Telemetry/ACLS review

Jason Morgan, RN, BS

ACLS Review• Intro/NSR: http://screencast.com/t/ezkKH8bxHpSt• Bradycardia: http://screencast.com/t/p9w8Y20S1l• Sinus tachycardia: http://screencast.com/t/R06x1rdrl• SVT: http://screencast.com/t/lE9pd7Le8vo• A-Fib: http://screencast.com/t/r2GUxo9vH• A-flutter/Heart Block: http://screencast.com/t/7LIr2bA2SBuF• V-tach: http://screencast.com/t/BtayDRNI• V-Fib: http://screencast.com/t/wouA6jwh• Torsades: http://screencast.com/t/eJLwqjvkb• Transport: http://screencast.com/t/vuZ5OfBOWR

3

Sinus Rhythm

Signal originates in SA node. You will see PQRST. On a 12 lead EKG you will see some waves that are inverted (AVR). This polarity and placement determines the normal inflection of the waves. With this baseline changes can be seen such as ST elevation, ST depression, as well as flipped or inverted T-waves to name a few.Tachycardia (>100 BPM) and bradycardia (<60 BPM)

Bradycardia

Sinus Tachycardia

6

SVT

Rapid heart rate: 150-250 BPM. Patients may feel lightheaded, dizzy, chest pain, SOB, anxious. Try a valsalva maneuver then attempt to slow the rate. Adenosine slows the rate, the dose is 6mg, 6mg, 12mg rapid IVP. Have the patient on the 12 lead. This will slow the rate and you could see the underlying rhythm. Calcium channel blockers and beta blockers can slow the rate as well. This can be transient. EP needs to see.

A-FibThe RR intervals follow no

repetitive pattern—they have been labeled as “irregularly irregular.”

While electrical activity suggestive of P waves is seen in some leads, there are no distinct P waves. Thus, even when an atrial cycle length (the interval between two atrial activations or the P-P interval) can be defined, it is not regular and often less than 200 milliseconds (translating to an atrial rate greater than 300 beats per minute).Adapted from UptoDate

A-flutter Atrial flutter is a relatively common

arrhythmia that can be deleterious by impairing the cardiac output and by promoting atrial thrombus formation that can lead to systemic embolization. It is characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min.

For many years, atrial flutter has been considered together with atrial fibrillation (AF). While some issues of therapy are the same, such as the restoration of sinus rhythm, the maintenance of sinus rhythm after cardioversion, slowing the ventricular rate, and prevention of systemic embolism, atrial flutter is quite distinct from atrial fibrillation Adapted from UptoDate

A-flutter with RVR (rapid ventricular rate)

A-flutterLooks

similar to SVT

Heart Block

Elongated PRI

PACER!

V-tach

V-fib

Torsades• Can look similar to

v-tach and v-fib at times

• Treat with 2 grams magnesium; dilute in 50 cc NS; DO NOT PUSH! – (unless it’s a code)

Transporting

• Defibrillator• Epi, Atropine, lidocaine• BVM• Suction• Phone• Helping hands