Recognizing heartrhythm disturbances in PSG Ann Ryckx

Arrhythmias Any change in the normal sequence of the electrical impulses from the sinus node (SA) to the ventricles can cause arrhythmia

P-wave: contraction of the atria QRS-complex: contraction of the ventricles T-wave: recovery of the ventricles

ECG in PSG Mostly only 1 channel Recognition of heartrhythm disturbances Not a diagnostic tool for other heartpathologies s.a. signs of ischaemia

Tachy-arrhythmia (too fast: > 100 bpm) Brady-arrhyhthmia (too slow: < 60 bpm)

Atrial arrhythmia An atrial arrhythmia is an arrhythmia caused by a dysfunction of the sinus node or the development of another atrial pacemaker within the heart tissue that takes over the rhythm of the sinus node

Sinus Tachykardia A condition in which the heart rate is faster than 100 beats per minute because the sinus node is sending out electrical impulses at a rate faster than usual

Supraventricular tachycardia = paroxysmal atrial tachycardia

AF: Atrial fibrillation

Atrial flutter The electrical signals come from the atria at a fast but even rate. When the signals from the atria are coming at a faster rate than the ventricles can respond to, the ECG pattern develops a "sawtooth" pattern, showing two or more flutter waves between each QRS complex.

Atrial extra systoly = premature beat

Ventricular arrhythmia A ventricular arrhythmia is an arrhythmia caused by a dysfunction of the sinus node an interruption in the conduction pathways the development of another pacemaker

Atrial ventricular Block AV Block

Atrial ventricular AV Block 1st degree Prolonged pr-interval (>200 msec)

Atrial ventricular AV Block 2nd degree Wenckebach. Progressive prolongation PR interval until a p-wave is blocked Mobitz Type II: pr-interval constant, evt. shorter after a p-wave block

Atrial ventricular AV Block 3d degree No atrial impulses reach the ventricles Possibly lifethreatening if the subsidiary pacing in the ventricles is not sufficiant

Ventricular tachycardia !! Life threatening !!

PVC: Premature ventricular complexe

Bigeminy

Trigeminy

Multifocal PVC

Ventricular tachycardia

Ventricular flutter !! Emergency !!

Ventricular fibrillation !! Emergency !!

Asystoly !! Emergency !!

CPR Cardio Pulmonary Resuscitation Newest guidelines

Step 1: check consciousness

Step 2: call for help

ABCD of basic life support Airways B Breathing C Check circulation D Defibrillation

Check and free the upper airway

Hyperextension, lift the chin

Close the nose, hyperextension

2 breaths, deep and slow

Check the circulation: carotis

Automatic External Defibrillation (AED)

No circulation: No AED available Basic Life Support 15 compressions on the chest 2 breaths Same rhythm, even if 2 reanimators

Check for the lower ribs

Lower third of the sternum

Arms stretched, 4-5 cm impression, rhythm 100/min.

15 compressions / 2 breaths

No circulation AED available In case of fibrillation or ventricular tachycardia connect the patient to the AED , perform analysis Without pulse: defibrillation Repeat ABC No result: restart BLS and defibrillation after 1 minute No fibrillation: BLS

Automatic External Defibrillation (AED)

Automatic External Defibrillation (AED)

Safetyposition after reanimation

THANKS !!

Reanimation child > 8 years old

Hyperextension, mouth to mouth breathing

Reanimation child < 8 years old

Reanimation pediatrics

Hyperextension

Hyperextension: push to chinbones forward

Mouth to nose breathing