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...

Search for Reversible Causes ·          Hypoxia ·          Hypothermia ·          Hyper/hypokalemia ·          Hypoglycemia ·          Tablets/toxins ·          Tension pneumothorax ·          Tamponade, cardiac ·          Thrombosis, pulmonary Hypoxia ·          Hypoventilation and hypoxia can lead to bradycardia ·          Assess ABCs ·          Give supplemental oxygen ·          Consider advanced airway management ·          Mechanical Ventilation- DOPE mnemonic · ...

Transcutaneous Pacing ·          May be helpful in children with bradycardia associated with congenital heart  disease or acquired heart disease ·          Not helpful with bradycardia related to post arrest hypoxia or ischemia myocardial insult or respiratory arrest Note:  Emergency transcutaneous pacing may be lifesaving if the bradycardia is due to complete heart block or sinus node dysfunction unresponsive to ventilation, oxygenation, chest compressions, and medications, especially if it is associated with congenital or acquired heart disease. Transcutaneous Pacing ·          Pediatric pads are recommended for children weighing less than 10 kg ·          Adult pads may be used on children weighing over 10kg ·          Use anterior/posterior placement or apex/anterior positi...

Stable patient ·          Observe ·          Support ABCs ·          Reassess patient for symptoms of cardiac compromise Note:  Reassess the patient to determine if bradycardia is still causing cardiorespiratory symptoms despite support of adequate oxygenation and ventilation Unstable patient ·          Perform chest compression ·          Heart rate < 60/min in infant or child with poor systemic perfusion despite oxygenation Note:  Revaluate the patient for signs of compromised cardiac output, including reduced responsiveness, weak central pulses, weak or absent peripheral pulses, hypotension, delayed capillary refill, and cool extremities. Drug Management ·          Epinephrine ·          Atr...

Primary Causes ·          Heart blocks (congenital heart disease) ·          Heart transplants (vagal denervation) ·          Cardiomyopathies ·          Myocarditis ·          Surgical injury to pacemaker or conduction system Secondary Causes ·          Hypoxemia ·          Hypothermia ·          Hypothermia ·          Head injury ·          Acidosis ·          Toxins- Digoxin, Beta Blockers, Calcium channel blockers ·          May be induced by excessive vagal stimulation from suctioning or intubation Managemen...