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Jason Morgan, RN, BS
Prolonged QT
 This can be a genetic
condition but can also be
caused by certain
medications.
 Haldol (haliperidol) can
cause prolonged QT,
therefore periodic EKG’s
should be done
 This can be cause
arrhythmia's as well as
Torsades
Torsades
 Can look similar to
v-tach and v-fib at
times
 Treat with 2 grams
magnesium; dilute
in 50 cc NS; DO
NOT PUSH!

(unless it’s a code)
A-flutter

Atrial flutter is a relatively
common arrhythmia that can be
deleterious by impairing the
cardiac output and by promoting
atrial thrombus formation that can
lead to systemic embolization. It is
characterized by rapid, regular
atrial depolarizations at a
characteristic rate of approximately
300 beats/min.
 For many years, atrial flutter has
been considered together with
atrial fibrillation (AF). While some
issues of therapy are the same, such
as the restoration of sinus rhythm,
the maintenance of sinus rhythm
after cardioversion, slowing the
ventricular rate, and prevention of
systemic embolism, atrial flutter is
quite distinct from atrial fibrillation

Adapted from UptoDate
A-flutter
A-flutter with RVR (rapid ventricular rate)
A-Fib
 The RR intervals follow no
repetitive pattern—they have
been labeled as “irregularly
irregular.”
 While electrical activity
suggestive of P waves is seen
in some leads, there are no
distinct P waves. Thus, even
when an atrial cycle length
(the interval between two
atrial activations or the P-P
interval) can be defined, it is
not regular and often less than
200 milliseconds (translating
to an atrial rate greater than
300 beats per minute).
 Adapted from UptoDate
A-fib/flutter
 Is this new or old?
 Is the patient stable?
 Vital signs; cardiac output
will decrease with a rapid
rate
 Blood pressure?
 Mental status?
 Nausea? Vomiting?
 Dizziness?
 Obtain an EKG
 Medications
 Metoprolol- beta 1 adrenergic
blocker


Usually 5 mg IVP (by provider)
Put patient on monitor
 Cardizem – calcium channel
blocker


Usually 10 mg IVP to start
Put patient on monitor
 Cardio-version
 Only with new onset otherwise
increased risk for clot
mobilization
 Pre-treat with pain meds

Fentanyl (short half-life)
Heart Block
Elongated
PRI
PACER!