1. Rhythm Strips Jessica Wagner UMSON

3. EKG Grid

6. Ventricular Rate 1 st method: Count the number of QRS complexes over the 6 second and then multiply by 10 The 2 nd method uses the small boxes. Count the number of small boxes for a typical R-R interval. Divide this number into 1500 to determine heart rate. In the second image, the number of small boxes for the R-R interval is 22.5. The heart rate is 1500/21.5, which is 69.8.

11. Ventricular Fibrillation Fibrillation is an uncontrolled twitching or quivering of muscle fibers (fibrils). When it occurs in the lower chambers of the heart, it is called ventricular fibrillation During VF, blood is not pumped from the heart  Sudden cardiac death results NO pulse http://health.nytimes.com/health/guides/disease/ventricular-fibrillation/overview.html

12. Causes of VF Conditions that can lead to VF include: – Ischemia of the heart muscle – Electrocution accidents or injury to the heart – Heart attack (#1 cause!) – Heart disease that is present at birth (congenital) – Heart muscle disease, including cardiomyopathies – Heart surgery – Narrowed coronary arteries – Sudden cardiac death (commotio cordis), typically occurring in athletes after an injury over the surface of the heart

13. Risk Factors Smoking Diabetes Hypertension

14. Symptoms A person who has a VF episode can suddenly collapse or become unconscious, because the brain and muscles have stopped receiving blood from the heart. The following symptoms may occur within minutes to 1 hour before the collapse: – Chest pain – Dizziness – Nausea – Rapid heartbeat – Shortness of breath

15. Diagnosing V Fib NEVER from a 12-lead EKG b/c it will look the same as asytole Cardiac monitor will show a very disorganized heart rhythm Go in the room and check on your patient (pulses?) “There is nothing to measure because your patient is dead… you better be doing CPR”

16. Treatment VF is a medical EMERGENCY!  TX STAT or death If person has VF episode at home: 911 – Place person’s head and neck in line with the rest of their body to make breathing easier – Start CPR by doing chest compressions Continue until person is alert or help arrives

17. Treatment (#1) VF is treated by delivering a quick electric shock through the chest using a device called an external defibrillator The electric shock can immediately restore the heartbeat to a normal rhythm, and should be done as quickly as possible Many public places now have these machines (AED)

18. Treatment An implantable cardioverter defibrillator (ICD) is a device that can be implanted in the chest wall of people who are at risk for this serious rhythm disorder The ICD can help prevent sudden cardiac death by quickly sending an electrical shock when ventricular fibrillation occurs Medicines may be given to control the heartbeat and heart function after 3 defibrillation attempts (i.e. amiodarone, vasopressin, epinepherine) – Antiarrhythmics agents: raise fibrillation and defibrillation threshold – Anticholinergic agents: reduce vagal activity  improves conduction – Vasopressor agents: augment blood flow