Float Nurse

Evaluate:  5Hs & 5Ts • Hypoxia • Hypovolemia • Hyper/hypokalemia • Hydrogen ions (acidosis) • Hypothermia Evaluate:  5Hs & 5Ts • Tension pneumothorax • Thrombosis: coronary • Thrombosis: pulmonary • Thrombosis: Tables/toxins • Tamponade, cardiac Hypoxia • Hypoventilation and hypoxia can lead to bradycardia • Assess ABCs • Give supplemental oxygen • Consider advanced airway management • Mechanical Ventilation- DOPE mnemonic • Hydrogen Ions (acidosis) • Assess ABGs • Bicarb 1mEq/kg o Known pre-existing bicarbonate responsive acidosis o Intubated patient with continued long arrest interval o Upon return of spontaneous circulation after long arrest interval o Tricyclic antidepressant or aspirin overdose o Known preexisting hyperkalemia • •Treat respiratory acidosis with ventilation Hyperkalemia • Assess serum potassium levels • Slow rhythm with tall T waves, widened QRS o 3.5-5.3  Normal o 5.3-6.0...

Bradycardia Intervention Mnemonic: PACE P - pacemaker A -atropine C -chronotrophic drugs E -evaluate Hs&Ts Indications for TCP Pacing • Standby for clinically stable bradycardia • Therapeutic bridge until placement of a transvenous • Hemodynamically unstable bradycardia Transcutaneous pacing • TCP should not be delayed while waiting for an IV and Atropine • Set rate between 60-80/min • Begin at lowest mA and increase • Observe for electrical capture • Assess for mechanical capture • Consider analgesics and sedation for pain Combo pad placement • Avoids pacemakers and ICDs • Insure the skin is dry • Shave excess hair if needed • Avoid medication patches • Avoid letting patches touch • Apex-anterior position • Anterior-posterior position Electrical Capture • Electrical capture is observed when a pacer spike is immediately followed by a QRS complex • Notice that the QRS complex is wide and there is ST elevation. Paced Rhythm Without...

Causes of Bradycardia • Acute myocardial infarction  • Drugs:  blockers, digoxin, Amiodarone  • Increased intracranial pressure  • Sick sinus syndrome  • Hypothermia  • Hypothyroidism Common Bradycardic Rhythms • Sinus bradycardia • NSR with sinus arrest • 2nd degree heart block type II • 3rd degree heart block Sinus Bradycardia Note:   Rate: The atrial and ventricular rates are equal; the heart rate is less than 60 beats per minute Rhythm: the rhythm is regular P Wave: The P waves are uniform. There is one P wave in front of every QRS complex. PRI: 0.12 - 0.20 seconds and constant.  QRS: less than 0.12 seconds Sinus Arrest Note: Rate: The rate varies according to the number and length of pauses Rhythm: The rhythm is regular except during pauses P Wave: The P waves are uniform. There is one P wave in front of every QRS complex. PRI: 0.12 - 0.2...

Beta-blocker toxicity 1210:  A 59 year old is brought in to the ER by EMS after he experienced a syncopal episode at work.   He has past medical history of hypertension, GERD, Diabetes type II, and elevated cholesterol.   He reported to EMS that on Friday, 3 days ago, he went to the doctor's office and was started on a new blood pressure medication (labatelol) that he was supposed to take twice a day.  He went to work this morning and began to feel weak and nauseated.  He sat down thinking that he could rest for a while but passed out.  A review of his home medications revealed that he had been taking both metoprolol and labetalol.  He did not understand that he was supposed to stop the metoprolol.   Initial rhythm by EMS Initial rhythm by EMS 1215:  Vital signs:   97.8-39-20.  BP 84/50.   O2 sats 94% on 2L/min Alert and mild confu...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. AV paced The rhythm is regular with a rate of 75/min.  There a pacer spikes before the P waves and the QRS complexes.  No ectopic beats are noted.  PR:  .16 sec,  QRS:  .16 sec,  QT:  .44 sec. 2. Atrial fibrillation The rhythm is irregular and the rate is 84/min   No P waves are present but there are fibrillatory waves between the QRS complexes.  No ectopy is present.  PR:  ---,  QRS:  .16 sec,  QT:  .36 sec. 3. NSR with PACs The rhythm is irregular due to the atrial ectopic beast.   The rate is 66/min.  P waves are upright and precede a QRS complex.   PACs are present,  3rd and 9th complexes.   PR:  .12 sec,  QRS:  .08 sec,  QT:  .40 sec. 4. Sinus tachycardia The rhythm is regular with a vent...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. 3rd degree AV block The rhythm is irregular with complete AV dissociation.   The atrial rate is 70/min and the ventricular rate is 40/min.   The P waves are upright but are note associated with a QRS complex.  The QRS complexes are narrow suggesting a junctional focus.  PR:  ---,  QRS:  .06 sec,  QT:  .48 sec. 2. Atrial paced The rhythm is regular with a rate of 57/min.  Small upright P waves are present and they are preceded by an atrial pacer spike.  The PR interval is prolonged.  No ectopic beats are noted.  PR:  .28 sec,  QRS:  .08 sec,  QT:  .40 sec. 3. 1st degree AV block The rhythm is regular with a rate of 63/min.  P waves are positive and correspond to a QRS complex.  The PR interval is prolonged.  PR:  .28 ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Atrial fibrillation The rhythm is irregular with a rate of 70/min.   No P waves are present but there are fibrillatory waves between each QRS complex.  No ectopic beats are noted.  PR:  ---,  QRS:  .08 sec,  QT:  .40 sec. 2. Normal sinus rhythm with 1st degree block The rhythm is regular and the rate is 83/min.  P waves are present, upright, and precede the QRS complexes.   The PR interval is prolonged.  No ectopic beats are noted.  PR:  .32 sec,  QRS:  .08 sec,  QT:  .36 sec. 3. Sinus rhythm with artifact The rhythm looks regular with a rate of 60.   There is artifact present which obscures the measurement of the intervals. 4. Normal sinus rhythm with sinus arrest The rhythm is irregular due to a pa...