Cardiac dysrhythmia management & pacemakers

Cardiac dysrhythmia management & pacemakers LATEST APRIL 2023 Cardiac dysrhythmias  Students to review slides 4-29 prior to class: this content will not be covered in NUR 4120  Normal sinus rhythm • Answers to evaluation of rhythm will always be within normal limits • Rate: 60-100bpm Sinus node dysrhythmias  Sinus bradycardia • HR 60 bpm • Sinus node creates impulse at slower than normal rate • Characteristics of NSR but a slower rate  Etiology: sinus bradycardia • Sleep • Athletic training • Hypothyroidism • Vagal stimulation  Vomiting, suctioning, pain • Medication  CCB (decrease HR/BP), amiodarone, beta-blockers • Increased intracranial pressure • CAD/Acute MI • Hypoxemia • Altered mental status • Acute decompensated heart failure  Sinus bradycardia: clinical manifestations and management • Clinical manifestations:  SOB altered LOC  Hypotension  EKG changes (ST segment changes PVC’s) • Management:  Resolve causative factors  Atropine 0.5 mg IV every 3-5 minutes ◊ Maximum dose of 3 mg ◊ Atropine won’t work on a patient with a heart transplant  Emergency transcutaneous pacing  Catecholamines  Sinus tachycardia • HR: 100-120 • Sinus node creates impulse at faster than normal rate • Does not start or stop suddenly  Etiology: sinus tachycardia • Physiologic stress  Acute blood loss, anemia  Shock  Hyper/hypovolemia  Heart failure  Pain  Hypermetabolic states  Fever  Exercise  Anxiety • Medications  Catecholamine  Atropine  Stimulants (caffeine, nicotine)  Illicit drugs (Ecstasy, cocaine)  Sinus tachycardia: clinical manifestations and management • Clinical manifestations  Decreased filling time of heart ◊ Reduces cardiac output  Syncope  Hypotension  Acute pulmonary edema (assess lung sounds, diff. breathing) • Management  Abolish the cause  Synchronized cardioversion (hemodynamic instability)  Vagal maneuvers  recharges SA node  Adenosine (only for narrow QRS)  Narrow QRS?