EKG Rhythms | ECG Heart Rhythms Explained - Comprehensive NCLEX Review

ECG interpretation is an important skill that you want to have and in this comprehensive video I'll cover some of the most important rhythms you'll need to know in nursing first let's look at normal sinus rhythm so in order to interpret an ECG you have to know what it should normally look like so with sinus rhythm this Rhythm originates from the SA node which is known as the sinoatrial node and the SA node is really the beginning part of the electrical conduction system and this is where we want our heart rhythms to originate so we have a normal rhythm in our patient now how do we know that we have normal sinus rhythm well let's look at these characteristics and criteria that tells us that we're dealing with normal sinus rhythm when you look at the ECG waveform you should note the p waves and there will be p waves present in front of every QRS complex and they should be upright measure less than 0.12 seconds and this tells us about the atrial Rhythm and rate so the atrial Rhythm for normal sinus rhythm should be regular and the ray should be be anywhere between 60 to 100 beats per minute also when you look at the PR interval it should measure between 0.12 to 0.20 seconds and if it measures greater than 0.20 seconds you could be dealing with a heart block and then when you look at the QRS complexes there should be one present after every P wave and they should measure no more than 0.12 seconds now this tells us about the ventricular Rhythm and rate so the normal sinus rhythm the ventricular Rhythm should be regular and the rate should be 6200 beats per minute it should actually be the same as the atrial rate there should also be a normal QT interval anywhere between 0.36 to 0.44 seconds and there should be a normal T wave after each QRS complex that should be round and upright and then finally the ST segment should be flat hence isoelectric so whenever you're looking at your patient's heart rhythm and you see that they meet all that criteria for normal sinus rhythm that is a good thing this is a normal Rhythm and it requires no treatment therefore as a nurse you want to just continue to monitor your patient by looking at those Telemetry strips looking at the cardiac monitor if they're on one just to make sure that they're not deviating from this Rhythm because many times patients do they may go into atrial fibrillation or sinus bradycardia or sinus tack or they develop a heart block where that PR interval is prolonged next let's look at sinus bradycardia sinus bradycardia is a rhythm that originates from the SA node which is known as a sinoatrial node however this Rhythm is a slow Rhythm and let the names of these rhythms help you Brady means slow and cardia means heart so we have a slow heart and with bradycardia what you have is a rate of less than 60 beats per minute and it's regular so what are the characteristics and criteria that tell you you're dealing with sinus bradycardia well when you look at the rhythm you're going to see that it has all the normal findings within its waveform as normal saunas Rhythm but it's going to be slow so whenever you look at the p waves they're going to look normal and our p waves tells us about the atrial rate and Rhythm so the atrial rate is going to be slow less than 60 but the rhythm is going to be regular also the QRS complex will be normal it will measure less than 0.12 seconds and the QRS complex tells us about the ventricular Ray and Rhythm so the ventricular rate will be less than 60 it should actually be the same as the atrial rate and the Rhythm will be regular furthermore the PR interval will be anywhere between 0.12 seconds to 0.20 seconds it will also have a normal T wave and a normal QT interval but it is important to note that the slower the rate the longer the QT interval could be because whenever you're right slower it makes that QT interval a little bit longer so a big thing what you want to remember about sinus bradycardia is that it is slow and it's going to be regular now let's look at the cause causes of sauna spray tocardia what could cause the heart to be at a slow rate well there are many causes of this so to help us remember those causes let's remember the word slow rates s is for six sinus syndrome this is a condition where that SA node is damaged so severely that it can't work as the pacemaker of the heart so the heart doesn't beat very fast it actually Beats at a slow rate and this condition can lead to other dysrhythmias as well such as like sinus arrest or Brady tacky syndrome L is for low thyroid hormone O is for older adult so as we get older so does our SA node and whenever it gets older it will cause her heart to be at a slower rate so that's why you may find that older adults have a naturally slower heart rate W is for weak and damaged heart muscles so if that patient has experience in my cardio infarction where there's been severe ischemia to that heart tissue it can damage the SA node because of that decreased blood supply also conditions that inflam aim or infect the heart like pericarditis can damage this area as well then we have R for Ray's intracranial pressure so a part of Cushing's Triad actually is a slow heart rate so if your patient has a slow heart rate the respirations are irregular and they have a wide and pulse pressure you want to think okay we have some issues with our intracranial pressure A is for athlete so people who are very well conditioned their heart will be at a slower rate T is for toxicity of certain medications so you want to be on the lookout for this group of drugs that could slow your patient's heart rate one group is called beta blockers and their generic names end in o-l-o-l like metoprolol another group is calcium channel blockers for example Verapamil and another drug is digoxin so remember whenever we give digoxin we also want to check the apical pulse and you don't want to give digoxin if the apical pulse is less than 60. e is for electrolyte imbalances so severe cases of hyperkalemia where that potassium level is very elevated it could cause bradycardia and then lastly stimulation of vagal response where it's either over active or the patient is having vomiting it can cause a patient to Brady down so now let's talk about the treatment for sinus bradycardia well with this Rhythm it doesn't always require treatment it depends on if your patient's having symptoms or not so look at your patient assess them ask them questions because you will know if they're having symptoms associated with this Rhythm and some symptoms you want to look out for is you want to make sure that they're not hypotensive that they're not having shortness of breath chest pain really fatigue they're getting clammy and sweaty that's telling you your heart's not perfusing and you need help but if they're not having symptoms like let's say they're a well-conditioned athlete or they're an older adult who's just had their SA node aged so they've been at a little bit of a slower rate usually in the 50s and they don't have signs and symptoms you just want to continue to monitor them but let's say you have that patient that's having signs and symptoms what do you want to do well you want to activate the emergency response system wherever you're at and get your patient treatment now treatment revolves around what's causing the sinus bradycardia so we'll find the cause and fix it for instance let's say they've had too much of a calcium channel blocker that dosage is just way too high for them we can stop it and hopefully that will correct it or if they have an electrolyte imbalance we can fix it now some other treatments that can be given are like medications and to help you remember those meds that can help increase that heart rate remember Aid Ade so you can give them atropine dopamine or epinephrine now some other things that can be done is we can give them temporary pacemaking so give them a temporary pacemaker to help Pace that heart and if they're really bad off they can get a permanent implanted pacemaker to help them with their heart rate now let's look at sinus tachycardia sinus tachycardia is a rhythm that originates from the sa no known as the Sino atrial node so whenever you look at this rhythm's name let the name help you tacky means fast and cardia means heart so we have a fast heart with sinus tachycardia the heart is beating at a fast rate usually greater than 100 beats per minute but it is regular now what are some characteristics and criteria that tells you you're dealing with sinus tachycardia when you go to look at the Rhythm on the ECG you're going to see that it has all the normal findings within the waveform as normal sinus rhythm but it's going to be fast you're going to see that it has normal p waves and our p waves tells us about the atrial Ray and Rhythm so the atrial rate will be fast greater than 100 beats per minute and its rhythm is going to be regular the QRS complex is going to be normal it should measure less than 0.12 seconds and you're actually going to notice it'll appear narrow especially if the rate is fast and our QRS complex tells us about the ventricular rate and Rhythm so the ventricular rate is going to be the same as the atrial rate greater than 100 beats per minute and the rhythm is going to be regular furthermore the prg intervals should be normal anywhere between 0.12 seconds to 0.20 seconds and the T wave will be normal along with the QT interval but it could be on the shorter side that QT interval because the rate is fast the faster the rate a little bit shorter it's going to be but overall the big takeaway with this rhythm is that it's going to be fast greater than 100 beats per minute and it's going to be regular now let's talk about the causes of tachycardia what can make your heart be very fast well there are a lot of causes so to help us remember those causes let's remember the phrase tacky Hearts T is for temperature elevation so whenever your patient has a high fever it increases the oxygen needs of the body so to meet those needs it causes your heart to be at a faster rate in hopes of Meeting those oxygen demands A is for air aerobics so any type of aerobic exercise will increase that heart rate which is a good thing we want to exercise that hard out sometimes C is for cardiac disease so if if a patient has a severe form of cardiac disease like with congestive heart failure or they've had a myocardial infarction that has really just damaged that heart it can cause that heart to be at a faster rate and we've really got to watch it because if the heart is beating too fast it can actually get too tired and it could lead to cardogenic shock then we have age for hyperthyroidism so in these patients sometimes sinus tachycardia may be their only symptom they go to the doctor they can feel their heart flying in their chest and they check their thyroid levels and it's elevated why is for Yelp which means pain so sometimes whenever patients are having pain that they cannot tolerate their heart rate will go up so this is one of those indicators to us as a nurse that we need to be looking to see okay I don't know of any other reason this patient is having this tachycardia think maybe your patient's in pain and they need their pain treated and this is especially true for patients who can't communicate pain to you maybe they're non-verbal or they're in a a state where they can't tell you H is for Hemorrhage or hypovolemic shock so one of the last ditch efforts during these things where a patient's bleeding out or having low fluid status is that the heart will increase in its rate in hopes of just trying to pump out more blood but in the end it won't be able to do that unless we treat it e is for emotional stress slash fear A is for anemia and again just trying to meet those oxygen demands then we have R for Respiratory conditions like pulmonary embolism pneumothorax chronic lung disease where the oxygen is decreased T is for therapeutic so medications can increase the heart rate like atropine albuterol dopamine epinephrine so if your patient is tachycardic look at their medication history see if they're taking any of these especially if they've maybe had a albuterol breathing treatment that can increase the heart rate and then lastly stimulants can do this like nicotine alcohol cocaine caffeine and amphetamines now let's look at the treatments for sinusachycardia so the thing with this Rhythm it doesn't always require treatment because it could just be the result of something that the patient's doing for example exercise we want the heart rate to get up during exercise that gives you a good cardiovascular workout but whenever you take that exercise away the heart rate goes down or if the patient's just extremely stressed they can cause their heart rate to go up but we remove that stress that goes down so in those cases whenever you can take it away and fix it it's good to go but sometimes that's not the case and it does require treatment therefore whenever this is the case we want to identify the cause and treat it and there's different types of tests that can be ordered to help us identify the cause so one type of test is like cardiac tests this can include a stress test an echocardiogram or a halter monitor this is a cardiac monitor that the patient wears and then they turn it in a cardiologist looks at their Rhythm and tries to determine hey what's going on with your heart rate we can also order labs to look at the thyroid levels make sure they don't have hyperthyroidism or look at the blood levels rule out anemia or any type of infection so look at that white blood count is it greater than 10 000 could indicate infection which could increase the heart rate and then we want to look at that medication history because they could be taking a medication that increase their heart rate or using a substance that does that in addition to that medications can be ordered to help slow down the rate and there's several groups of medications that can help slow the heart rate down one group of medications is called beta blockers and these medications are generic name tends to end in o-l-o-l for example like metoprolol also calcium channel blockers could be ordered like Verapamil or deltiazem to help slow that heart rate down and then sometimes the patient just simply needs some pain medication to help treat that pain to decrease the heart rate or antipyretics for fever our next rhythm is atrial fibrillation so afib is one of the most common rhythms you're going to see in a hospitalized patient and what's occurring with this rhythm is that the Atria are not beating like they Nation instead they're beating at a very fast irregular rate and what's happening in a sense is that those Atria are just quivering and whenever they quiver they don't pump blood very well instead blood just pulls in there which could lead a blood clot to develop which could eventually lead the patient to have a stroke now how can you tell that your patient is in afib well let's look at the criteria and characteristics for this Rhythm when you look at the ECG waveform you're going to see that p waves are not present before the QRS complexes instead the p waves are replaced with these irregular fibulatory wave which we call F waves and they can be either described as being fine or coarse depending on their amplitude now because of this you can't count the atrial rate but if you could the atrial rate would be really fast and irregular it would be greater than 400 beats per minute now when you look at the QRS complexes they will be present and they should measure less than 0.12 seconds now our QRS complex tells us about the ventricular right and Rhythm so the rhythm is going to be irregular and the right can be anywhere between being normal or it can be fast greater than 100 beats per minute now if it's greater than 100 beats per minute it's termed uncontrolled afib and whenever this occurs significant complications can happen because that heart is just beating way too fast it's not something like it should therefore heart failure can develop if we don't get this rate under control and if the rate is less than 100 beats per minute this is considered controlled afib and because of the presentation of this Rhythm you cannot measure the PR interval or the QT interval now what are the causes of afib well it can happen after heart surgery a lot of times after a person has some procedure on their heart it can cause them to enter this Rhythm or they have some significant heart problem like they have a valve problem especially problems with the mitral valve or they have coronary arteries disease they've had a heart attack or a pericarditis plus lung conditions can affect this especially like COPD and further Studies have shown that patients who have sleep apnea are at risk for developing atrial fibrillation so we definitely want to make sure we're screening patients for sleep apnea because they may be at risk for this abnormal heart rhythm so what's the treatment for afib well it really depends on the patient are they having symptoms are they stable or unstable is this patient having controlled or uncontrolled afib so the patient is stable meaning they have no symptoms and it's controlled so it's less than 100 beats per minute we want to make sure that we continue to monitor them and that that rate stays controlled and then notify the doctor for further orders if needed and if the patient's condition becomes unstable but let's say that the patient is unstable their blood pressure is dropping they have decreased cardiac output you can tell that this heart is just not able to maintain perfusion plus they have have an uncontrolled right well they're going to need a procedure called a synchronized cardioversion and with a cardioversion it's going to deliver a shock synchronize with the patient's R wave and convert them back to normal sinus rhythm now before the cardioversion you want to know how long the patient's been in afib because they may need anticoagulation prior to having the cardioversion to prevent blood clot problems and many times before a cardioversion a tee will be performed which is a trans-esophageal echocardiogram and it is where they use ultrasound they go through the patient's mouth down through the throat and they will go behind the heart through like the esophagus and they can take pictures of the heart and see if there are any blood clots present in the heart and if the patient doesn't have a blood clot they can be cardioverted now after the cardioversion patients may need for several weeks after the procedure some type of anticoagulation to prevent any blood clot problems now patients can also be cardioverted through pharmacological methods instead of through electrical methods and medications that can be used for that are like cardisime which is known as deltiazine also adenosine amiodarone or other types of medications and then some other medications that can be used that you want to be familiar with as a nurse are those anticoagulants one type is warfarin also known as coumadin and this is just going to help with clot formation preventing that and then the patient can be prescribed beta blockers for instance like propranol or calcium channel blockers they'll tiazem and pill form just to help maintain a normal rate and Rhythm and then sometimes the patient needs further treatment because sometimes it just doesn't work very well the patient continues to go in atrial fibrillation so they may consider doing an ablation and an ablation is a procedure that ablates hence that word means destroys or erodes some of the tissue in the heart to prevent it from abnormally firing like this in the future another rhythm is atrial flutter atrial butter also referred to as a flatter occurs because there is an abnormal electrical signal causing the Atria to contract very rapidly now atrial flutter is similar to atrial fibrillation that we talked about in the previous review but there are some differences that you want to be familiar with so what are some characteristics and criteria to tell you that you're dealing with a flutter well whenever you look at that ECG waveform you're going to see that there are no p waves but flutter waves that look like a Sawtooth and the Atria are firing very rapidly typically around a rate of 300 beats per minute give or take and its presentation will be regular now it's important to know that these waves that you see in front of the QRS complex are not p waves but abnormal P wave that we term flutter waves and they have this saw tooth appearance now this Sawtooth appearance is one of the key points in helping you discern atrial flutter from atrial fibrillation now when you look at the QRS complex it should measure less than 0.12 seconds and our QRS complex tells us about the ventricular right which can vary it can be regular or irregular but we don't want it to be too fast or too slow because this will affect how the heart can pump out blood hence our cardiac output and in this Rhythm you cannot measure the PR interval or the QT interval or assess the T waves now what can cause atrial flutter well anything that really affects the heart especially a heart valve problem where we have the tricuspid and the mitral valve involved or if the patient's had a myocardial infarction a heart attack it can cause this Rhythm or if they've underwent heart surgery plus if they have an overactive thyroid it could lead to atrial flutter now how do we treat atrial flutter well we really want to control that heart rate and we can do that by administering medications and so medications include calcium channel blockers such as deltaism also known as cardizem or administering beta blockers one type is like Propranolol or digoxin especially if the patient has heart failure because it'll help that heart pump more efficiently where it's weak from the heart failure and we can give antiarrhythmic drugs like amiodarone and one thing we really want to do with this rhythm is we want to prevent a blood clot from forming because those Atria are not Contracting as they should and blood can pull there and whenever we have blood pull in the heart it could lead to a blood clot so the patient may be on some anticoagulants such as Warfarin or also known as Coumadin to help prevent this now if this rhythm is persistent and the patient starts to develop symptoms where they become unstable we can do a synchronized cardioversion and this is where a shock is synchronized to the patient's r-wave so we will hopefully convert them back into normal sinus rhythm and then finally some patients need a procedure called an ablation and this is a procedure that ablates and that word means destroys or erodes some of the tissue in the heart to prevent it from firing abnormally next let's look at ventricular tachycardia what is ventricular tachycardia well it's an abnormal heart rhythm that originates from the ventricles hence why we call it ventricular tachycardia and the reason that this rhythm is occurring is because electrical conduction system is sending out an abnormal electrical signal that is causing those ventricles to just contract very rapidly and the problem with this rhythm is that these ventricles cannot pump Blood Out efficiently through the heart and if it can't do that cardiac output cannot be maintained so we really want to correct this as soon as we notice it now one thing you want to remember about this rhythm is that it can be short in duration and quip for example a patient can have a bunch of premature ventricular contractions also known as PVCs together like three or more in a row and we refer to this as v-tac or this Rhythm can be sustained where it's just continuing so what are some characteristics and criteria that tell you that you're dealing with ventricular tachycardia well the Hallmark finding in this rhythm will be its QRS complex and the QRS complex is really the star of this Rhythm it's really easy to identify because the QRS complex is going to be really wide it's going to be greater than 0.12 seconds and it's going to look bizarre therefore because of this the ventricular rate is going to be very fast anywhere between 100 to 250 beats per minute and the rhythm is going to be regular because of this you really can't assess the T wave in addition you can't assess p waves either so you won't be able to determine the atrial Ray or its Rhythm or assess the PR interval and as you can see here in this Rhythm what really catches your eye is this bizarre looking QRS complex it's very wide it's regular and you can see that it's very fast you can't really see any p waves no PR intervals or T waves and here this is a classic example of ventricular tachycardia now a couple things you want to remember about vtac is that it can have various presentations vtac can appear monomorphic and refer to this as monomorphic v-tac and this is where its presentation is the same throughout or it can appear as polymorphic and we refer to this as polymorphic v-tac and this is where the Rhythm does not look the same throughout but it's different and one type of polymorphic v-tac is called torsods the plant and you want to be aware of these different presentations Because treatment is slightly different for each now what can cause v-tac well if a patient is having abnormal electrolyte levels especially abnormal potassium like hypokalemia it can lead to this or if a patient has had a myocardial infarction where there's a lot of damage to that heart tissue which will affect how that electrical conduction system can work plus medication toxicity can lead to this like ditch toxicity or if a patient has heart disease specifically like heart failure coronary artery disease or some type of valve disease but now let's say that your patient is in polymorphic v-tacs such as torso a plant what could cause this Rhythm well one of the most common causes is that the patient is taking a medication that prolongs that QT interval such as amioderone sodol or procainamide so you wouldn't want to give your patient these medications for treatment of this rhythm in addition a low calcium magnesium or potassium level can cause it now let's talk about the treatment for vtac so with this Rhythm it requires immediate attention because it could easily progress to ventricular fibrillation which will lead to death now depending on where you're at how your patient is doing are they stable unstable they don't have a pulse you want to get help so some things you want to do is you want to activate the emergency response system you want to get supplies like Crash Cart defibrillator and you want to follow ACLS protocol so let's say that your patient is stable meaning they have no symptoms and they have a good pulse what can be ordered is like an antiarrhythmic medication such as amiodarone IV and if this doesn't convert them to normal sinus rhythm what could be considered is synchronized cardioversion which will help put that patient back into a normal Rhythm but let's say that your patient is unstable meaning they're having symptoms but they still have a pulse so their symptoms are revolving around decreased cardiac output because whenever that heart is pumping like this especially those ventricles it's not pumping very well so cardiac output will fall so you'll start to see hypotension mental status changes that pulse will be there but it'll be weak they'll be cool and clammy and they can have chest pain so what can be ordered for this is that synchronized cardioversion can be used where we can put them back into a normal Rhythm and then follow it up with like an antiarhythmic like amiodarone but now let's say we have worst case scenario our patient is in this Rhythm but they have no pulse well what you want to do is you want to start CPR immediately so you'll be doing chest compressions defibrillation giving epinephrine friend and then other medications can be given throughout that time where you're doing chest compressions and defibrillating such as like amiodarone or lidocaine and then in addition you want to be securing that Airway now in regards to treatment for like let's say a polymorphic v-tac like torsods one thing that can be given is magnesium sulfate and then stopping any medications that prolong that QT interval so you would not want to give the patient amiodarone or propanamide because those increase that QT interval and of course if the patient is unstable has no pulse you'd want to treat it like the FIB with CPR and defibrillation and then once the patient is converted back to a normal Rhythm it may be necessary that they get an implanted ICD which is a cardioverter defibrillator to prevent any further episodes of this happening again now let's look at ventricular fibrillation what is v-fib well this is a rhythm that originates from your ventricles and the ventricles are really important for helping you squeeze blood out of your heart and maintain cardiac output so with this Rhythm what happens is that there's an abnormal electrical signal causing those ventricles to really just quiver they are not pumping and squeezing that blood out like they should so because of this what will happen is that cardiac output will fall so this rhythm is deadly and if it is not reversed or treated the patient can die within minutes so characteristics and criteria that tells you that you have ventricular fibrillation well this rhythm is fairly easy to identify it has a chaotic rapid Rhythm that has no organization to it instead what you see on that ECG strip is fibulatory waves that can vary in size this means that they can be coarse fibulatory waves and whenever you see this it means that the patient may have a better chance of being revived or you can see fine fibulatory waves which is similar to a flat line which we refer to as a Sicily and whenever you see these fine waves the chances are getting slim for that patient to be revived and then of course due to the nature of this rhythm you're not going to be able to see p waves QRS complexes T waves PR intervals or anything like that and here on this strip you can see a classic example of ventricular fibulation this is actually coarse fibulatory waves and again notice you cannot find and p waves QRS complexes T waves really what it looks like is just a bunch of squiggly lines on the ECG strip and these lines are being produced from our ventricles which are just setting in the chest quivering they're not Contracting like they should now what can cause v-fib well anything that affects the heart especially heart disease so if the patient has severe heart disease let's say they have a severe heart attack this could cause v-fib because with a heart attack you can get ischemia that can damage the heart muscle so much that will cause it not to pump efficiently and it can lead to this Rhythm plus any type of electrolyte imbalances especially ones that affect potassium levels so we have severely low or high levels that could cause v-fib in addition hypoxia can lead to this which is where we have low levels of oxygen in the blood and there's a lot of diseases that can cause low levels of oxygen in the blood especially diseases that affect their respiratory system and then lastly drug overdose can lead to this Rhythm as well now let's talk about the treatment for v-fib so again as I said earlier this rhythm is deadly so your patient isn't going to survive very long without treatment and they're going to be unresponsive they're not going to have a pulse so what you want to do is you want to get a help immediately so call a code or activate the emergency response system in your area and you want to start CPR immediately and follow ACLS protocol so you're going to be doing chest compressions defibrillation giving epinephrine and other medications like amiodarone lidocaine and securing that Airway and then if the patient is successfully resuscitated it may be necessary to consider an implanted ICD a cardioverter defibrillator to help treat any further episodes in the future our next Rhythm is a systole asystole occurs when there is no contraction in the heart and whenever you look at the word look at the letter A that means without and Sicily means contraction so whenever you put that together we have no heart contraction now what are the characteristics and criteria to tell you that you're dealing with asystole well this rhythm is actually one of the most easiest rhythms to identify out of all the rhythms you have to know as a nurse and what it looks like is a flat line on the ECG and there's no ECG waveform so you're not going to see a p q r s t on there at all and the ECG those electrodes are not picking up any heart contraction from the Atria or The ventricle so that tells you that this heart is not pumping now the thing about this whenever you see a flat line on an ECG you want to immediately check your patient always check them check their pulse and make sure everything is plugged in and attached because if those Telemetry wires become unplugged or an electrode isn't sticking right or you have a bad connection it can present as a systole and you don't truly have it so always check your patient now what can cause a systole well really anything that leads to death and many times what happens is that this patient is in a lethal Rhythm like v-tac or v-fib and it's untreated and it progresses so Sicily where this heart quits Contracting so whenever we take ACLS to help prepare us for these situations we're taught the H's and the t's so you want to be looking at those H's and T's as potential causes for this Rhythm and some of those include like hypothermia hypophalemia hypoxia toxins thrombosis tension pneumothorax and so forth so what is the treatment for a syst sleep so as a nurse whenever you find your patient in this you want to confirm that this is a Sicily check that pulse and if you have no pulse you want to immediately activate the emergency response system if this is calling code blue do that call 9-1-1 whatever steps you need to take then you want to start CPR immediately and then you want to check the Rhythm per acls's recommendation and asusly is not a shockable rhythm so we cannot defibrillate this Rhythm so you want to continue doing CPR doing Rhythm checks per protocol then some things that can be given you can administer epinephrine you want to support that Airway and then of course as you're continuing CPR and Rhythm checks you're going to be checking those H's and T's thinking about what could be causing this another Rhythm you'll want to know is pea which is pulseless electrical activity PA is a rhythm that whenever you look at the ECG you will see organization to it and what you will see in terms of organization can vary on the ECG you can see p waves with QRS complexes which makes it look like normal sinus rhythm sinus tack or sinus bradycardia and this makes its appearance seem like a normal finding but it's anything but normal because whenever you go to check your patient your patient will be unresponsive they will not have a Falls and they won't be breathing therefore pea is a life-threatening Rhythm and it indicates that your patient is in Cardiac Arrest therefore as a nurse It's always important that you check your patient you fill that pulse to confirm your findings with what you're seeing on that ECG reading now what causes pea well one big cause is hypoxia where the patient doesn't have enough oxygen in the blood another cause is hypovolemia like hypovolemic shock or an electrolyte imbalance where the potassium levels being affected where we have hypo or hyperkalemia or the patient has a blood clot like thrombosis or they've experienced some type of trauma or cardiac disease now what is the treatment for pea so as a nurse after you've confirmed that you do have PA you want to immediately activate the emergency response system call code blue call 9-1-1 and start CPR immediately so you'll be doing CPR you'll have a team of people helping you and you'll be doing Rhythm checks per acls's recommendations to see what kind of Rhythm you have now one thing you want to remember about PA is that it is a non-shockable rhythm we cannot shock this Rhythm so we'll just continue CPR until we have a rhythm that we can shock now some medications that can be given are like epinephrine and we'll be supporting the airway throughout this and throughout this time of trying to resuscitate this patient we'll be thinking of the H's and the t's what could be causing this pea for instance is it hypovolemia is it hypoxia is there toxins involved do we have a clot like thrombosis is there attention pneumothorax and so forth and finally let's look at the different types of Av heart blocks and the reason heart blocks occur in the heart is because there is some type of block in the electrical conduction system now there's various types of heart blocks you want to be familiar with and these types include first degree heart block second degree heart block and there's a couple of these there's a second degree type 1 which has several names it's sometimes referred to as mobitz type 1 or winky Bach and then we have second degree type 2 which is sometimes referred to as mobitz type 2 and then lastly we have the complete heart block which is referred to sometimes as third degree heart block so first let's take a look at first degree heart blocks so whenever you go to analyze this Rhythm you may think at first that you have some type of sinus rhythm but whenever you take a closer Peak you will see that it has a subtle little secret it actually has something up with its PR intervals the pr intervals will be prolonged hence they will be lengthened and with this Rhythm the PR interval will be greater than 0.20 seconds and this will occur regularly throughout the Rhythm and the reason that this is occurring is because electrical signal is able to go down through the Atria to the ventricles so you get the P wave and the QRS complex but it is is doing this slowly through that AV node which creates that longer PR interval so what are some characteristics and criteria this Rhythm must have in order to be a first degree heart block well whenever you look at this Rhythm it's going to look very similar to normal sinus rhythm the p waves are going to be normal the rhythm of the p waves which looks at our atrial rate will be regular it can have a rate between 60 to 100 beats per minute and then sometimes these rhythms can be a little bit slower so you may see sinus spray to cardio with a first degree AV Block in addition the QRS complex is going to be normal it's going to measure less than 0.12 seconds and the QRS complex represented our ventricular rates our ventricular rate can be anywhere between 60 to 100 beats per minute or slightly slower and it's going to be regular in addition you're going to have a normal QT interval but when you go to measure the PR interval it is going to be prolonged it is going to be greater than zero point two zero seconds and as you can see with this Rhythm here we have a prolonged PR interval that is the only difference between this and a sinus rhythm is this interval now to help you remember this heart block from all the other heart blocks you have to know remember we are dealing with first degree heart block first means one so we're dealing with really one big problem with this Rhythm we have a prolonged PR interval that is occurring regularly throughout the Rhythm now what causes first degree AV heart blocks well this can actually be normal in some patients and will continue to monitor it it can also be caused by a myocardial infarction or certain medications such as calcium channel blockers beta blockers and digoxin now what is the treatment for a first degree heart block well typically patients don't have signs and symptoms with this type of Rhythm and usually the only reason we know that a patient's in a first degree heart block is because they had a routine EKG where we could actually see it or we put them on a heart monitor and we could see the Rhythm and see that prolonged PR interval so we'll just continue to monitor them make sure they don't advance to another type of heart block or another type of abnormal Rhythm and if the patient has an extensive heart history they may need to be further evaluated by a cardiologist plus let's say they're on some type of medication that can do this that I listed earlier well those medications may need to be adjusted and this heart rhythm May resolve itself next let's look at second degree type 1 heart blocks also known as mobitz type 1 or winky box now the reason that this rhythm is occurring is because that electrical signal that's going from the Atria to the ventricles is getting progressively slower until it doesn't really stimulate the ventricles to contract hence produce a QRS complex so all of a sudden we will drop a QRS complex therefore the key to help you really understand this heart block from all the other types of heart blocks is that that PR interval is going to gradually start lengthening so whenever you look at that rhythm you're going to notice that the P wave is getting further and further away from the QRS complex and then all of a sudden there's a P wave but a missing QRS complex and then the cycle is just going to repeat itself again therefore whenever we look at the characteristics and criteria for this to be a second degree type 1 heart block you're going to see normal looking p waves and the p waves tell us about the atrial rate and atrial Rhythm so the atrial rate will be normal the Rhythm will be regular but the Hallmark is that we're going to have gradually longer PR intervals until we don't have a QRS complex behind a p way and this cycle will repeat itself again so whenever you do see those QRS complexes they will look normal and they will measure less than 0.12 seconds but some of those will be gone and because of that the ventricular Rhythm will be irregular and the ventricular rate will be slightly slower than the atrial rate now what can cause this type of heart block well a monocardial infarction can especially an active Mi that's affecting the inferior wall of of the heart because it's causing acute ischemia that's depriving that heart tissue of that oxygen it needs to function in addition medications can do this like calcium channel blockers beta blockers digoxin rheumatic fever and increased vagal tone now how is a second degree type 1 treated well first of all you want to assess your patient and see if they're having any symptoms if they're not you want to continue to monitor them and a cardiologist may be consulted just to further evaluate the patient sometimes they need medication to stop that slow that AV conduction system such as the calcium channel blockers beta blockers digoxin and that will help them but you also want to evaluate your patient make sure that they're not having a heart attack in mi and if they are they need treatment immediately now let's say your patient is having symptoms they're presenting with signs and symptoms that shows you that they're having low cardiac output that it's falling the heart's not able to pump blood and maintain itself so the patients having mental status changes they have a really weak pulse their blood pressure is severely low their pale their see all that's telling you hey my patient is not perfusing fast something's wrong so with this you want to activate the emergency response system wherever you're at and with this sometimes what will be ordered is atropine or temporary pacing now let's look at second degree type 2 which is also known as mobitz type 2. so the reason that this rhythm is occurring is because electrical conduction system is not sending a steady signal from the Atria to the ventricles because whenever it normally does that we get a P wave followed by a QRS complex and because that signal is not steady we're going to actually lose that QRS complex therefore what you want to remember is that the PR interval does not progressively get longer and longer and then all of a sudden we drop a QRS complex that happens in second degree type 1. in second degree type 2 that PR interval is going to stay constant meaning it's going to stay the same throughout that Rhythm and then we will lose a QRS complex at some point so whenever you look at the characteristics and criteria for this Rhythm you'll see the following the atrial rate will be normal 60 to 100 beats per minute and the Rhythm will be regular that PR interval is going to be constant it's going to stay the same and a PR interval can actually be normal or it could be prolonged Now The ventricle Ray will be slower less than 60 beats per minute and the reason for this is because we're missing some QRS complexes sometimes which throws off our ventricular Ray and the rhythm of the ventricular rate will be regular again because we're missing some complexes now whenever you do see the QRS complexes sometimes they can be y greater than 0.12 seconds or narrow less than 0.12 seconds and this depends really on where that block signal is within that conduction system now what are some causes of this type of heart block well an active my cardio infarction can cause this especially one that's affecting the anterior wall of the heart Advanced coronary artery disease followed by any type of structural damage to the electrical conduction system and then medications that slow the AV conduction systems such as calcium channel blockers beta blockers digoxin and so forth now what is the treatment for this type of heart block with this type of heart block it is considered worse than the second degree type 1 that we discussed earlier and the reason for this is because our ventricular Ray is on the slower side and when we slow down the ventricular rate it affects how much blood or heart can pump to our body and Keep Us Alive therefore it lowers cardiac output and because of this the patient is more likely to have symptoms with this Rhythm so if a patient does have symptoms that correlate with low cardiac output like low blood pressure weak pulls they're getting cold sweating mental status changes they need treatment so some treatment includes temporary pacing and then insertion of a permanent pacemaker now sometimes patients do have this Rhythm that ventricular Ray is able to maintain their cardiac output so they don't really have symptoms so if that's the case we would monitor them closely and consult with Cardiology for further evaluation that may include stopping certain medications to help with that AV conduction now lastly let's look at complete heart blocks also known as third degree heart blocks this type of heart block is the worst of all blocks and the reason is occurring is because electrical signal from the Atria isn't making it to the ventricles because normally remember whenever the Atria contract it creates the P wave and then right after that we have ventricular contraction which creates the QRS complex so on an EKG strip you should have P wave QRS complex P wave QRS complex and that shows you that signals traveling from the Atria to the ventricles causing contraction and it's working so well together but here in this rhythm you're going to have p waves and QRS complexes that aren't collaborating hence working together they're really independent of each other so over here there will be some p waves they're doing their own thing and then QRS complexes who are doing their own thing therefore when whenever we're looking at the characteristics and criteria to determine if this is a third degree heart block you're going to see the following regular p waves making that atrial Rhythm regular and its rate normal and the QRS complexes will be regular making the ventricular Rhythm regular but there will be less of those QRS complexes than p waves so the ventricular rate will be slower than the atrial rate now it's important to know that the ventricular rate can be 40 or less depending on what structure is firing for the ventricles causing it to contract and when you measure those QRS complexes the width can vary depending on what structure is firing so they can be narrow or wide so greater or less than 0.12 seconds in addition you can have variable PR intervals because again the P wave and the QRS complexes are independent now what could cause this type of heart block well the person could be born with it so it could be congenital or the person has severe heart disease or they have a myocardial infarction or they're taking some type of medication that they became toxic on like digoxin or they have structural damage to their heart that's affecting the electrical conduction system or there is a heart valve problem now what is the treatment for a third degree heart block well with this your patient's usually going to have some signs and symptoms because whenever the heart is beating like this those ventricles and Atria they're really being independent of each other it's not going to profuse your body so you're going to have a low cardiac output which you can present with a low blood pressure weak pulse mental status changes that patient just doesn't look good in their pill they're cold they're clammy all of that's telling you hey that heart is not pumping enough blood throughout the body to keep it alive and this could progress to death so what you want to do is you want to activate that emergency response system and this will get a team in the room to help you now some treatment that can be given to that patient is that atropine can be administered to help that heart pump more efficiently or the patient could be connected to a temporary pacemaker which will again get that heart beating correctly so we can maintain cardiac output it and then eventually the patient will need a permanent pacemaker implanted okay that wraps up this video on heart rhythms you'll want to know and if you want to see more videos on ECG interpretation NCLEX reviews and nursing skills you can click the link in the YouTube description below

Channel: RegisteredNurseRN

Views: 598,730

Keywords: ekg rhythms, ecg rhythms, heart rhythms, ecg heart rhythms, heart rhythms explained, ecg rhythms made easy, ekg rhythms made easy, ekg rhythms explained, ekg rhythms practice, ekg rhythms for dummies, ekg rhythms made simple, ekg nursing, ekg nclex, ecg nclex, ecg interpretation, ekg interpretation, comprehensive nclex review, nclex review, nclex, next generation nclex, heart rhythms next generation nclex, nclex exam, acls, acls rhythms, rn, nurse, nursing school

Id: RoU4s18DXI4

Length: 48min 44sec (2924 seconds)

Published: Mon Feb 27 2023