...electrical shock to “shockable” heart rhythms. What are “shockable” heart rhythms? The heart has its own electrical system that triggers the contraction of the heart muscles. It is responsible for the control of all of the events that occur in the heart during pumping out of blood to the circulation. When there are problems within the heart, blood vessels and electrolytes may cause a disruption of the electrical system and may result in arrhythmia. Arrhythmias are problems with the conduction of electricity in the heart that causes abnormal heart rhythms. There are a number of arrhythmias but not all of them are treated with defibrillation. The only “shockable” arrhythmias are pulseless ventricular tachycardia and ventricular fibrillation. Both of these arrhythmias may cause cardiac arrest. Ventricular tachycardia is the fast, regular beating of the ventricles. During this arrhythmia, there is decreased blood that is pumped through the circulation because there is also a little amount of time for the ventricles (the chambers of the heart that fills during relaxation) to fill. Since the...
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...Exercise-induced arrhythmias can be determined by answering similar questions to those posed when evaluating an ECG at rest: * What is the atrial rhythm? In the normal heart, P waves should be clearly identifiable because they occur prior to every QRS complex. Identification of a P wave may be difficult at high heart rates during exercise because the P wave may be superimposed on the T wave of consecutive beats. * What is the ventricular rhythm? In the normal heart the duration of the PR interval and the QRS complex are shortened. * Is the AV conduction normal? QRS complexes should always be preceded by a fixed PR interval. * Are there any unusual complexes? The morphology of some ECG parameters may change throughout exercise in a predetermined fashion (discussed later); however, P waves, QRS complexes, and T waves will have the same nomenclature in a single lead at any given time. * Is the rhythm dangerous? Dangerous rhythms that indicate the need to stop exercise immediately during stress testing include ventricular fibrillation (VF), sustained ventricular tachycardia (VT), and ST-segment elevation (≥1 mm) in leads without diagnostic Q waves (other than V1 or aVR). Relative ECG stop test indicators include ST or QRS changes such as excessive ST-segment depression (>2 mm of horizontal or downsloping ST-segment depression) or marked axis shift; arrhythmias other than VT including multifocal PVCs, triplets, supraventricular tachycardia (SVT), heart block, and bradyarrhythmias;...
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...PULSELESS ELECTRICAL ACTIVITY Pulseless electrical activity refers to a cardiac arrest situation in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse but is not. Under normal circumstances, electrical activation of the cardiac muscle cells precedes mechanical contraction of the heart. Pulseless electrical activity is also referred to as PEA or, by the older term, electromechanical dissociation. Pulseless electrical activity is the clinical condition characterized by unresponsive and lack of a palpable pulse in the presence of organized cardiac electrical activity. Electrical activity is a necessary but not sufficient condition for mechanical activity. In pulseless electrical activity, the heart either does not contract or there are other reasons why this results in an insufficient cardiac output to generate a pulse and supply blood to vital organs. This condition is usually noticed because a person loses consciousness and stops breathing spontaneously. This is confirmed by examining the airway for obstructions, observing the chest for airway movement (rise and fall, and feeling a pulse (which is usually the carotid pulse) for a ten second period. The possible causes of pulseless electrical activity is remembered as the six Hs and the six Ts. The six Hs are as followed: hypovolemia, hypoxia, hydrogen ions (acidosis), hyperkalemia/hypokalemia, hypoglycemia, and hypothermia. The six Ts are also as followed: toxins (drug overdose)...
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...Cardiopulmonary Arrest PNCI - Learner Robert Johnson Age: 60 Weight: 70 kg Base: Stan D. Ardman Patient History Past Medical History: Hypertension well-controlled by medication, hypercholesterolemia and obesity; minor car accident three weeks ago in which he sustained whiplash Allergies: No known drug allergies Medications: Lopressor (metoprolol), Zocor (simvastatin) Code Status: Full Code Social/Family History: Married with two adult children who live locally; Does not smoke, drink or use illicit drugs Handoff Report Situation: The patient is a 60-year-old male in room 425 on the Orthopedic Unit who is recovering from an anterior-posterior interbody fusion of L4 – L5 performed two days ago. His has had an uneventful recovery. He is in his room eating breakfast. Background: Hypertension, hypercholesterolemia and obesity. The hypertension has been well controlled by his medication. He is wearing a soft neck collar for support following a minor car accident three weeks ago in which he sustained whiplash. The patient has no known drug allergies and is awake and alert. Assessment: Vital signs: HR 87, BP 128/62, RR 18, SpO2 has been 98% on room air, Temp 37.1oC Cardiovascular: No telemetry; HR regular Respiratory: Clear in both lung fields GI: Advanced to full liquid diet and tolerating it well GU: Voiding clear, yellow urine Extremities: Pink, warm and with adequate turgor; Movement is strong in all four extremities (4+) Skin: Warm and dry; No signs of infection...
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...Heart Attacks in Youth Jennifer Velasquez HCS/457 January 16, 2012 Michelle Clemons Heart Attacks in Youth Headlines across the country are similar to a headline recently in La Center, Washington: Eighth Grader Collapses During First Day of Basketball Practice. Children collapsing during sporting events are becoming fairly common around the country. According to Caldwell (2011), “Studies show that 175 to 233 deaths occur each year among high school athletes” (para. 3). Most individuals are required by state law to pass a sport physical before him or her can even begin the first day of practice. Many individuals have different opinions as to why children are collapsing with heart issues. Health professionals locally, on state level and nationally are monitoring the findings and are trying to come up with a solution to minimize loss of life. Because so many children participate each year in physical sports, it is important to find out why children are coming up with heart issues and determine how to lower the amount of children from collapsing and prevent premature death. Functions at Various Government Levels Because children collapsing at sporting events has only recently started to become more common, the three levels of government; National, State, and Local levels have not began working to diligently on a solution. At least if they have, they are not disclosing available resources or much information at this current time. Therefore, locating information...
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...Demo 2 Patient Monitoring System Through Internet Patient Monitoring System through Internet is system used to track off the patient’s health statue. For example some this system will inform the doctor with patient’s heart’s pumping rate, blood’s pressure rate, and many other necessary things. Each activity in the body have different signal in this system so the doctor can differentiate each activity for what it belongs for. For instance if the activity was for brain’s signals it will be (ECG), for the heart (EEG), and for muscles (EMG). These signals called biological signals and made as a form of electrical signals. Bioelectrical signals show various biological activities. This system needs electrodes to extract signals from the body. This system works by attaching devices on special places on the patient body and each part in the body represents a special kind of signals. This system has several parts and one of these parts is Isolation Amplifier. Isolation Amplifier is made to transfer signals to system but also it’s a main reason for patient’s safety because it prevents signals from going back. Imagine that these amplifiers don’t prevent signals from going back. What would happen? Simply the system will cause the patient and electric shock. The second part is called Bio-potential amplifier, which it acts on bioelectric signals. Signal from patient is gone to increase level of signal by the bio-potential amplifier. All the amplifiers are made to recommend the...
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...Gustavo G. Blume 1, Christopher J. Mcleod 1, Marion E. Barnes 2, James B. Seward 1, Patricia A. Pellikka 1, Paul M. Bastiansen 1, and Teresa S.M. Tsang 2* 1 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; and 2Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada Online publish-ahead-of-print 12 May 2011 The interest in the left atrium (LA) has resurged over the recent years. In the early 1980s, multiple studies were conducted to determine the normal values of LA size. Over the past decade, LA size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes, including major public health problems such as atrial fibrillation, heart failure, stroke, and death. More recently, functional assessment of the LA has been shown to be, at least as, if not more robust, a marker of cardiovascular outcomes. Current available data suggest that the combined evaluation of LA size and LA function will augment prognostication. The aim of this review is to provide a critical appraisal of current echocardiographic techniques for the assessment of LA function and the implications of such assessment for prediction and disease prevention. ----------------------------------------------------------------------------------------------------------------------------------------------------------Keywords Left atrium † Left atrial function † Echocardiography Introduction The left...
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...COVER ARTICLE PRACTICAL THERAPEUTICS Acute Management of Atrial Fibrillation: Part I. Rate and Rhythm Control DANA E. KING, M.D., LORI M. DICKERSON, PHARM.D., and JONATHAN L. SACK, M.D. Medical University of South Carolina, Charleston, South Carolina Atrial fibrillation is the arrhythmia most commonly encountered in family practice. Serious complications can include congestive heart failure, myocardial infarction, and thromboembolism. Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or digoxin. Medical or electrical cardioversion to restore sinus rhythm is the next step in patients who remain in atrial fibrillation. Heparin should be administered to hospitalized patients undergoing medical or electrical cardioversion. Anticoagulation with warfarin should be used for three weeks before elective cardioversion and continued for four weeks after cardioversion. The recommendations provided in this two-part article are consistent with guidelines published by the American Heart Association and the Agency for Healthcare Research and Quality. (Am Fam Physician 2002;66:249-56. Copyright© 2002 American Academy of Family Physicians.) I Members of various family practice departments develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family Medicine at the Medical University of South Carolina. Guest editor of the series is ...
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...Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis. Lip GY, Edwards SJ. Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK. g.y.h.lip@bham.ac.uk Abstract OBJECTIVE: To compare the effectiveness of aspirin, warfarin, and ximelagatran as thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF). METHODS: Systematic review of randomised controlled trials in patients with NVAF treated with adjusted-dose warfarin and aspirin, fixed low-dose (FLD) warfarin, ximelagatran or placebo. Outcome measures studied were ischaemic stroke, systemic embolism, mortality and haemorrhage. Meta-analysis was performed using a fixed effects model. RESULTS: We identified 13 trials (n=14,423 participants) of sufficient quality to be included in the analysis. Adjusted-dose warfarin significantly reduced the risk of ischaemic stroke or systemic embolism compared with aspirin (relative risk [RR] 0.59; 95% confidence interval [CI]: 0.40 to 0.86), FLD warfarin (RR 0.36; 95% CI: 0.23 to 0.58), or placebo (RR 0.33; 95% CI: 0.24 to 0.45). However, aspirin and placebo had a lower risk of major bleeding compared to warfarin (RR 0.58; 95% CI: 0.35 to 0.97 and RR 0.45; 95% CI: 0.25 to 0.82, respectively). The oral direct thrombin inhibitor, ximelagatran was as effective as adjusted-dose warfarin in the prevention of ischaemic strokes...
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...Atrial Fibrillation Pathophysiology March 20, 2016 Introduction Atrial Fibrillation, commonly known as A-Fib or AF, is the most common type of persistent cardiac arrhythmia. AF effects only 2% of the population under the age of 65, but 9% of those over the age of 65 (Centers for Disease Control and Prevention [CDC], 2015). Many other cardiac diseases are seen with AF, either as a cause, or as a result of the atrial fibrillation. Left untreated, AF can result in tachycardia that causes ventricular dysfunction and/or heart failure, along with a significantly increased risk of thromboembolic stroke. I recently conducted an interview with my father who has had AF for nearly 20 years and I compared my findings in the literature against his experiences with the disease. Pathophysiology Atrial Fibrillation is a supraventricular tachyarrthymia. In the heart, ventricular rate is controlled by the conduction and refractory properties of the AV node and the progression of wave fronts entering the AV node. Calcium channels are accountable for the major depolarizing current in AV nodal cells. Beta-adrenergic receptor stimulation boosts AV nodal conduction, whereas vagal stimulation impedes AV nodal conduction. Sympathetic activation and vagal withdrawal, as with illness or exertion, speeds up the ventricular rate. After each atrial excitation wave that depolarizes AV nodal tissue, those cells become refractory for a time, preventing subsequent impulses from propagating...
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...Adult ACLS 2010 อ.นพ.อนทนนท อมสุวรรณโครงการจัดตัวรรณ โครงการจัดตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คดตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยงภาควชาเวชศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยรฉุกเฉิน คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์àeกเฉุกเฉิน คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์àeน คณะแพทยศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยร มหาวทยา"ยธรรมศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยร Key changes from the 2005 ACLS Guidelines Continuous quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal t ube placement Cardiac arrest algorithms are simplified and redesigned to emphasize the importance of hig h-quality CPR Key changes from the 2005 ACLS Guidelines Atropine is no longer recommended for routine use in the management of PEA/asystole There is an increased emphasis on physiologic monitoring to optimize CPR quality and detec t ROSC Key changes from the 2005 ACLS Guidelines Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia Adenosine is recommended as a safe and potentially effective therapy in the initial mana gement of stable undifferentiated regular mono morphic wide-complex tachycardia Topic in ACLS 2010 Management Management of Cardiac Arrest of Symptomatic Bradycardia and Tachycardia Management of Cardiac Arrest Management of Cardiac...
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...Atrial fibrillation is a heart condition which can cause an abnormally fast and irregular heart rhythm (see appendix one). AF can be initiated when the normal impulses produced by the sinus node are overwhelmed by rapid electrical discharges from the atria and neighbouring parts of the pulmonary veins (Klabunde, 2005). Episodes of AF are not always accompanied by symptoms, however chest pains, palpitations and shortness of breath can occur sporadically. The exact causes of AF can be debated, however it may be more common in specific groups of people. People suffering with hypertension, atherosclerosis and heart valve disease may be more prone to experiencing AF (NHS, 2013). Genetics may also be a growing factor in the pathogenesis of AF (Hong and Xiong, 2014). Studies have shown that 30% of individuals with atrial fibrillation had parents with atrial fibrillation (Fox, 2004). Treatments for AF may differentiate between individuals due to factors such as age, overall health and type of AF. Cardiologists may first try to discard the possibility of any underlying triggers for AF, such as hyperthyroidism. The main risk factor for AF sufferers can be increased chance of strokes occurring, therefore treatments may usually include anticoagulant medicines such as warfarin. Cardioversion (electric...
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...Introduction For the purpose of this assignment I have chosen to review a client with atrial fibrillation in a primary care setting. I will discuss the patient’s original presentation, including analysis and interpretation of his 12 lead electrocardiogram (ECG), diagnosis and subsequent management. Throughout the assignment I will discuss local and national guidelines and the evidence behind the chosen management for this client. For the purpose of this assignment the client will be referred to as Mr. Jones. Cardiac arrhythmias affect more than 700,000 people in England is one of the top ten reasons for hospital admission (Department of Health 2005). Atrial fibrillation (AF) is the most common and important cardiac arrhythmia, it the most common of all the arrhythmias seen in general practice. AF affects 5% of the UK population over the age of 65 years, rising to 10% in those over 75 years of age (Kirby 2005). The principal significance, both to the patient and the healthcare system is the increased risk of embolic stroke. Atrial fibrillation is associated with 15% of all strokes and with 36% of strokes in patients over the age of 60 (Hobbs 1999). Having a diagnosis of AF increases the risk of stroke five fold. It is an arrhythmia associated with serious morbidity, mortality and health service utilisation. AF and its complications now consume 1% of the United Kingdom National Health Service budget (Watson, Shanstila, and Lip 2007). Despite this it is an area that frequently...
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...Guide to Rhythm Strip Interpretation using six-step method How to use this guide: when you see an unfamiliar rhythm, analyze each part separately, according to the six step method. Put your answers in writing, and then compare. Don’t leap to conclusion about the name of the rhythm until you have completed all the steps. If the strip is composed of two distinct rhythms, analyze each one separately. For more info send email to: Joeniemczura@gmail.com rhythm | Rate | P wave | PR interval | QRS width | Clinical significance | treatment | Sinus rhythm | 60- 100 | Upright in lead II | 0.12 -0.20 | .06 - .10 | None. Patient will live three minutes. | None. treat failure and assess Sa o2 | Sinus bradycardia | Below 60 | Precede each QRS, normal shape | normal | normal | Normal in young athletic individuals; common in early post-inferior M.I.; may precipitate CCF | Oxygen. check for hemodynamic impairment; if present, atropine first then pacemaker using bradycardia protocol, possibly dopamine drip | Sinus tachycardia | 100- 160 | Precedes each QRS, normal configuration | normal | normal | Increased sympathetic outflow; hypoxia; hemorrhage | Oxygen. Treat underlying cause, do not correct the rate if a definitive cause is left untreated | Pemature Atrial Contraction (PAC) | A single beat faster than base rate | Different from normal, may be buried in preceding QRS | May be slightly long or normal | Could be normal slightly aberrant | Occasional ones insignificant; may be precursor...
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...unit (MICU). These signs included left sided facial drooping, non-reactive left pupil, right sided weakness in the upper and lower extremities, and the inability to speak. Along with the signs and symptoms of the stroke, a 12-lead EKG revealed that he also has atrial fibrillation. The initial computerized tomography (CT) scan of his brain revealed nothing, but a subsequent MRA (magnetic resonance angiogram) concluded that he did, in fact, have an occluded branch of the left MCA that eventually converted to become hemorrhagic and he was admitted to the MICU. The MRA also found a persistent left trigeminal artery, which is insignificant to his presenting disease process. Along with all of this, a two dimensional echocardiogram revealed some significant hearts problems that will be discussed later. I cared for this patient during the clinical shift on September 18, 2012. History and Physical The only history and physical that was available in this patient’s chart was some narrative comments from his daughter notated by the physician, and this is most likely due to the fact that the patient could not verbalize anything on his own. According to his daughter (who lives with the patient), AV has had atrial fibrillation for “a long time,” and has managed it with digoxin. He also has a history of hypertension that he manages with metoprolol, he has type II diabetes mellitus that he controls with his diet, and he has no surgical history whatsoever. Upon...
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