1. CARDIAC RHYTHMS AND THE EMT

2. What We Need to Know:
V-Fib
V-Tach
Asystole

3. What We Want to Know: How come it does that What it isn’t
What it’s going to be

4. EMT DEFIBRILLATION 10 COMMANDMENTS
I. Thou shalt save a life.
II. Thou shalt act professionally.
III. Thou shalt never ignore the patient.
IV. Thou shalt follow standing orders.
V. Thou shalt know ventricular fibrillation with all your heart.

5. VI. Thou shalt act fast.
VII. Thou shalt act cautiously.
VIII. Thou shalt document the care you give.
IX. Thou shalt maintain the equipment.
X. Thou shalt never screw up.

8. Cardiac Cycles Make Us Smile

9. Normal Sinus Rhythms Make Us Very, Very Happy

10. Hook ‘em Up: 3-lead

11. Hook “em Up: 5-Lead

12. We Should See: Itty bitty boxes, itty boxes, & big boxes
Itty bitty boxes=.05 seconds
Itty boxes=.20 seconds
Big boxes=1 second

13. Normal Sinus Rhythm 60-100 beats per minute
Each complex is complete: P wave, QRS complex, T wave
No untoward, wide, bizarre, ectopic, early, late, or different looking complexes
All intervals within normal limits

14. Sinus Arrhythmia 60-100 beats per minute 100-160 beats per minute
Each complex is complete: P wave, QRS complex, T wave
No untoward, wide, bizarre, ectopic, early, late, or different looking complexes
All intervals except the R-R are within normal limits

15. Sinus Tachycardia 100-160 beats per minute
Each complex is complete: P wave, QRS complex, T wave
No untoward, wide, bizarre, ectopic, early, late, or different looking complexes
All intervals within normal limits

16. Sinus Bradycardia Rate less than 60 beats per minute
Each complex is complete: P wave, QRS complex, T wave
No untoward, wide, bizarre, ectopic, early, late, or different looking complexes
All intervals within normal limits

17. Junctional Rhythm 40-60 beats per minute No preceding P wave or..
Occasionally the P waves have a retrograde conduction either before or after the QRS complex
QRS and the T wave are usually normal

18. Atrial Fibrillation Irregularly irregular rhythm
Ventricular rate will vary
No P waves
Undulating base line

19. Atrial Flutter
P waves take on a saw-toothed appearance, become flutter ‘f’ waves
R waves may appear regular
Atrial rate is / minute
Several flutter waves for each R wave

20. Ventricular Tachycardia
beats per minute
Only wide, tall, bizarre-looking complexes
QRS greater than 0.12 second (3 itty bitty boxes, wide, weird-looking

21. Ventricular Fibrillation
Uncoordinated firing of ventricles like a ‘bag of worms’
Does not generate a pulse
Completely incoordinated electrical activity without any discernible complexes
All waves are f waves

22. Asystole No pulse Less than 5 beats per minute Occasional agonal beats
No complexes

23. Pulseless Electrical Activity
Electrical impulse is generated, but cardiac muscle does not respond
Rhythm can be anything
Treatment is CPR
PALPATE PULSES

24. Premature Ventricular Contractions (PVCs)
Rate depends on the underlying rhythm. Do not count the PVCs
Wide, bizarre, early and different-looking complex.
No P waves are present before the PVC

25. Let’s Get Worried
Paired PVCs
Multiform PVCs

26. More Worries
Bigeminy
R-on-T

27. What do you think? Torsades De Pointes Regular or irregular
Rate beats per minute
P wave hidden
QRS complex usually wide, twisting above and below baseline
May start and stop suddenly

28. And as long as we’re worrying…..
ST Elevation
May signify injury

29. Artifact: Loose electrodes Dried gel Muscle tremor or patient movement
Broken cable tips or wires
60-cycle interference

30. Artifact
60-cycle interference
Tremors
Patient movement
Tapping

31. Artifact Patient brushing teeth Patient swinging telemetry
Respirations

32. And finally…. If the monitor looks like this:
And the patient looks like this:
Check your leads

34. Cause to Worry?

36. What’s this?

37. What’s this?

38. What’s this?

39. What are we going to do about it??
SHOCK EM!!

40. Defibrillation Procedure
Determine need
Assess patient
Witnessed/non-witnessed arrest—shock as soon as equipment is ready
Follow with 2 minutes of CPR

41. Shockable Rhythms
Pulseless V-Tach
V-Fib

42. Non-Shockable Rhythms:
Asystole
PEA—Pulseless Electrical Activity
Can show as ANY rhythm on the monitor

43. Defibrillation Procedure
Attach monitor
Properly place pads
Set Defib power
CLEAR THE PATIENT
Place paddles on chest with aprox. 25# of pressure

44. Defibrillation Procedure
Deliver shock
Immediately provide 2 minutes of CPR
Re-assess patient
Repeat shock as needed

45. Cautionaries:
Do not dump load through open-air discharge or paddle-to-paddle
Keep paddles clean
Keep your hands and patient’s chest as dry as possible

46. Document: By voice recording By maintaining rhythm strips
By trip report

47. Trouble-shooting Loose cables/electrodes Patient movement
Defib power not turned on
Low battery

48. Maintenance: Schedule routine maintenance checks Check battery
Check defib operation
Check monitor paper
Check wires for wear
Document maintenance checks

49. Questions??