1. EKG RhythmQuiz 2 Treatment of DysrhythmiasFabulous Nurse University

2. A Fabulous Nurse Magazine andHarrington Educational PartnersProduction 2012 All Rights Reserved 3. EKG Rhythm EKG Rhythm EKG Rhythm EKG Rhythm EKG RhythmQuiz 2 Quiz 2 Quiz 2 Quiz 2 Quiz 2Category 1 Category 2 Category 3 Category 4 Category 5$100 $100 $100 $100 $100$200 $200 $200 $200 $200$300 $300 $300 $300 $300$400 $400 $400 $400 $400$500 $500 $500 $500 $500 4. How would you treat a patient with Premature Junctional Contractions,PJCs?Return to Main Board Answer 5. Intervention needed only ifPJCs are frequent or new topatient Treat underlying etiology Document patients rhythm,response, and interventions Return to Main Board 6. You noticed that your patient has PrematureVentricular Contractions, PVCs. What should you donext?Return to Main BoardAnswer 7. Intervention needed only ifpatient is symptomatic Notify MD if PVCs are new to thepatient Treat underlying etiology Administer oxygen Follow standing orders Document patients rhythm,response, and interventions Return to Main Board 8. Pacemaker spikes precede pacemaker beats. Whatintervention is required?Return to Main BoardAnswer 9. No intervention required Intervene only if pacemaker isnot sensing or not capturing Document patients rhythmReturn to Main Board 10. Your analysis of a patientsrhythm reveals seconddegree AV Block, Type II(2*AVB Type II) aka MobitzII. What now?Return to Main BoardAnswer 11. Intervention needed only if symptomaticor new to patient Treat symptomatic bradycardia per ACLSGuidelines with transcutaneous pacing,TCP or transvenous pacing Determine and treat underlying etiology NOTE: Atropine is not recommended forthis rhythm Document patients rhythm , response, &interventions Return to Main Board 12. Your patients heart rate is less than 60 beats/min. You identify that it is SinusBradycardia (SB). What intervention is required?Return to Main BoardAnswer 13. Intervention needed only ifsymptomatic Treat symptomatic bradycardia perACLS Guidelines Atropine (for narrow complex only) Transcutaneous pacing, TCP Dopamine 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Prepare for transvenous pacing Treat underlying etiology Document patients rhythm, response,& interventionsReturn to Main Board 14. The monitor shows Sinus Rhythm. However, your patient is unresponsive andpulseless. You determinethat the rhythm is PEA or Pulseless Electrical Activity.What should you do?Return to Main BoardAnswer 15. Call a code. ABCD per ACLS Guidelines Intervention is rhythm specific Treat shockable rhythm per ACLS Guidelinesfor pulseless VFib/VTach Defibrillate x 1 then resume CPREpinephrine 1mg every 3-5 min ORVasopressin 40 U x 1Amiodarone 300 mg IV/IO (may repeat at the dose x1) ORLidocaine 1-1.5 mg/kg IV/IOMagnesium 1-2 g IV/IO for torsades de pointes Treat underlying etiology Document patients rhythm, response, &interventionsReturn to Main Board 16. Patients rhythm is NormalSinus Rhythm What intervention is required?Return to Main Board Answer 17. No intervention needed Continue to observe patientand document patients rhythmReturn to Main Board 18. Premature AtrialContractions, PACs, requirewhat type of intervention?Return to Main Board Answer 19. Intervention needed only ifPACs are frequent or new topatient Treat underlying etiology Document patients rhythm,response, and interventions Return to Main Board 20. Idioventricular Rhythm (IVR) is a wide complex bradycardia. How wouldyou treat this rhythm?Return to Main BoardAnswer 21. Intervention needed only ifsymptomatic Treat symptomatic bradycardia perACLS Guidelines Transcutaneous pacing, TCP Dopamine 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Prepare for transvenous pacing Treat underlying etiology Document patients rhythm, response,& interventionsReturn to Main Board 22. 78 year old patient withAtrial Fibrillation. How would you address thepatients rhythm?Return to Main BoardAnswer 23. Intervene only if patient symptomatic, heart rate is>100 beats/min and/or rhythm is new to patient Vagal maneuvers to slow HR and evaluate rhythm Immediate cardioversion if Rapid VentricularResponse (RVR) and patient symptomatic Treat stable tachy arrhythmia per ACLS Guidelines Adenosine 6mg 12mg 12mg IVP in 1-2min intervals if no conversion Consider calcium channel blocker e.g. diltiazem OR Consider beta-blocker e.g. metoprolol Treat underlying etiology / contributing factors Document patients rhythm, response, &interventions Return to Main Board 24. What is the recommended management of Accelerated Idioventricular Rhythm (AIVR)?Return to Main Board Answer 25. Observe patient because AIVR ornon-paroxysmal VT is a protectiveand mostly transient rhythm Intervention is symptom specific Treat underlying etiology (why isthere a loss of atrial kick?) Document patients rhythm,response, and interventionsReturn to Main Board 26. Bundle Branch Block BBB To treat or not to treat?Return to Main BoardAnswer 27. Observe patient since BBB isusually asymptomatic Underlying cause of BBB mayproduce symptoms Treat underlying etiology Document patients rhythm,response, and interventionsReturn to Main Board 28. Per ACLS guidelines, howwould you treat a patientwith Atrial Flutter (Aflutter)?Return to Main BoardAnswer 29. Intervene only if patient symptomatic, heart rate is>100 beats/min and/or rhythm is new to patient Vagal maneuvers to slow HR and evaluate rhythm Immediate cardioversion if Rapid VentricularResponse (RVR) and patient symptomatic Treat stable tachy arrhythmia per ACLS Guidelines Adenosine 6mg 12mg 12mg IVP in 1-2min intervals if no conversion Consider calcium channel blocker e.g. diltiazem OR Consider beta-blocker e.g. metoprolol Treat underlying etiology / contributing factors Document patients rhythm, response, &interventions Return to Main Board 30. What is the preferred treatment for a patient that is alert with Ventricular Tachycardia (VT/VTach)?Return to Main Board Answer 31. Determine if stable versus unstable VTach Immediate cardioversion if patient symptomatic Treat stable VTach per ACLS Guidelines Amiodarone 150mg IV over 10 minutes Repeat amiodarone (max 2.2 g/24 hours) OR Procainamide 20 mg/min drip until VT resolves, hypotension or QRS widens more Procainamide 1-2 mg/min maintenance gtt OR Sotalol Treat underlying etiology / contributing factors Document patients rhythm, response, &interventions Return to Main Board 32. How would you intervene if your patients rhythm isSecond-Degree AV Block,Type IWenckebach or Mobitz I?Return to Main Board Answer 33. Intervention needed only ifsymptomatic Treat symptomatic bradycardia perACLS Guidelines Atropine (for narrow complex only) Transcutaneous pacing, TCP Dopamine 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Prepare for transvenous pacing Treat underlying etiology Document patients rhythm, response,& interventionsReturn to Main Board 34. How would you manage a patient with Sinus Pause / Sinus Arrest?Return to Main BoardAnswer 35. Intervene only if pause/arrest is long or patient issymptomatic Treat symptomatic bradycardia per ACLSGuidelines Epinephrine 1mg every 3-5 min OR Vasopressin 40 U x 1 (substitute for 1st or 2nd epinephrine dose) Atropine (for narrow complex only) Transcutaneous pacing, TCP Dopamine 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Prepare for transvenous pacing Treat underlying etiology Document patients rhythm, response, &interventionsReturn to Main Board 36. Sinus Tachycardia is a commonly seen arrhythmia.What are the interventions for Sinus Tach that you must be aware of?Return to Main Board Answer 37. Treat underlying etiology e.g. pain,fever, dehydration Document patients rhythm, response,& interventions Return to Main Board 38. How would you manageFirst Degree AV-Block (1* AVB)?Return to Main Board Answer 39. Usually asymptomatic so continue tomonitor patient Treat symptomatic bradycardia perACLS Guidelines Atropine (for narrow complex only) Transcutaneous pacing, TCP Dopamine 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Prepare for transvenous pacing Treat underlying etiology Document patients rhythm, response,& interventionsReturn to Main Board 40. What is the treatment forAccelerated JunctionalRhythm (AJR) or JunctionalTachycardia (JT)?Return to Main Board Answer 41. Intervene only if patient symptomatic Treat symptomatic Junctional Tachycardia (HR >100) per ACLS Guidelines Vagal maneuvers to slow HR and determine the origin of patients rhythm Adenosine 6mg 12mg 12mg IVP in 1-2min intervals if no conversion Consider calcium channel blocker e.g. diltiazem OR Consider beta-blocker e.g. metoprolol Treat underlying etiology / contributing factors Document patients rhythm, response, &interventions Return to Main Board 42. The monitor showsAsystole. What now?Return to Main BoardAnswer 43. Verify rhythm in a second lead Call a code Initiate uninterrupted CPR x 2 minutesEpinephrine 1mg every 3-5 minORVasopressin 40 U x 1 (substitute for 1st or 2nd epinephrine dose)Atropine 1 mg every 3-5 min (max 3mg)Resume CPR for another 2 minutes Treat underlying etiology Document patients rhythm, response, &interventions Return to Main Board 44. What is the recommendedmanagement of Complete Heart Block or Third DegreeAV-Block (3* AVB)?Return to Main Board Answer 45. Intervene only if patient is symptomatic Treat symptomatic bradycardia per ACLSGuidelines Atropine (for narrow complex only) Transcutaneous pacing, TCP Dopamine 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Prepare for transvenous pacing Patient will need a Permanent Pacemaker(PPM) Treat underlying etiology Document patients rhythm, response, &interventionsReturn to Main Board 46. What interventions are required for AtrialTachycardia (AT)?Return to Main BoardAnswer 47. Intervene only if patient symptomatic and/orrhythm is new to patient Vagal maneuvers to slow HR Treat stable tachy arrhythmia per ACLS Guidelines Adenosine 6mg 12mg 12mg IVP in 1-2min (in the absence of asthma) Consider calcium channel blocker e.g. diltiazem OR Consider beta-blocker e.g. metoprolol Consider cardioversion if AT resistant tomedications Treat underlying etiology / contributing factors Document patients rhythm, response, &interventions Return to Main Board 48. How is Junctional Rhythm or Junctional EscapeRhythm managed?Return to Main Board Answer 49. Intervene only if patient is symptomatic Treat symptomatic Junctional Bradycardia perACLS Guidelines Atropine 0.5 mg IV every 3-5 minutesTranscutaneous pacing, TCPDopamine 2-10 mcg/kg/minEpinephrine 2-10 mcg/minPrepare for transvenous pacing Treat underlying etiology Document patients rhythm, response, &interventions Return to Main Board 50. What kind of interventionswould you initiate for SinusArrhythmia (SA)?Return to Main BoardAnswer 51. No intervention needed Continue to observe patientand document patients rhythmReturn to Main Board 52. What is the ACLSrecommendation for Ventricular Fibrillation (VF/Vfib)?Return to Main Board Answer 53. Call a code / ABCD per ACLS Guidelines Treat per ACLS Guidelines for pulselessVFib/VTach Initiate CPR uninterrupted x 2 minutes Defibrillate x 1 then resume CPR Epinephrine 1mg every 3-5 min OR Vasopressin 40 U x 1 Defibrillate x 1 then resume CPR Amiodarone 300 mg IV/IO (may repeat at the dose x1) OR Lidocaine 1-1.5 mg/kg IV/IO Magnesium 1-2 g IV/IO for torsades de pointes Treat underlying etiology Document patients rhythm, response, &interventions Return to Main Board 54. To play more games and try other fun learning toolsvisit the Fabulous Nurse Magazine website. Fabulous NurseMagazinewww.fabulousnurse.com 2012 All Rights Reserved