Presentation is loading. Please wait.

Presentation is loading. Please wait.

CARDIAC RHYTHMS AND THE EMT

Similar presentations


Presentation on theme: "CARDIAC RHYTHMS AND THE EMT"— Presentation transcript:

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.

6

7

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

33

34 Cause to Worry?

35

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??


Download ppt "CARDIAC RHYTHMS AND THE EMT"

Similar presentations


Ads by Google