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Some rhythms are better than others Junctional escape rhythms are typically stable and may produce adequate cardiac output. indd 51 10/7/2011 4:18:07 PM RECOGNIZING CARDIAC ARRHYTHMIAS 52 slower and less stable, posing a risk for intermittent or permanent ventricular standstill. What the ECG tells you • Rhythm: Atrial and ventricular rhythms are regular but aren’t related. • Rate: Atrial rate, which is usually within normal limits, exceeds ventricular rate. A ventricular escape rhythm ranges from 20 to 40 beats/minute.
Five T’s • Tension pneumothorax • Toxins (overdose) • Thrombosis (pulmonary) • Thrombosis (cardiac) • Tamponade How it’s treated • Begin CPR immediately and check rhythm every 2 minutes. Establish an airway and IV or intraosseous access with minimal CPR interruption. Monitor airway with continuous waveform capnography. • Administer epinephrine every 3 to 5 minutes • Identify the cause of PEA and treat accordingly. The patient may need volume infusion for hypovolemia from hemorrhage; pericardiocentesis for cardiac tamponade; needle decompression or chest tube insertion for tension pneumothorax; surgery or thrombolytic therapy for massive pulmonary embolism; or ventilation for hypoxemia.
QRS complex: Duration usually remains within normal limits because the block commonly lies above the bundle of His; the complex is absent periodically. • T wave: Normal size and configuration but its deflection may be opposite that of the QRS complex. • QT interval: Usually within normal limits. Type I seconddegree AV block is known as the footprints of Wenckebach. indd 49 10/7/2011 4:18:06 PM 50 RECOGNIZING CARDIAC ARRHYTHMIAS What to look for • Usually no symptoms • Possibly a first heart sound that becomes progressively softer with intermittent pauses • Hypotension or syncope (if ventricular rate is low) How it’s treated • For most patients, treat the underlying cause.
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