Jason Morgan, RN, BS

Prolonged QTThis can be a genetic

condition but can also be caused by certain medications.

Haldol (haliperidol) can cause prolonged QT, therefore periodic EKG’s should be done

This can be cause arrhythmia's as well as Torsades

TorsadesCan look

similar to v-tach and v-fib at times

Treat with 2 grams magnesium; dilute in 50 cc NS; DO NOT PUSH!

(unless it’s a code)

A-flutter  Atrial flutter is a relatively

common arrhythmia that can be deleterious by impairing the cardiac output and by promoting atrial thrombus formation that can lead to systemic embolization. It is characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min.

For many years, atrial flutter has been considered together with atrial fibrillation (AF). While some issues of therapy are the same, such as the restoration of sinus rhythm, the maintenance of sinus rhythm after cardioversion, slowing the ventricular rate, and prevention of systemic embolism, atrial flutter is quite distinct from atrial fibrillation

Adapted from UptoDate

A-flutter with RVR (rapid ventricular rate)

A-flutter

A-FibThe RR intervals follow no

repetitive pattern—they have been labeled as “irregularly irregular.”

While electrical activity suggestive of P waves is seen in some leads, there are no distinct P waves. Thus, even when an atrial cycle length (the interval between two atrial activations or the P-P interval) can be defined, it is not regular and often less than 200 milliseconds (translating to an atrial rate greater than 300 beats per minute).Adapted from UptoDate

A-fib/flutterIs this new or old?Is the patient stable?

Vital signs; cardiac output will decrease with a rapid rate

Blood pressure?Mental status?Nausea? Vomiting?Dizziness?

Obtain an EKG

MedicationsMetoprolol- beta 1

adrenergic blocker Usually 5 mg IVP (by

provider) Put patient on monitor

Cardizem – calcium channel blocker Usually 10 mg IVP to start Put patient on monitor

Cardio-version Only with new onset

otherwise increased risk for clot mobilization

Pre-treat with pain meds Fentanyl (short half-life)

Heart Block

Elongated PRI

PACER!