Download File

Telemetry/ACLS review
Jason Morgan, RN, BS
ACLS Review
•
•
•
•
•
•
•
•
•
•
Intro/NSR: http://screencast.com/t/ezkKH8bxHpSt
Bradycardia: http://screencast.com/t/p9w8Y20S1l
Sinus tachycardia: http://screencast.com/t/R06x1rdrl
SVT: http://screencast.com/t/lE9pd7Le8vo
A-Fib: http://screencast.com/t/r2GUxo9vH
A-flutter/Heart Block:
http://screencast.com/t/7LIr2bA2SBuF
V-tach: http://screencast.com/t/BtayDRNI
V-Fib: http://screencast.com/t/wouA6jwh
Torsades: http://screencast.com/t/eJLwqjvkb
Transport: http://screencast.com/t/vuZ5OfBOWR
Sinus Rhythm
Signal originates in SA node. You will see PQRST. On a 12 lead EKG
you will see some waves that are inverted (AVR). This polarity and
placement determines the normal inflection of the waves. With
this baseline changes can be seen such as ST elevation, ST
depression, as well as flipped or inverted T-waves to name a few.
Tachycardia (>100 BPM) and bradycardia (<60 BPM)
3
Bradycardia
Sinus Tachycardia
SVT
Rapid heart rate: 150-250 BPM. Patients may feel lightheaded,
dizzy, chest pain, SOB, anxious. Try a valsalva maneuver then
attempt to slow the rate. Adenosine slows the rate, the dose is
6mg, 6mg, 12mg rapid IVP. Have the patient on the 12 lead.
This will slow the rate and you could see the underlying
rhythm. Calcium channel blockers and beta blockers can slow
the rate as well. This can be transient. EP needs to see.
6
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-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
Looks
similar to
SVT
A-flutter with RVR (rapid ventricular rate)
Heart Block
Elongated
PRI
PACER!
V-tach
V-fib
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)
Transporting
•
•
•
•
•
•
Defibrillator
Epi, Atropine, lidocaine
BVM
Suction
Phone
Helping hands