1. You Are Now Entering The IMC/TeleUNIT

2. Designed to provide care for those who need less monitoring than those in the Intensive Care units, but, still require more monitoring than those on a regular medical or surgical units. What is an IMC unit? INTERMEDIATE CARE UNIT

3. Provides for continuous electronic monitoring. Patients are not necessarily in a critical state but do have a cardiac history. What is a TELEMETRY unit?

4. Nurses Nurse Manager CNA’s Telemetry monitor Techs Doctors (Internal Med, Cardiologists, Electrophysiologists, Endocrinologists, etc.) RT, OT, PT, ST, Radiology Techs, etc. THE IMC/TELEMETRY TEAM

5. ER ICU OR Med/Surg floor Nurse/Patient ratio 1:3 to 1:5 Where do the patients come from?

6. GI bleeds Arrhythmias MI’s Respiratory distress Angina Pectoris Infections CHF Pancreatitis Pneumonia Post Surgery Acute Renal Failure Most Common Conditions

7. Patient is admitted EKG monitor put on Equipment placed in room Treatment occurs –Tests, procedures, medication Time on unit – 1 day to one month (average of 4 days) Now What?

8. Common Equipment Heart monitors –electrodes Suction canisters VS machine

9. Common Equipment EKG monitor screen Oxygen hook up –Nasal cannula, masks IV pumps and poles

10. Focusing on cardiac labs Cardiac Markers Measured to evaluate heart function. They are often discussed in the context of MI’s, but other conditions can lead to an elevation in cardiac marker level. Elevation usually means there has been heart damage Cardiac Enzymes –Troponin –CK –CK-MB LABS

11. CODE BLUE http://www.youtube.com/watch?v=4EWlNpKrCuc

12. What does an EKG tell you? It shows you the electrical activity of the heart.

13. I am glad you asked!!!! P wave – tells you when the atrium is contracting QRS complex - the contraction of the ventricles T wave – the relaxation of the ventricles Ok NOW How do I read it?

14. Strips are printed in 6 sec. strips. To calculate rate - you count the number of beats per strip if rhythm is regular. Measure each component of each heart beat to determine if it is normal or abnormal. Ok NOW How do I read it?

16. H ECG ComponentTime(sec) Small square0.04 Large square0.20 P Wave0.10 PR Interval0.12 - 0.20 QRS0.04-0.08 Measurements of Each Component

17. EKG Rhythm Examples This is Normal Sinus Rhythm. ALL parts of the beat are present. Everything is working as it should and the rate is WNL.

18. EKG Rhythm Examples This is Sinus Bradycardia. ALL parts of the beat are present. The rate however is < 60 bpm.

19. EKG Rhythm Examples This is Sinus Tachycardia. ALL parts of the beat are present. The rate however is > 100 bpm.

20. EKG Rhythm Examples This is Sinus Rhythm with Premature Ventricular Contractions (PVC’s). ALL parts of the beat are present. However, the ventricle occasionally beats early.

21. EKG Rhythm Examples This is Atrial Fibrillation. No definable P or T waves. Irregular rhythm and rate usually 100-160 bpm. Atrium is beating about 200-300 bpm

22. EKG Rhythm Examples This is 1 st Degree Heart Block. P waves are longer than one block (0.10 sec).

23. EKG Rhythm Examples This is 3rd Degree Heart Block (Complete HB). P waves are consistent BUT NO message being sent to the ventricles. Slow rate (ventricle rate)

24. What’s Next? Transfer to another floor ICU Discharge

25. NOW IT IS YOUR TURN TO PRACTICE!!!!