Float Nurse

Secondary Survey ·          Intubate and secure airway device. ·          Oxygenate with 100% O 2 . ·          IV access Note: Given the potential association of PEA with hypoxemia, placement of an advanced airway is theoretically more important than during VF/pulseless VT and might be necessary to achieve adequate oxygenation or ventilation. Methods of Confirming ET tube Placement ·          Direct cord visualization ·          End-tidal CO2 monitor Yellow - yes, tube is correctly placed Tan - think about it Purple - problem with tube placement ·          Bilateral breath sounds ·          CXR ·          Continuous waveform capnography ...

PEA mnemonic:  Keep them ALIVE A - assess ABCs L - listen for pulse using doppler I - Initiate CPR V - vasoconstrictors E - evaluate reversable causes A ssess ABCs- Primary Survey ·          Assess responsiveness and pulse ·          Active EMS system ·          Call for defibrillator/monitor Note:  If a rhythm is present on the monitor but the pulse is absent (eg,PEA), CPR should be started immediately, beginning with chest compressions, and should continue for 2 minutes before the rhythm check is repeated. L isten for Pulse Using Doppler ·          A doppler will help distinguish between a pulseless state and profoundly weak cardiac contractions with a low cardiac output (pseudo-PEA). ·          True PEA:  no pulse and no perfusion · ...

Pulseless Electrical Activity PEA Displays a rhythm on the monitor Lacks a palpable pulse Patients with PEA have poor outcomes Need to find underlying cause ASAP No pulse = no perfusion PEA Patients who have PEA will not benefit from defibrillation attempts. The focus of resuscitation is to perform high-quality CPR with minimal interruptions and to identify reversible causes or complicating factors 3:17 PM  A 65 year old female with end stage renal disease was found to be unresponsive and have "gasping" respirations.    This was the initial rhythm.   A weak pulse was present.   Positive pressure ventilations were initiated.  3:20 PM  Despite aggressive ventilations, her heart rate slows down and her pulse is no longer palpapable.  A code blue is called and CPR is initiated.  Notice that the P wave amplitude is much smaller and the QRS complex is beginning to widen.   This could be related to...

Identify the following rhythms 1. 2. 3. 4. 5. Answers 1. Ventricular bigeminy The rhythm is irregular with some ventricular ectopy.   The heart rate is 90/min.  The P waves are positive and are paired with a QRS complex.  There are PVCs every other beat.     Notice the 3rd and 4th PVCs have an upright P wave.  Theses P waves suggest perhaps that the PVCs may be some kind of aberrant premature atrial contraction.  PR:  .12 sec.  QRS:  .08 sec,  QT:  .36 sec. 2. 1st degree block with unifocal PVCs The rhythm is irregular with a rate of 84/min.  There are upright P waves that precede the QRS complexes.   The PR interval is prolonged.   A unifocal PVC is seen every fourth beat, quadrigeminy.   A compensatory pause follows each PVC.   PR:  .24 sec,  QRS:  .12 sec,  QT:  .38 sec. 3. Sinus tachycardia with unifocal P...

Identify the following rhythms 1. 2. 3. 4.  5. Answers 1. Normal sinus rhythm The rhythm on this strip is regular with a heart rate of 79/min.   P waves are upright, uniform, and are followed by a QRS complex.   No ectopic beats are noted.  PR:  .16 sec,  QRS:  .12 sec,  QT:  .44 sec. 2. Sinus tachycardia with unifocal PVCs and a couplet of PVCs The heart rhythm is regular.   The rate is 115/min.   The P waves are upright and precede the QRS complex.  The P waves are wide suggesting left atrial enlargement.  Single unifocal PVCs and a couplet of PVCs is seen.  PR:  .16 sec,  QRS:  .12 sec,  QT:  .32 sec. 3. Normal sinus rhythm with unifocal PVCs The rhythm is irregular due to the ventricular ectopy.   The rate is 108/min.   The P waves are positive and have a corresponding QRS complex.   Unifocal PVCs ar...

Identify the following rhythms strips 1. 2. 3. 4. 5. Answers 1. NSR with 1st degree AV block and unifocal PVCs The heart rhythm is irregular with frequent PVCs.   The heart rate is 90/min.  The P waves are upright and uniform.   The PR interval is prolonged.  Both single and a couplet of unifocal PVCs are seen.   PR:  .24 sec,  QRS:  .16 sec,  QT:  .44 sec. 2. NSR with ST depression The rhythm is regular with a rate of 58/min.   P waves are upright and have a corresponding QRS complex.  No ectopic beats are noted.  The ST segment is down slopping with an inverted T wave. PR:  .16 sec,  QRS;  .08 sec,  QT:  .36 sec. 3. Ventricular paced with unifocal PVCs The heart rhythm is regular with a rate of 78/min.   P waves are absent and there appears to be some fibrillation between the QRS complexes.   Two unifocal PVCs are...

Identify the following rhythms 1. 2. 3. 4. 5. Answers 1. Accelerated junctional rhythm The rhythm is regular with a rate of 71/min.   There are retrograde P waves that follow the QRS complexes.   No ectopic beats are seen.   PR:  ---,  QRS:  .08 sec,  QT:  .44 sec. 2. Normal sinus rhythm The rhythm is regular with a heart rate of 75/min.   The P waves are uniform and precede the QRS complex.   No ectopic beats are observed.   PR:  .16 sec,  QRS:  .12 sec,  QT:  .40 sec. 3. Normal sinus rhythm with PACs The rhythm is irregular with some premature atrial contractions.   The ventricular rate is 60/min.  The P waves precede the QRS complex.  The P waves of the PACs, the 2nd and 9th complexes, differs in shape than the P waves of sinus origin.   PR:  .12 sec,  QRS:  :08 sec,  QT:  .40 sec. ...