Float Nurse

Sunrise, sunset Sunrise, sunset Swiftly fly the years, One season following another, Laiden with happiness and tears Fiddler On The Roof Sunrise, Sunset lyrics A 70 year old is admitted with chest pain.   He has a history of cardiomyopathy and has a pacemaker/ICD.   His initial blood work showed negative troponins but his BNP was elevated at 839.   An echo from a previous admission estimated his EF to be 25%. A previous cath report showed that the patient had a 40% left main and 80% circumflex blockage.   As you are making rounds on his 2nd hospital day,  he suddenly loses consciousness and becomes apenic.  A code blue is called. 0810  Placed on monitor.  Initial rhythm accelerated idioventricular rhythm/ventricular paced.  However, the patient is pulseless and apenic.  PEA.  CPR initiated with positive pressure ventilations. The arrows are markers that show that the monitor is se...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Asystole No ventricular or atrial activity is identified.   Check to make sure all the leads are connected.   Check to make sure all the wires are connected and that the monitor is in the correct lead.  Increase the waveform size to assess for fine ventricular fibrillation.   Begin CPR and give epinephrine 1mg or vasopressin 40 units as initial medications.  Look for reversible causes:  hypoxia,  hypovolemia, hydrogen ions (acidosis), hypothermia,  hyper/hypokalemia,  tension pneumothorax,  toxins/tablets, thrombosis coronary,  thrombosis pulmonary,  tamponade 2. Atrial flutter The rhythm is regular with a rate of 50/min.  There are flutter waves between each QRS complex.  No ectopic beats are seen.  PR:  ---,  QRS:  .12 sec,  QT:  .32 sec. ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Accelerated junctional rhythm with a PVC The rhythm is irregular due to the PVC.  The rate is 70/min.  No P waves are present.  A single PVC begins the rhythm strip.  PR:  ---,  QRS:  .08 sec,  QT:  .44 sec. 2. Atrial paced The rhythm is regular with a rate of 62.   Pacer spikes precede each P wave (seen best in the V1 lead).  No ectopic beats are seen.  PR:  .24 sec,  QRS:  ..12 sec,  QT:  .40 sec. 3. Idioventricular rhythm The rhythm is regular.  The rate is 35/min.  No P waves are present.  The QRS complex is wide and there is down slopping of the ST segment.  PR:  ---,  QRS:  .16 sec,  QT:  .48 sec. 4. Normal sinus rhythm with multifocal PVCs The rhythm is irregular with a rate...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Atrial fibrillation with rapid ventricular response The rhythm is irregular with a rate of 170/min.   No P waves are seen but some fibrillatory activity is noted.  No ectopy is present.   PR:  ---,  QRS:  .08 sec,  QT;  .28 sec. 2. Normal sinus rhythm The rhythm is regular and the rate is 93/min.  The P waves are upright and wide suggesting left atrial enlargement.  No ectopic beats are present.  PR:  .14 sec,  QRS:  .12 sec,  QT:  .34 sec. 3. Normal sinus rhythm with a PAC The rhythm is irregular due to the PAC.  The rate is 60/min.   The P waves are upright and precede the QRS complexes.   The 8th complex arrives early in the cardiac cycle.   The P wave is buried within the T wave of the preceding complex thus changing the shape of the ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. 1st degree block The rhythm is regular with a rate of 75/min.   There are upright P waves associated with each QRS complex, however, the PR interval is prolonged.  No ectopic beats are identified.  PR:  .28 sec,  QRS:  .10 sec,  QT:  .38 sec. 2. 2nd degree block type I The rhythm is irregular and the rate is 50/min.   There are upright P waves present but the P waves following the 1st and 3rd complexes are not conducted.   There is progressive prolongation of the PR interval.  No ectopy is present.   PR: ---,  QRS:  .10 sec,  QT:  .52 sec. 3. Sinus arrhythmia with a U wave The rhythm is irregular with a rate of 80/min.  There are upright P waves that precede the QRS complexes.  There are U waves that follow the T waves.   ...