Telemetry / Arrythmias

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Telemetry / Arrythmias Dan Crouch Kristi Kuhn Kate Lindley Ben Voss

description

Telemetry / Arrythmias. Dan Crouch Kristi Kuhn Kate Lindley Ben Voss. Unresponsive patient in ED. Junctional tachycardia. Regular Narrow complex No P waves. Surgical consult for arrhythmia. Paroxysmal SVT (PAT). Benign rhythm If sustained: Vagal maneuvers Adenosine DCCV. - PowerPoint PPT Presentation

Transcript of Telemetry / Arrythmias

Page 1: Telemetry / Arrythmias

Telemetry / Arrythmias

Dan Crouch

Kristi Kuhn

Kate Lindley

Ben Voss

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Unresponsive patient in ED

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Junctional tachycardia

Regular Narrow complex No P waves

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Surgical consult for arrhythmia

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Paroxysmal SVT (PAT)

Benign rhythm If sustained:

• Vagal maneuvers

• Adenosine

• DCCV

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70 yo AAF with palpitations

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Premature ventricular complexes

Abnormal but usually benign• Concerns: very frequent, history of ischemia

Ask about symptoms (palpitations, “skipping a beat”)• Beta-blockers for symptomatic patients

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Called to see sleeping patient

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NSVT

ICM or NICM• Usually not an indication for ICD

Ask about symptoms Use more beta-blockers

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Patient with L-sided weakness

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Atrial fibrillation

Irregular No coordinated atrial activity (no P waves) Rate control Anticoagulation

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Lung transplant pt with SOB

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Atrial flutter (2:1)

Regular rhythm Flutter circuit rate: 300 bpm Re-entrant circuit Diagnostic maneuvers: vagal stimulation, adenosine

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Typical atrial flutter

“Sawtooth” pattern

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Atrial flutter (variable block)

Regular flutter waves @ 300 bpm Irregular ventricular response

• Usually seen with AV nodal blockade

May be difficult to distinguish from coarse Afib

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Nursing student asks for help

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Mobitz I (Wenkebach)

Regular P waves Lengthening P-R interval Shortening R-R interval Predictably dropped beats (grouped beats)

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Patient with syncope

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Mobitz II

Randomly dropped beats Frequently progresses to 3rd degree AVB or complete

heart block Can be indication for pacemaker

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27 yo WM with syncope at work

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Complete Heart Block

Normal sinus node activity (P waves) No ventricular response Pt presented with syncope while driving forklift

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Patient with chest pain

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Ventricular tachycardia

Wide complex tachycardias• VT until proven otherwise for patients with ischemia

• Brugada criteria: only AV dissociation useful on tele– GET AN EKG!!

• Non-malignant rhythm with aberrancy also possible

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Pt missed dialysis

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Hyperkalemia

QRS widening Peaked T waves Treatment:

• Calcium first• Insulin/glucose, albuterol, glucagon, NaHCO3, IVF/Lasix• Kayexalate last

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18 yo WF postpartum

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Torsades de pointes

Polymorphic ventricular tachycardia Life-threatening with degeneration to VF Usually precipitated by PVC in setting of long QT Often associated with QT-prolonging drugs Check for electrolyte disturbances (especially Mg)

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Regardless of the telemetry…

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