Cardiac dysrhythmia management & pacemakers LATEST APRIL 2023

Cardiac dysrhythmia management & pacemakers LATEST APRIL 2023 Cardiac dysrhythmias − Students to review slides 4-29 prior to class: this content will not be covered in NUR 4120 − Normal sinus rhythm • Answers to evaluation of rhythm will always be within normal limits • Rate: 60-100bpm Sinus node dysrhythmias − Sinus bradycardia • HR 60 bpm • Sinus node creates impulse at slower than normal rate • Characteristics of NSR but a slower rate − Etiology: sinus bradycardia • Sleep • Athletic training • Hypothyroidism • Vagal stimulation ▪ Vomiting, suctioning, pain • Medication ▪ CCB (decrease HR/BP), amiodarone, beta-blockers • Increased intracranial pressure • CAD/Acute MI • Hypoxemia • Altered mental status • Acute decompensated heart failure − Sinus bradycardia: clinical manifestations and management • Clinical manifestations: ▪ SOB altered LOC ▪ Hypotension ▪ EKG changes (ST segment changes PVC’s) • Management: ▪ Resolve causative factors ▪ Atropine 0.5 mg IV every 3-5 minutes  Maximum dose of 3 mg  Atropine won’t work on a patient with a heart transplant ▪ Emergency transcutaneous pacing ▪ Catecholamines − Sinus tachycardia • HR: 100-120 • Sinus node creates impulse at faster than normal rate • Does not start or stop suddenly − Etiology: sinus tachycardia • Physiologic stress ▪ Acute blood loss, anemia ▪ Shock ▪ Hyper/hypovolemia ▪ Heart failure ▪ Pain ▪ Hypermetabolic states ▪ Fever ▪ Exercise ▪ Anxiety • Medications ▪ Catecholamine ▪ Atropine ▪ Stimulants (caffeine, nicotine) ▪ Illicit drugs (Ecstasy, cocaine) − Sinus tachycardia: clinical manifestations and management • Clinical manifestations ▪ Decreased filling time of heart  Reduces cardiac output → Syncope → Hypotension