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5 Ventricular Rhythms

1. Idioventricular Rhythm (IVR)
2. Accelerated Idioventricular Rhythm (AIVR)
3. Ventricular Tachycardia (VT)
4. Ventricular Fibrilation (VF)
5. Asystole (Cardiac Standstill)

A kind of Ventricular rhythm that occurs when three or more ventricular escape beats occur in a row at 20-40 bpm (vent firing rate). P wave absent or irregular. QRS is wide and bizarre b/c normal conduction has been bypassed. T wave opposite QRS. <20 bpm is an Agonal Rhythm.

Idioventricular Rhythm (IVR)

A type of ventricular rhythm that exists when three or more ventricular beats occur in a row at 41-100 bpm. Considered a benign escape rhythm that occurs when sinus rate slows. P waves absent or irregular. T waves opposite QRS.

Accelerated Idioventricular Rhythm (AIVR)

A Kind of ventricular rhythm tat exists when three or more PVCs occur in a row at a rate greater than 100 bpm.

Ventricular Tachycardia (VT)

2 Lengths of VT

1. Sustained VT
2. Nonustained VT

A length of VT that persists for more than 30 seconds.

Sustained VT

A length of VT that is short and lasts no longer than 30 seconds.

Nonsustained VT

2 Kinds of VT

1. Monomorphic Ventricular Tachycardia
2. Polymorphic Ventricular Tachycardia

A kind of VT in which the QRS complexes are of the same shape and amplitude. Often a regular rhythm with visible P waves and similar looking QRS and T waves.

Monomorphic Ventricular Tachycardia

A kind of VT in which the shape and amplitude vary from beat to beat. The QRS appear to twist from upright to negative and vice versa. Irregular rhythm all around.

Polymorphic Ventricular Tachycardia

Two kinds of Polymorphic VT

1. Polymorphic VT with Normal QT
2. Torsades de Pointes (TdP) (Polymorphic VT with Long QT Syndrome (LQTS))

A kind of polymorphic VT that occurs in the presence of a long QT interval, a QRS that changes in shape, amplitude, and width ("twisting" around isoelectric line).

Torsades de Pointes (TdP) (Polymorphic VT with Long QT Syndrome (LQTS))

1. Recurrent syncope during physical or emotional stress
2. Sudden loss of consc. in adolescent
3. Any unexplained cardiac arrest in young person

All may indicate what?

Tordades de Pointes

4 Treatments for Stable Wide Complex Tachycardias (e.g., WPW, VT) per AHA

1. Chant
2. 6mg Adenosine rapid IV Push (repeat 2x at 12mg)
3. Consider Ca++ Channel Blocker (Diltiazim) or B-blocker (Metoprolol)
4. Synch Cardioversion (50-200 biphasic)

6 Treatments for Unstable Tachycardia w/ Pulse (WPW, VT, J-Tach)

1. Check SpO2
2. Prep Suction
3. Assure IV
4. Prepare Intubation
5. Consider Sedation
6. Deliver synch Cardioversion at 50, 100, 150, 200 J Biphasic.

A kind of ventricular rhythm that is chaotic b/c of the quivering of the ventricles. No effective contraction or pulse. The rhythm looks chaotic and varies in shape and amplitude.

Ventricular Fibrilation (VF)

10 Treatments for VF or Pulseless VT

1. Check pulse for <10seconds
2. Clear and Defib at 200J biphasic
3. Perform high quality CPR for 2 minutes after all defibs from this point on
4. Establish IV
5. Intubate and confirm tube placement
6. 1mg Epi now and every 3-5 min while pulseless
7. After 2min, check pulse/rhythm for <10sec, defib at 200J biphasic & resume CPR
8. 300mg Amiodarone, May repeat at 150mg in 5 min
9. After 2 min: check, defib, resume CPR
10. Continue with 2minutes of CPR followed by rhythm check, defib, and Rx as long as this rhythm persists.

The therapeutic delivery of an unsynchronized electrical current through the myocardium over a very brief period to terminate a cardiac dysrhythmia (usually at 360 Jmonophasic or 200 J Biphasic).

Defibrilation

2 "Shockable" Rhythms (i.e., by Defib)

1. VT
2. VF

2 "non-shockable" rhythms (i.e., no defib)

1. Asystole
2. PEA

A type of "ventricular" rhythm that represents the total absence of ventricular electrical activity. Displays no ventricular rate, rhythm, pulse or cardiac output.

Asystole

8 Treatments for Asystole

1. Confirm rhythm in a 2nd Lead
2. 2 Min of high quality CPR while searching for underlying cause
3. Est IV
4. Intubate and confirm placement
5. 1mg Epi Now and every 3-5 min as long as pulseless
6. After 2min: Check pulse/rhythm for <10sec, resume CPR
7. Continue with 2min cycles of high quality uninterrupted CPR followed by rhythm/pulse checks & Rx admin as long as rhythm persists.
8. Treat underlying cause of ______ by ____ and Transport.

A type of ventricular rhythm that has P waves, but otherwise looks like asystole.

Ventricular Arrest

A cardiac arrest situation in which a heart rhythm is observed on the ECG that should be producing a pulse, but is not.

Pulseless Electrical Activity (PEA)

7 Treatments for PEA

1. 2 Min of high quality CPR while searching for underlying cause
2. Est IV
3. Intubate and confirm placement
4. 1mg Epi Now and every 3-5 min as long as pulseless
5. After 2min: Check pulse/rhythm for <10sec, resume CPR
6. Continue with 2min cycles of high quality uninterrupted CPR followed by rhythm/pulse checks & Rx admin as long as rhythm persists.
7. Treat underlying cause of ______ by ____ and Transport.

5 Treatments for Pulselessness

1. Order 2 min of uninterrupted, high quality CPR
2. Order ventilation on high flow O2
3. Order IV and Intubation, confirming placement and monitoring ETCO2
4. Order 1mg Epi every 3-5 minutes while pulseless
5. Assess for underlying Causes

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