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CARDIAC RHYTHMS AND THE EMT. What We Need to Know: V-Fib V-Fib V-Tach V-Tach Asystole Asystole.

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Presentation on theme: "CARDIAC RHYTHMS AND THE EMT. What We Need to Know: V-Fib V-Fib V-Tach V-Tach Asystole Asystole."— Presentation transcript:

1 CARDIAC RHYTHMS AND THE EMT

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

3 What We Want to Know: How come it does that How come it does that What it isnt What it isnt What its going to be What its going to be

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

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

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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, itty boxes, & big boxes Itty bitty boxes=.05 seconds Itty bitty boxes=.05 seconds Itty boxes=.20 seconds Itty boxes=.20 seconds Big boxes=1 second Big boxes=1 second

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

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

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

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

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

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

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

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

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

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

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

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

25 Lets Get Worried Paired PVCs Paired PVCs Multiform PVCs Multiform PVCs

26 More Worries Bigeminy Bigeminy R-on-T R-on-T

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

28 And as long as were worrying….. ST Elevation ST Elevation May signify injury May signify injury

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

30 Artifact Tremors Tremors Patient movement Patient movement Tapping Tapping

31 Artifact Patient brushing teeth Patient brushing teeth Patient swinging telemetry Patient swinging telemetry Respirations Respirations

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

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34 Cause to Worry?

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36 Whats this?

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39 What are we going to do about it??

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

41 Shockable Rhythms Pulseless V-Tach Pulseless V-Tach V-Fib V-Fib

42 Non-Shockable Rhythms: Asystole Asystole PEAPulseless Electrical Activity PEAPulseless Electrical Activity Can show as ANY rhythm on the monitor Can show as ANY rhythm on the monitor

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

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

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

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

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

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

49 Questions??


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