Cardiac dysrhythmia management & pacemakers LATEST APRIL 2023
Cardiac dysrhythmias
Students to review slides 4-29 prior to class: this
... [Show More] 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? [Show Less]