1 / 32

Ventricular Arrhythmias

Ventricular Arrhythmias. Terry White, RN, EMT-P. Analyze the Rhythm. Analyze the Rhythm. Analyze the Rhythm. Premature Ventricular Complexes (PVCs). Definitions Early depolarization of the ventricles Occur as a result of automaticity or reentry

alva
Download Presentation

Ventricular Arrhythmias

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Ventricular Arrhythmias Terry White, RN, EMT-P

  2. Analyze the Rhythm

  3. Analyze the Rhythm

  4. Analyze the Rhythm

  5. Premature Ventricular Complexes (PVCs) • Definitions • Early depolarization of the ventricles • Occur as a result of automaticity or reentry • A PVC is a characteristic of an underlying ECG rhythm • PVC is not the name of a dysrhythmia

  6. Premature Ventricular Complexes • Causes • Hypoxia • Myocardial Ischemia • Electrolyte Imbalance • Digitalis Toxicity • Stimulants • Chronic Heart Disease (CHF, COPD)

  7. Premature Ventricular Complexes (PVCs) • Characteristics • Complex is earlier than expected • Wide QRS (wide is not always ventricular) • OFTEN has a compensatory pause • Usually irregular • Not preceded by a P wave • T wave opposite deflection • May or may not result in perfused beat

  8. Premature Ventricular Complexes (PVCs) • More Terms to Know • Unifocal, Multifocal • R on T Phenomenon • Bigeminy, Trigeminy, Quadrigeminy, Couplet

  9. Premature Ventricular Complexes (PVCs) • PVCs are not always dangerous • Common for some people • Consider treating PVCs if: • >6/minute associated with: • Severe Chest pain • Hypotension, Decreased Perfusion • Shortness of Breath

  10. Premature Ventricular Complexes (PVCs) • Treat PVCs if consistently see any of the following with other symptoms: • Multifocal • Ventricular Couplets • Runs of Ventricular Tachycardia • R on T Phenomenon (Malignant PVCs)

  11. Premature Ventricular Complexes (PVCs) • Management (Rate <60) • Oxygen & Ventilation are initial treatments for ALL ectopic beats • ECG Monitor, IV NS TKO • assess the underlying rhythm • Treat like bradycardia • Atropine • TCP • Dopamine

  12. Premature Ventricular Complexes (PVCs) • Management (Rate >60) • Oxygen & Ventilation are initial treatments for ALL ectopic beats • ECG Monitor, IV NS TKO • assess the underlying rhythm • If symptomatic (see previous):

  13. Premature Ventricular Complexes (PVCs) • Management (Rate >60) • Lidocaine • IV Bolus, 1 - 1.5 mg/kg • Infusion, 1 - 4mg/min • Repeat IV push 0.5 - 0.75 mg/kg every 5 minutes to 3 mg/kg max • Increase Infusion 1mg/min for every 1mg/kg IV bolus given

  14. Premature Ventricular Complexes (PVCs) • Management (Rate >60) • Procainamide • 20 mg/min IV until: • PVCs suppressed • 17 mg/kg given • Hypotension occurs • QRS widens by 50% or more • Continuous infusion at 1 - 4 mg/min

  15. Premature Ventricular Complexes (PVCs) • Management (Rate >60) • Bretylium • IV push, 5 mg/kg slowly • Infusion, 1 - 2 mg/min • Used less frequently today due to supply shortage

  16. Analyze the Rhythm

  17. Idioventricular Rhythm • Causes • Myocardial ischemia • Hypoxia • High vagal tone • Drug effects

  18. Idioventricular Rhythm • Characteristics • A ventricular focus takes over as an escape pacemaker site • Rate 20 - 40 bpm • Wide QRS complexes • No P waves

  19. Idioventricular Rhythm • Management • Slow rate will probably decrease cardiac output • Usually a later and often pre-terminal rhythm • If symptomatic, treat as unstable bradycardia • Do NOT give Lidocaine or other ventricular antidysrhythmics!!!!!!!

  20. Analyze the Rhythm

  21. Accelerated Idioventricular Rhythm • Characteristics • Like Idioventricular rhythm except for rate • Rate, greater than 40 bpm but less than 100 bpm

  22. Accelerated Idioventricular Rhythm • Management • Patient may maintain adequate cardiac output • Identify underlying cause and treat!!! • Monitor cardiac output and perfusion • Often a late and pre-terminal rhythm • Do NOT give Lidocaine or other antidysrhythmics!!!!!!!

  23. Analyze the Rhythm

  24. Ventricular Tachycardia (VT) • Causes • Myocardial ischemia • Hypoxia • Electrolyte imbalance • Digitalis toxicity • Myocardial trauma

  25. Ventricular Tachycardia (VT) • Characteristics • Pacemaker site • Irritable ventricular focus takes over as pacemaker site, OR • May result from multiple ventricular foci attempting to become pacemaker site • Complexes look similar to PVCs • May see P waves before complexes but uncommon • Rate, usually between 100 and 250 bpm

  26. Ventricular Tachycardia (VT) • Complications • Can decrease cardiac output • Increases cardiac workload • Decreases coronary perfusion • Can quickly deteriorate into V-fib

  27. Ventricular Tachycardia (VT) • Types • Monomorphic • QRS complexes all have same morphology • Polymorphic • QRS complexes have more than one morphology • “Torsades de Pointes” • “Twisting of the points” • Usually > 200 bpm • Susceptible if slow repolarization (long QT)

  28. Ventricular Tachycardia (VT) • Treatment of Stable and Unstable • Oxygen, Ventilations, Assess Pulse • ECG Monitor • If unstable, proceed to synchronized cardioversion • IV NS TKO • Determine monomorphic vs polymorphic • If wide complex of unknown origin, attempt 12 lead ECG to determine

  29. Ventricular Tachycardia Treatment: Monomorphic • Treatment of Stable (limit to one antidysrhythmic) • procainamide 20 mg/min IV • avoid if poor cardiac function • amiodarone 150 mg slow IV (15 mg/min) • lidocaine 1.0 mg/kg IV (max 3.0 mg/kg) • Begin with 0.5 - 0.75 mg/kg poor cardiac function • Follow with lidocaine infusion, 1 - 4 mg/min • synchronized cardioversion

  30. Tachycardia: Wide Complex (VT) Polymorphic (Torsades) • Treatment (limit to one antidysrhythmic) • Normal QT • Lidocaine, 1 - 1.5 mg/kg IV (max 3.0 mg/kg), repeat @ 0.5-0.75 mg/kg q 5 min to max 3 mg/kg • Amiodarone, 150 mg slow IV (15 mg/min) • Procainamide, 20 mg/min until • PVCs suppressed • 17 mg/kg given • Hypotension occurs • QRS widens by 50% or more • Then, infusion at 1 - 4 mg/min

  31. Tachycardia: Wide Complex (VT) Polymorphic (Torsades) • Treatment (limit to one antidysrhythmic) • Long QT (including Torsades w/o arrest) • Magnesium sulfate 10%, 1-2 g slow IV over 5 mins or greater • Lidocaine, 1 - 1.5 mg/kg IV (max 3.0 mg/kg), repeat @ 0.5-0.75 mg/kg q 5 min to max 3 mg/kg • Other considerations • phenytoin, isoproterenol, or overdrive pacing

  32. Interesting Questions What is a capture beat? What is a fusion beat? How do they help or hurt you in your ECG interpretation?

More Related