Abnormal ECG Interpretation and Treatment

8/11/2019 Abnormal ECG Interpretation and Treatment

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SPM200 Skills Lab 7 Notes

(Updated: 1/5/2011)

Skill Lab #7: Abnormal !" #nterpretation and $reatment

Origins of the ACLS Approach:

A!LS trainin% ori%inated in Nebraska in t&e earl' 170s* #ts p+rpose ,as to brin% order and or%ani-ation to t&e treatment o.

ardia arrest*

Primary Survey: (CA!

o+s on t&e basi !P and de.ibrillationCir+lation: %ie &est ompressions (30 ompressions 4 rate o. 100/min)

Air,a': open t&e air,a'

reat&in%: proide positie4press+re entilation (2 breat&s)A/e.ibrillation: A#6S (VF/pulseless VT)

1. !&ek t&e patient .or responsieness and presene/absene o. normal breat&in% or %aspin%*

2. !all .or &elp*

3. !&ek t&e p+lse .or no more t&an 10 seonds*

4. "ie 30 ompressions* (2 inches; > 100/min.)5. pen t&e air,a' and %ie 2 breat&s* (Over 1 second)

. es+me ompressions*

$&e 2 basi A!LS skills are t&e abilit' to per.orm !P and operate an A (A+tomated 8ternal e.ibrillator)* $&ere are 7adaned A!LS skills:

1* !are o. t&e air,a'*

2* eo%nition o. r&'t&m3* letrial t&erap' #: de.ibrillation

9* letrial t&erap' ##: ardioersion

5* letrial t&erap' ###: trans+taneo+s pain%

* #6 aess to ir+lation7* Seletion o. appropriate res+sitation mediation

"eications:

$rug $ose %oute &reatment

Adenosine 412 m%#6 p+s& ,it& saline

.l+s&; < 5 min*S6$

iltia-em0*25 m%/k% = 20 m%

t&en 0*35 m%/k% = 25 m%#6

Stable; narro,4omple8ta&'ardias; A or S6$

pinep&rine 1 m% #6 rad'

Amiodarone300 m% 8 1 dose

150 m% (2nddose)#6 bol+s 6; 6$

Proainamide 20 m% to 50 m%/min +ntilarr&'t&mia s+ppressed

#6 Pre4e8ited A; $a&'

Lidoaine

1 to 1*5 m%/k% bol+s

0*5 to 0*75 m%/k% eer' 5 mins

(Ma8 3 m%/k%)

P+s&

@ 410 min

#n.+se 149 m%/min

Bemod'namiall' stable

monomorp&i 6$

6asopressin 90 #U#6 p+s&

1 dose onl'As'stole; PA; 6$/6

' Atrial )lutter1


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(Updated: 1/5/2011)

%ate:Bas man' atrial ontrations .or one entri+lar ontration* Atrial rate is 2504350 beats/min+te* 6entri+lar is +s+all'bet,een 04100 beats/min+te* #. t&e entri+lar rate is 150; 2:1 ond+taneC 2 atrial ontrations to 1 entri+lar ontration*%hythm:>ot& atrial and entri+lar patters are re%+lar; b+t t&e' dont mat& in rate*P*%S& +nformation:Bas P ,ae (sa,4toot&ed or .l+tter ,aes); @S omple8; b+t t&e $ ,ae is not seen bea+se it is

oered b' t&e man' P ,aes*

$ifferential $iagnosis: A+te !oronar' S'ndrome; !ardiome%al'; !oronar' Arter' iseaseSigns , Symptoms: S>; palpitation ? !&est Pain (!P)&reatment: S'n&rono+s ! s&ok; di%italis;


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(Updated: 1/5/2011)

$ifferential $iagnosis: (P+%A&/S4 P+lmonar' disease; +s&emia; %&e+mati &eart disease; Anemia; atrial m'8oma;&&'roto8iosis; /t&anol; Sepsis) ardia ale disorder; &'pertensie ardioas+lar disease; ardiom'opat&'; M#; t&'roto8iosis;

!P; onstritie periarditis; !B; ertain dr+%s*

Signs , Symptoms: S>; palpitation ? !&est Pain (!P)&reatment:Preipitatin% a+se; +se o. p&armaolo%ial a%ents .or ardioersion or eletrial s'n&roni-ed ardioersion is

ommon to onert a r&'t&m to S* Ablation an be done in t&e letro4P&'siolo%' (P) lab to interr+pt t&e aberrant .oi; as a

+re .or A .ib* !"#e $on#rol%i%o8in; >eta blokers* &n#i"rrh'#hmics%!orert; !ardi-em; Proainimide; @+inidine;

Amiodarone

00Anti1coagulate in ne,4onset; si%ni.iant risk .or emboli-ation*

2 Sinus raycaria

%ate:>ot& t&e atria and entriles are less t&an 0 beats/min+te*%hythm:e%+lar r&'t&m t&ro+%&o+tP*%S& +nformation:Bas P ,ae; S omple8; and $ ,ae present*

$ifferential $iagnosis: re


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(Updated: 1/5/2011)

$ifferential $iagnosis: A ariation in sin+s r&'t&m t&at +s+all' related to respirator' rate and res+lts .rom inrease a%al tone

in&ibition* $&e &eart rate inreases ,it& inspiration and dereases ,it& e8&alation* !ommon in at&letes* A marked ariation in

P4P interal ma' indiate Sik Sin+s S'ndrome ? Fanderin% Paemaker*

Signs , Symptoms: Unommon; palpitations or di--iness&reatment: Unneessar'

4 Sinus &achycaria

%ate:Atrial and entri+lar ontrations are present and t&e rate meas+res 100410 beats/min+te*%hythm:e%+larP*%S& +nformation:Bas P ,ae; @S omple8; and $ ,ae present

9


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(Updated: 1/5/2011)

$ifferential $iagnosis: pain; an8iet'; dr+%s (amp&etamines)Signs , Symptoms: S>; pain; and an8iet'&reatment:None; +nless s'mptomatiC treat +nderl'in% disease

* Asystole(6entri+lar Standstill)%ate:No rate obserable bea+se t&e atrial pattern ma' be isible or not and t&e entri+lar pattern is not present*%hythm:Atria rate; i. present; is re%+lar* 6entri+lar rate not s&o,n/isible*P*%S& +nformation:P ,ae o.ten present; @S omple8 absent; and no $ ,ae isiable*

"ost )re5uent Causes of Asystole an P/A (416s , 4 1&s!

6'poolemia &o8ins ()

6'po8ia &amponade; ardia

6'dro%en ion4 (aidosis) &ension pne+mot&ora8

6'er4/&'pokalemia &&rombosis; oronar' or p+lmonar'

6'pot&ermia &ra+ma

$ifferential $iagnosis: See aboe table* !ommonl' in seerel' diseased &earts* Leads disonneted*Signs , Symptoms: eat&&reatment: $rans+taneo+s pain%; pinep&rine and Atropine; reersible onditions assoiated ,it& as'stole

7 8entricular &achycaria(64ta&; 6$)%ate:$&ere is no atrial ontration isible = t&e entri+lar ontration is present and rapid (1004250 beats/min+te)%hythm:Atrial r&'t&m is not apparentC entri+lar r&'t&m is +s+all' re%+lar*P*%S& +nformation:P ,ae is not isible* @S omple8 is ,ide and bi-arre* $&e $ ,ae is present and al,a's pointin% in

t&e opposite diretion o. t&e @S omple8*

5


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(Updated: 1/5/2011)

$ifferential $iagnosis:

Signs , Symptoms: &an%e in mental stat+s; !P; S>; palpitation; p+lse s* p+lseless&reatment: Lidoaine; proainamide; ! s&ok;


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Abnormal ECG Interpretation and Treatment