. Prepare the skin by briskly rubbing each site until the skin reddens using the rough patch on the back of the electrode or a dry gauze pad. Using a five-leadwire system This illustration shows the correct placement of leadwires for a five-leadwire system. The chest electrode shown is located in the V1 position, but you can place it in any of the chest lead positions. Each leads color is included in the key. Remove the backing from the electrodes and apply one to each prepared site by pressing it against the pa- Thats right.

If youre using a snap-on leadwire, at- electrodes about your tach it to the electrode before placing the electrode on the and wires to electrical patients chest to prevent patient discomfort. Turn on the monitor. Select the lead you wish to view following the moni- tors instructions. Interpreting rhythm strips: An eight-step method You can learn to analyze and interpret ECGs systematically and correctly by using this eight-step method.

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First, scan the entire strip and identify the waveform components. Then follow these steps. Step 1: Determine the rhythm To determine the hearts atrial and ventricular rhythms, use either the paper-and-pencil method or the calipers. These 8 steps will Memory jogger lead you to success in analyzing and To help you remember where to place electrodes in a interpreting rhythm five-electrode configuration, think of the phrase White, strips. Then think of snow over trees white above green , and smoke over fire black above red. And, of course, chocolate brown electrode lies close to the heart!

See Methods of measuring rhythm. Then ask yourself, Does the rhythm appear to be regular or irregular? Step 2: Determine the rate Next, calculate the hearts atrial and ventricular rates, using the times ten method, the 1, method, or the sequence method. See Calculating heart rate, page Methods of measuring rhythm You can use either of the following methods to determine atrial and ventricular rhythm. Paper-and-pencil method Place the electrocardiogram ECG strip on a flat surface. Then position the straight edge of a piece of paper along the strips baseline.

Move the paper up slightly so the straight edge is near the peak of the R wave. With a pencil, mark the paper at the R waves of two consecutive QRS complexes, as shown. This is the R-R interval. Next, move the paper across the strip and line up those two marks with succeeding R-R intervals. If the distance for each R-R interval is the same, the ventricular rhythm is regu- lar. If the distance varies, the rhythm is irregular. Use the same method to measure the distance between the P waves the P-P interval and determine whether the atrial rhythm is regular or irregular.

Then adjust the legs and place the other point on the peak of the next R wave, as shown. This distance is the R-R interval. Next, pivot the first point of the calipers toward the third R wave and note whether it falls on the peak of that wave. Check succeeding R-R intervals in the same way. If theyre all the same distance, the ventricular rhythm is regular. Using the same method, measure the P-P intervals to determine whether the atrial rhythm is regular or irregular.

Calculating heart rate You can use one of three methodsthe times ten method, the 1, method, or the sequence methodto determine atrial and ventricular heart rates from an electrocardiogram waveform. Times ten method The simplest, quickest, and most common technique, the times ten method is particu- larly useful if the patients heart rhythm is irregular. First, obtain a rhythm strip. Then locate the small markings at the top of the strip.

Each marking represents 3 seconds. Count the number of P waves to determine atrial rate or R waves to determine ventricular rate over a 6-second time period two 3-second markings. Multiply by First, identify two consecutive P waves on the rhythm strip. Next, select identical points in each wave and count the number of small squares between the points. Then divide 1, by the number of small squares counted 1, small squares equal 1 minute to get the atrial rate.

To calculate the ventricular rate, use the same procedure but with two consecutive R waves instead of P waves. Sequence method The sequence method gives you an estimated heart rate. First, find a P wave that peaks on a heavy black line. Assign the following numbers to the next six heavy black lines: , , , 75, 60, and 50, respectively. Then find the next P wave peak and estimate the atrial rate based on the number assigned to the nearest heavy black line. Estimate the ventricular rate following the same procedure but use the R wave instead of the P wave.

Next, determine if the atrial P-P interval rate and ventricular R-R interval rate are continually the same measure- ment. Then determine if theyre associated with each other. Are they all up- a time. Do the P waves and QRS complexes have a one-to-one relationship? Is the distance between each P wave and its QRS complex the same? Step 4: Determine the duration of the PR interval After youve determined the duration of the PR interval normal duration is 0. Whats the duration of the QRS complex? Normal duration is 0.

Are all the QRS complexes the same distance from the T waves that follow them? Do all the QRS complexes point in the same direction? Do any QRS complexes appear different from the others on the strip? If so, measure and describe each one individually. Step 6: Evaluate the T wave Examine the strip once more and ask these questions: Are T waves present? Do all the T waves have the same size and shape? Could a P wave be hidden in a T wave? Do the T waves point in the same direction as the QRS complexes?

Step 7: Determine the duration of the QT interval Note whether the duration of the QT interval falls within normal limits 0. Step 8: Evaluate other components Im so proud of Finally, observe other components on the ECG strip, including myself! My normal ectopic or aberrantly conducted beats and other abnormalities.

U wave. Note your findings. Recognizing normal sinus rhythm Before you can recognize an arrhythmia, you must be able to rec- ognize a normal sinus rhythm NSR. NSR is a heart rhythm that starts in the SA node and progresses to the ventricles through a normal conduction pathwayfrom the SA node to the atria and AV node, through the bundle of His to the bundle branches, and on to the Purkinje fibers.

NSR is the standard against which all other rhythms are compared. PR interval is within normal limits 0. Recognizing narrow complex tachycardias Narrow complex tachycardias are arrhythmias that involve an accelerated heart rate and a narrow QRS complex. They include sinus tachycardia, atrial fibrillation, atrial flutter, atrial tachycar- dia, multifocal atrial tachycardia MAT , WPW syndrome, and junctional tachycardia.

Pesty tachy may persist Persistent sinus tachycardia, especially with acute myocardial infarction MI , may lead to ischemia and myocardial damage by raising oxygen requirements. PR interval: Within normal limits and constant. QRS complex: Normal duration and configuration. T wave: Normal size and configuration. QT interval: Within normal limits but commonly shortened. Maybe all this nico- tine has pushed my What causes it discharge rate over the top Caffeine, nicotine, and alcohol ingestion Digoxin toxicity Hypothyroidism and hyperthyroidism Normal cardiac response to demand for increased oxygen dur- ing exercise, fever, stress, pain, and dehydration Any occurrence that decreases vagal tone and increases sympa- thetic tone Inflammatory response after MI In acute MI, it may be one of the first signs of heart failure, cardiogenic shock, pulmonary embolism, or infarct extension.

Adrenergics Anticholinergics Antiarrhythmics. How its treated Treatment aims to correct the underlying cause. If the patient is symptomatic, a beta-adrenergic blocker such as metoprolol Lopressor may be given. Atrial fibrillation Help! I think Atrial fibrillation, usually called A-fib, is defined as chaotic, asyn- atrial fibrillation is chronous, electrical activity in atrial tissue.

It stems from the firing of making me lose my a number of impulses in reentry pathways. Atrial fibrillation results atrial kick. On impulse The ventricles respond only to those impulses that make it through the AV node. On an ECG, atrial activity is no longer represented by P waves but by erratic baseline waves called fibrillatory waves, or f waves.

This rhythm may be either sustained or paroxysmal occurring in bursts. It can be preceded by or the result of premature atrial contractions PACs. The patient may develop an atrial rhythm that fre- quently varies between a fibrillatory line and flutter waves. P wave: Absent. Erratic baseline f waves appear instead.

These chaotic f waves represent atrial tetanization from rapid atrial de- polarizations. PR interval: Indiscernible. QRS complex: Duration and configuration are usually normal. QT interval: Unmeasurable. What causes it Rheumatic heart disease, valvular disorders especially mitral stenosis , hypertension, MI, coronary artery disease CAD , heart failure, cardiomyopathy, and pericarditis Thyrotoxicosis Chronic obstructive pulmonary disease COPD Drugs such as digoxin Lanoxin Cardiac surgery Occasional increased sympathetic activity from exercise.

What to look for Irregular pulse rhythm with a normal or rapid rate palpita- tions ; peripheral pulse commonly slower than apical pulse Signs and symptoms of decreased cardiac output if ventricular rate is rapid. How its treated If the patient is hemodynamically unstable, perform synchro- nized cardioversion immediately initially, to joules or the biphasic equivalent. If using monophasic energy, start at joules and increase in a stepwise fashion as indicated. For patients with a rapid rate, consult a practitioner and admin- ister a beta-adrenergic blocker, such as esmolol I.

For patients with atrial fibrillation of 48 hours or less duration, administer amiodarone Cordarone , ibutilide Corvert , propafe- none Rhythmol , flecainide Tambocor , or digoxin to control the rhythm, as ordered by the practitioner. Consider anticoagulants when deciding how quickly to correct atrial fibrillation that has been present longer than 48 hours be- cause rapid conversion may cause blood clots. Originating in a single atrial focus, this rhythm results from reentry and, pos- sibly, increased automaticity.

Fast flutter, slow kick The significance of atrial flutter depends on the acceleration of the ventricular rate. The faster the ventricular rate, the more dan- gerous the arrhythmia. Like atrial fibrillation, atrial flutter results in a loss of atrial kick. Even a small rise in the ventricular rate can cause angina, syncope, hypotension, heart failure, and pulmonary edema. Atrial fibrillation or flutter may appear. Ventricular rhythm depends In patients with on the AV conduction pattern; its usually regular, although cycles atrial flutter even may alternate.

An irregular pattern may signal atrial fibrillation or a small increase in indicate a block. P wave: Saw-toothed or picket fence appearance called flutter waves. PR interval: Unmeasurable. QRS complex: Duration is usually within normal limits but the complex may be widened if flutter waves are buried within. T wave: Not identifiable. What causes it Acute or chronic cardiac disorder, mitral or tricuspid valve disor- der, cor pulmonale, and cardiac inflammation such as pericarditis MI transient complication Digoxin toxicity Hyperthyroidism Alcoholism Cardiac surgery.

What to look for Absence of symptoms or palpitations Cardiac, cerebral, and peripheral vascular effects if ventricular filling and coronary artery blood flow are compromised. How its treated If the patient is hemodynamically unstable, perform synchro- nized cardioversion immediately, beginning with, 50 to joules of biphasic energy. Increase energy in a stepwise fashion if the intial shock fails. If a monophasic device is used, begin with joules and increase the energy in a stepwise fashion if necessary.

Follow the orders of the practitioner for rhythm control. Consider anticoagulants when deciding how quickly to correct atrial flutter that has been present longer than 48 hours because rapid conversion may cause blood clots. Benign in a healthy person, cardia is benign in this arrhythmia can be dangerous in a patient with an existing car- a healthy person. I sure hope Im healthy! The ventricular rate depends on the AV conduction ratio. P wave: Usually upright, the P wave may be aberrant or hidden in the previous T wave. If visible, it precedes each QRS complex.

PR interval: May be unmeasurable if the P wave cant be distin- guished from the preceding T wave. T wave: Usually distinguishable but may be distorted by the P wave. QT interval: Usually within normal limits but may be shortened because of the rapid rate. What causes it Digoxin toxicity most common cause Primary cardiac disorders, such as MI, cardiomyopathy, pericar- ditis, valvular heart disease, and WPW syndrome Secondary cardiac problems, such as hyperthyroidism, cor pul- monale, and systemic hypertension COPD In healthy people, physical or psychological stress, hypoxia, hypokalemia, excessive use of caffeine or other stimulants, and marijuana use.


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What to look for Rapid apical or peripheral pulse rates Signs and symptoms of decreased cardiac output, such as hypo- tension, syncope, and blurred vision. How its treated Attempt vagal stimulation. Administer adenosine Adenocard. If the patient is hemodynamically unstable, perform synchro- nized cardioversion immediately initially, 50 to joules of bi- phasic or monophasic energy. Multifocal atrial tachycardia MAT results from the extreme rapid firing of multifocal ectopic sites. Very rare in healthy people, this arrhythmia is usually found in acutely ill patients with pulmonary disease or elevated atrial pressures.

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P wave: Configuration varies, usually with at least three unique P waves. PR interval: Varies. QRS complex: Duration and configuration are usually normal but may become aberrant if the arrhythmia persists. T wave: Usually distorted. QT interval: May be indiscernible. What causes it Atrial distention from elevated pulmonary pressure usually seen in patients with COPD. What to look for Palpitations Rapid apical or peripheral pulse rates Signs and symptoms of decreased cardiac output, such as blurred vision, syncope, and hypotension.

How its treated First, distinguish MAT from atrial fibrillation because both may cause an irregular rhythm. You must dis- For a patient with a rapid rate, consult a practitioner and ad- tinguish MAT from minister a calcium channel blocker verapamil [Calan] or diltia- atrial fibrillation zem or a beta-adrenergic blocker use cautiously in patients with because both can pulmonary disease. Wolff-Parkinson-White syndrome Seen mostly in young children and adults ages 20 to 35, WPW syn- drome occurs when an anomalous atrial bypass tract bundle of Kent develops outside the AV junction, which connects the atria and ventricles.

This pathway can conduct impulses either to the ventricles or atria. With retrograde conduction, reentry can arise, resulting in reentrant tachycardia. The delta wave is the hallmark of WPW syndrome. No tachy, no problem WPW syndrome is usually considered insignificant if tachycardia doesnt occur or if the patient has no associated cardiac disease.

When tachycardia does occur in WPW syndrome, decreased cardiac output may develop. Rate: Atrial and ventricular rates are within normal limits, except when SVT occurs.

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P wave: Normal in size and configuration. PR interval: Short less than 0. QRS complex: Duration greater than 0. T wave: Usually normal but may be deflected in a direction opposite the QRS complex. What to look for Usually no symptoms If tachyarrhythmias develop with a high ventricular re- sponse, palpitations, sudden onset of chest pain, shortness of breath and, possibly, syncope. How its treated If the patient is hemodynamically unstable, perform syn- chronized cardioversion immediately initially, 50 to joules of biphasic energy.

For patients with a rapid rate, consult a practitioner and consider administering amiodarone to control the rate. For patients with atrial fibrillation and WPW syndrome, consult a practitioner and prepare for synchronized cardioversion or to administer procainamide. Consider anticoagulants when deciding how quickly to correct atrial fibrillation with WPW syndrome that has been present longer than 48 hours because rapid conversion may cause blood clots. Junctional tachycardia Considered an SVT, junctional tachycardia is characterized by three or more premature junctional contractions in a row.

This happens when an irritable focus from the AV junction has enhanced automaticity and overrides the SA nodes function as the hearts pacemaker. The atria depolarize by retrograde conduction, and conduction through the ventricles is normal. Well, that depends The significance of junctional tachycardia depends on the rate, the underlying cause, and the severity of the accompanying cardiac disease. At higher ventricular rates, junctional tachycardia may compromise cardiac output by affecting ventricular filling. The atrial rhythm may be difficult to determine if the P wave is absent or hidden in the QRS complex or preceding T wave.

Atrial rate may be diffi- cult to determine if the P wave is hidden in the QRS complex or if it precedes the T wave. QRS complex: Duration within normal limits; usually normal configuration. T wave: Usually normal configuration but may be abnormal if the P wave is hidden in the T wave. Fast rate may make the What do you mean T wave indiscernible.

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I feel fine. How its treated Discontinue digoxin therapy. Key points Administer beta-adrenergic blockers or calcium channel block- Surviving cardiac ers to control rate. The high- Wide complex tachycardias are arrhythmias that involve an accel- est survival rates are erated heart rate and a wide QRS complex.

They include prema- reported among patients ture ventricular contractions PVCs , monomorphic ventricular of all ages who have had: tachycardia, polymorphic ventricular tachycardia, torsades de a witnessed arrest pointes, and ventricular fibrillation. PVCs may occur singly, in early, effective chest pairs, in threes, or in fours; in many cases, theyre followed by compressions.

PVCs that occur every other beat are. Those that occur every fourth beat are known as Two PVCs that quadrigeminy. Two PVCs that occur together are called a couplet. See When PVCs spell danger, page Are you serious? The significance of PVCs depends on how well the ventricles func- tion and how long the arrhythmia lasts. Cardiac output diminishes because of insufficient ventricular filling time.

Generally, PVCs are more serious if they occur in a patient with heart disease. In an ischemic or damaged heart, PVCs are more likely to develop into ventricular tachycardia, flutter, or fibrillation. Rate: Atrial and ventricular rates reflect the underlying rhythm. P wave: Usually absent in the ectopic beat; however, may ap- pear after the QRS complex with retrograde conduction to the atria.

Usually normal if present in the underlying rhythm. PR interval: Unmeasurable, except in the underlying rhythm. QRS complex: Occurs earlier than expected; duration exceeds 0. T wave: Occurs in direction opposite QRS complex.

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