dysrhythmia questions and answers 2023

1. Atrial Flutter. Note the sawtooth baseline, no definable P wave. Treatment: Correct any metabolic derangement or electrolyte imbalance then use Antidsyrhythmics. Usually Amiodarone, Digoxin, beta blocker (Metoprolol, Toprol) or calcium channel blocker (Diltiazem, Cardizem) for rate control and control of the aberrant atrial impulse. If severely elevated and symptomatic may need synchronized cardioversion. Remember—all atrial flutter and atrial fibrillation patients must be anticoagulated to prevent throwing a clot when they go back into regular rhythm. This means Heparin, Coumadin and/or antiplatelet like Aspirin and Clopidogrel (Plavix). 2. Supraventricular tachycardia (SVT). Rate 200 Treatment: Attempt Valsalva maneuver usually once. Then Adenosine 6mg IV slow push. Adenosine WILL CAUSE ASYSTOLE briefly. Half life is 10 seconds. If no response after first dose, may repeat with Adenosine 12mg IV slow push. Again, asystole. Monitor closely. 3. Atrial Fibrillation (afib). No P wave, irregular rate. This study source was downloaded by from CourseH on 07-11-2023 03:45:09 GMT -05:00 dysrhythmia questions and answers 2023 Treatment: same as atrial flutter. 4. Sinus bradycardia. Rate 40 Treatment: if symptomatic, Atropine 0.5mg IV push. May repeat up to a total dose of 3mg. If atropine fails to increase the rate, you will then proceed on to transcutaneous pacing and the patient will likely need to have a permanent pacemaker placed. 5. Sinus Tachycardia. P, QRS all normal. Rate 120 Treatment: address underlying cause if new. Usually dehydration, stress, pain, blood loss, fever, etc. If symptomatic, can treat with IV beta blocker (Metoprolol, Toprol) or IV calcium channel blocker (Diltiazem, Cardizem) 6. Premature Atrial Complex (PAC), (if the irregularity is before the QRS it’s an atrial problem) This study source was downloaded by from CourseH on 07-11-2023 03:45:09 GMT -05:00 Treatment: address underlying metabolic issues, electrolyte imbalance, stop any medications that prolong QT or encourage dysrhythmia. 7. Premature Ventricular Complex (PVC). This is an example of bigeminy. PVCs are wide irregular QRS complexes because they’re a ventricular problem. Treatment: address underlying metabolic issues, electrolyte imbalance, hypoxia. Stop any medications that prolong QT or encourage dysrhythmia. 8. Ventricular fibrillation (Vfib). Note it can be a wide squiggle or a fine squiggle but there’s no definable complexes. Treatment: Check pulse, start CPR, perform defibrillation (note: defibrillation is DIFFERENT than synchronized cardioversion, you will learn more about this when/if you take Advanced Cardiac Life Support (ACLS). This study source was downloaded by from CourseH on 07-11-2023 03:45:09 GMT -05:00 9. Ventricular Tachycardia (Vtach). Wide QRS complexes on top of each other. Treatment: Check pulse, start CPR, perform defibrillation. 10. First degree heart block. Note how long the PR interval is (distance between the P and the QRS). There’s the block/conduction delay. Treatment: correct underlying metabolic issue, stop QT prolonging agents or pro-dysrhythmics.