Exam (elaborations)
Med Surg 2 Ch 35 Dysrhythmias Part 2 (1)
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- B260 Infection Control
- Institution
- B260 Infection Control
Med Surg 2 Ch 35 Dysrhythmias Part 2 (1)
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Med Surg 2 Ch 35 Dysrhythmias Part 2-Always cause a risk of decreased perfusion, decreased cardiac output
-*Always assess the patient* (not just the ECG)
--How is the pt tolerating the rhythm? (ie. Pulse deficit, chest pain, consciousness, HR changes,
hypotension)
-Causes include CAD, *electrolyte imbalances (K+ & Mg)*, changes in heart muscle, injury from
an MI, healing process after cardiac surgery, dig toxicity
-HR on the monitor may not be the patient's pulse rate b/c a QRS complex may not produce a
pulse esp. with PVCs (filling time is too slow)
-The cause determines the treatment
-Dig toxicity can cause almost any dysrhythmia - ANS-Cardiac Dysrhythmias
-Stable
--Asymptomatic or mild symptoms (ie. palpitations)
-Unstable (decreased perfusion/CO)
--Pulseless
--Dizziness
--Syncope
--Hypotension
--Chest pain
--Shortness of breath - ANS-Stable vs Unstable
-For ACLS, best route is IV or IO, endotracheal route is least desired (only for epi, vasopressin,
lidocaine)
--Endotracheal meds have to be diluted and given in much higher doses than IV/IO meds,
dosages are controversial
-For ACLS, *all meds need 20 mL NS flush (and CPR) to circulate the meds* - ANS-Medications
-Used for *Bradycardia*
-*0.5 mg every 3-5 min, up to 3 mg total* - ANS-Atropine
-Used for *tachycardia (SVT - Supraventricular Tachy - Atrial Dys)*
, - *6mg rapid IV push*
--*2nd dose of 12 mg*
-*Causes brief period of asystole*
-Slows conduction through the AV node
-Can also be given for *wide QRS only if the rhythm is regular* - ANS-Adenosine
-For cardiac arrest to stimulate the heart (Flat line)
-*1 mg every 3-5 min or 2-10 mcg/min*
--*No max* - ANS-Epinephrine
-Used for recurrent V. Fib and unstable V. Tach
--Atrial dysrhythmias, Ventricular dysrhythmias
--Used for abnormally fast electrical activity
-Ventricular dysrhythmias
--*300 mg IV, 2nd dose of 150 mg*
-Atrial Dysrhythmia Dosage
--*150 mg bolus*
--*Then 24h drip @ 1 mg/min for 6 hrs, and 0.5 mg/min for 18 hrs*
-Very toxic, very long half-life
-Not used routinely for oral management of dysrhythmias
-Not recommended for afib, but often used,
-Half life is 60-142 days
-Causes pulmonary, liver, eye, thyroid, and neuro toxicities - ANS-Amiodarone
-Slows conduction of electrical impulses decreasing heart rate in *SVT*
Techniques:
-Valsalva (bear down)
-Coughing
-Immersing the face in ice water (diving reflex)
-Carotid massage
-Blowing plunger out fo syringe - ANS-Vagal Stimulation
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