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 rhythm and describe the electrical interventions associated with each rhythm. 1. a.    Attempted defibrillation of ventricular fibrillation b.    Attempted transcutaneous pacing of atrial flutter c.    Attempted cardioversion of atrial fibrillation d.    Attempted defibrillation of multifocal atrial tachycardia 2. a.   Unsuccessful defibrillation of ventricular fibrillation b.   Successufl cardioversion of atrial fibrillation c.   External pacing of aystole with good electrical capture d.   Failure to capture complete heart block 3.  Is this the appropriate electrical intervention for this rhythm? a.   Yes, synchronized cardioversion is an acceptable intervention for polymorphic VT b.   Yes, overdrive pacing is being attempted for polymorphic ventricular tachycardia c.   No,  unsynchronized cardioversion is only appropriate this monomorphic VF d.   No, ...

Identify the following rhythm strips 1. a.   Defibrillation of ventricular fibrillation b.   Cardioversion of polymorphic ventricular tachycardia c.   Defibrillation of ventricular tachycardia d.   Cardioversion of supraventricular tachycardia 2. a.  Cardioversion of supraventricular tachycardia b.  Cardioversion of unifocal ventricular tachycardia c.  Defibrillation of ventricular fibrillation d.  Defibrillation of unifocal ventricular tachycardia 3. a.  Defibrillation of ventricular tachycardia to ventricular fibrillation b.  Defibrillation of ventricular fibrillation to polymorphic ventricular tachycardia c.  Defibrillation of ventricular tachycardia to atrial fibrillation d.  Defibrillation of unifocal ventricular tachycardia to polymorphic ventricular tachycardia 4. a.  External pacing of Mobitz II with good electrical capture b.  External pacing of complete heart block w...