Post on 13-Jan-2016
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
70 yo AAF with palpitations
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
Called to see sleeping patient
NSVT
ICM or NICM• Usually not an indication for ICD
Ask about symptoms Use more beta-blockers
Patient with L-sided weakness
Atrial fibrillation
Irregular No coordinated atrial activity (no P waves) Rate control Anticoagulation
Lung transplant pt with SOB
Atrial flutter (2:1)
Regular rhythm Flutter circuit rate: 300 bpm Re-entrant circuit Diagnostic maneuvers: vagal stimulation, adenosine
Typical atrial flutter
“Sawtooth” pattern
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
Nursing student asks for help
Mobitz I (Wenkebach)
Regular P waves Lengthening P-R interval Shortening R-R interval Predictably dropped beats (grouped beats)
Patient with syncope
Mobitz II
Randomly dropped beats Frequently progresses to 3rd degree AVB or complete
heart block Can be indication for pacemaker
27 yo WM with syncope at work
Complete Heart Block
Normal sinus node activity (P waves) No ventricular response Pt presented with syncope while driving forklift
Patient with chest pain
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
Pt missed dialysis
Hyperkalemia
QRS widening Peaked T waves Treatment:
• Calcium first• Insulin/glucose, albuterol, glucagon, NaHCO3, IVF/Lasix• Kayexalate last
18 yo WF postpartum
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)
Regardless of the telemetry…