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 ·      ...

Chronotropic drugs ·          For the treatment of adults with symptomatic and unstable bradycardia ·          Recommended as an alternative to pacing Dopamine 5-20ug/kg/min Low dose 1-5ug/kg/min Moderate dose 5-10ug/kg/min High dose 10-20ug/kg/min Note: At lower doses dopamine has a more selective effect on inotropy and heart rate; at higher doses (>10 mcg/kg per minute), it also has vasoconstrictive effects. Dopamine infusion may be used for patients with symptomatic bradycardia, particularly if associated with hypotension, in whom atropine may be inappropriate or after atropine fails Epinephrine 2-10ug/min ·          Epinephrine infusion ·          Mix 1mg in 250 NS Note Epinephrine infusion may be used for patients with symptomatic bradycardia, particularly if associated with ...

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. Increase mA by 5-10mA Until Electrical Capture is Obtained Mechanical Capture ·          Improved BP ·          Palpable pulse ·          Improved level of consciousness ·          Improved respiratory status ·          Cessation of chest pain ·          Improvement in skin color Note:  Pulse rate should equal that of the rate set by the pacemaker.  Monitoring continuous pulse oximetry is a good way of verifying the pulse rae and...

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 ·   ...

Primary Survey ·          Assess ABCs ·          Breathing-secure noninvasive airway ·          Call for monitor/defibrillator Note: Because hypoxemia is a common cause of bradycardia, initial evaluation of any patient with bradycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by pulse oximetry Secondary Survey ·          Oxygen ·          IV access-fluids ·          Vital signs, pulse oximeter, BP ·          Obtain 12 lead ·          Differential diagnosis Bradycardia Intervention Mnemonic: PACE...

Third Degree Heart Block ECG Characteristics Rate: The atrial rate is typically normal. The ventricular rate will be slower. If a junctional focus is controlling the ventricles, the rate will be 40 - 60. If the focus is ventricular, the rate will be 20 - 40. Rhythm: Since the atrial and ventricular foci are firing regularly, the P - P and the R - R intervals will be regular. P Wave: Upright and uniform. There are more P waves than QRS complexes PRI: There is no PRI, because the block at the AV node is complete. There is no association between the P waves and the QRS complexes. QRS: If the focus is junctional, less than 0.12 seconds. If the focus is ventricular, the QRS will be > 0.12. Types of Bradycardia ·          Absolute Bradycardia: Defines bradycardia by heart rate (below 60) ·          Relative Bradycardia: Defines bradycardia by symptoms ( i.e. hypotension with ...

Management of Bradycardia 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 ·          2 nd degree heart block type II ·          3 rd degree heart block   Sinus Bradycardia       ECG  Characteristics   Rate: The atrial an...