DR.NOHA ELSAYED

Cardiovascular Monitoring

Cardiac Dysrhythmia

Sinoatrial Node (Sinus) Dysrhythmias

Sinus bradycardia: the SA node fires electrical impulses at a rate that is slower than normal (that is, less than 60 impulses per minute)

Sinus tachycardia: the SA node fires electrical impulses at a rate that is faster than normal (that is, greater than 100 impulses per minute)

Sinus Bradycardia - SB

Regularity – regularRate – less than 60 / minP waves – 1:1PRI - .12 - .20QRS - .12 or less

Sinus Tachycardia - ST

Regularity – regularRate - > 100 / minP waves = 1:1PRI = .12 - .20QRS = .12 or <

Sinus Arrhythmia - SA

Caused by a variety of factors: anxiety, stimulants, fever, exercise, medical conditions

Regularity – irregularRate – anything; freq. in normal rate of 60 –

100 / minP waves – 1:1PRI - .12 - .20QRS - .12 or <

Sinus Rhythms

Interpretation SR SB ST SA

Regularity Regular Regular Regular Irregular

Rate 60 – 100/ min < 60 min > 100 min Could be any rate, usually between 60 - 100

P waves 1:1 1:1 1:1 1:1

PRI .12 - .20 .12 - .20 .12 - .20 .12 - .20

QRS .12 or < .12 or < .12 or < .12 or <

Atrial Dysrhythmias

Atrial flutter: Atrial contraction (represented by the P waves on the ECG) is regular but faster than normal (250 to 400 times per minute)

Atrial fibrillation: is caused by rapid, uncoordinated twitching of the myocardium of the atria; in atrial fibrillation, the P waves are irregular and small, and they occur at a rapid rate all along the ECG

Atrial Fibrillation : A Fib

Atrial Flutter : A Flutter

Atrioventricular Junction Dysrhythmias

Junctional rhythm: occurs if the SA node fails to fire and send an electrical impulse through to the AV node or if the SA node fires the impulse too slowly

Junctional rhythms

P wave after QRS - junctional

Ventricular Dysrhythmias

Premature ventricular contractionVentricular tachycardia Ventricular fibrillation

Premature Ventricular Contraction: PVC

Ectopic beat – dangerous if occurs oftenRegularity – may interrupt the regularity of

underlying rhythmRate – depends on underlying rhythmP wave – will not be one before ectopic beatPRI – none in ectopic beat – measure underlying

rhythmQRS – ectopic beat – wide and bizarre, also look

at underlying rhythm

Ventricular Tachycardia - VT

Medical Emergency – most pts will be unconscious & can’t feel pulse

Regularity – usually regular, can be slightly irregular

Rate – 150 – 250 / minP waves – nonePRI – noneQRS - >.12

Ventricular Fibrillation - VF

Start CPR!!Regularity – baseline totally chaoticRate – can’t determineP waves - ?PRI - ?QRS - ?

Asystole

No electrical activityStart CPR

Cheat Sheet – Ventricular Dysrhythmias

Interpretation PVC – premature ventricular contraction

VT – Ventricular Tachycardia

VF – Ventricular Fibrillation

Asystole

Regularity The underlying rhythm can be regular or irregular

Usually regular, can be irregular

Baseline totally chaotic

No electrical activity, only a flat line

Rate Determined by underlying rhythm

150 – 250Per min.

Can’t be determined

P waves Ectopic not preceded by a P wave

none No discernible P waves

PRI Ectopic comes from lower focus, no PRI

none none

QRS Wide and bizarre >.12

Wide and bizarre >.12

No discernible QRS complex

Atrioventricular Blocks

First-degree atrioventricular block Second-degree atrioventricular block * Type I - Wenckebach rhythm

* Type II - Mobitz type I rhythm

Third-degree atrioventricular block (Mobitz type II rhythm)

Observations to Report to the Nurse Immediately

The PR interval is longer than earlierThe QRS complex changed shape or

widenedThe ECG shows a new dysrhythmia that

was not there beforeC/O chest pain or discomfortC/O shortness of breathC/O dizziness Person unconscious

Artifacts Can Be Caused by:

Electrical interference from other electrical equipment (such as an electric razor) or monitoring devices in the area

Loose electrodes, especially if the person is diaphoretic (sweating) or recently repositioned

Electrodes dried outElectrodes placed over an excessively

hairy areaDefective monitor or lead wiresPatient movement (for example, from

shivering or brushing the teeth)

Artifact:

12 Lead EKG:

Prepare equipmentBed at comfortable working heightAdjust patient’s clothing to expose chest;

provide privacyDetermine correct position for each

electrode If excessive hair, remove with shaver Clean with alcohol pad to remove oils if needed Ask patient to lay still and obtain tracing

12-Lead Tracing: