Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Ventricular Dysrhythmias

Definition/Etiology:

• PCCN Focus: Identification, Cause & Treatment
• Definition
  • Rhythm whose impulse is generated by the Ventricles, instead of the Sinus Node
  • Analogy – Stone in Pond
• Types & Etiology/Cause
  • Hypoxia
  • Electrolyte Disturbances
  • Medications
  • Injury to Myocardium
  • Injury to Electrical System
  • CAD/ACS

Pathophysiology:

• Cardiac Conduction Pathway
  • SA node (sinoatrial node)
  • INTERNODAL PATHWAYS (Atria Contract)
  • AV node (Delay)
  • His-Purkinje Network (Ventricles COntract)’
  • The SA node fires another impulse and the cycle begins again.
• Ventricular Dysrhythmia
  • Ventricles
    • A good analogy for this is the movement of water in a pond. If you drop a stone into one corner of a pond a neat ripple moves across the pond. In the same way, during a normal rhythm, electricity spreads smoothly from the pacemaker across the atria to the ventricles. If you drop stones randomly all over a pond you get choppy, messy waves moving in all directions.

Noticing: Assessment & Recognizing Cues:

• Decreased Cardiac Output
• Subjective
  • Unresponsive
• Objective
  • Vitals
    • N/A
  • Heart Sounds
    • NONE – Not Beating
  • Lung Sounds
    • NONE – Not Breathing

Interpreting: Analyzing & Planning:

• Labs – Drawn quickly when calling RR/CB
  • ABGs – Hypoxemia
  • Electrolytes – Decreased KCL/MAG
  • Troponin – Infarcts
  • BUN/Creatinine – Renal Function
• Diagnostics
  • ECG: (Most are wide and irregular)
    • VTach – Pulse vs No Pulse
      • Three or Wide & Irreg beats same shape
    • Torsades
      • Appears like Vtach except QRS twists around baseline
    • Vfib
      • Fibrillation waves with NO QRS
    • Asystole
      • Flatline

Responding: Patient Interventions & Taking Action:

• Rapid Response vs Code Blue
• ABCs First
  • Airway, O2, Heart Monitor and IV
• Pathways
  • Vtach + Pulse = Atrial Dysrhythmia Algorithm
    • Rate Control + Cardioversion (Sync Button)
  • Vtach – Pulse/Vfib/Torsades
    • Assess ABCs
    • CPR
    • Defibrillation
      • 120-200J biphasic
      • 360J monophasic
    • Epinephrine
    • Defib → Amiodarone
  • Asystole
    • CPR + Meds Only
    • NO Defibrillation
      • alt-ctl-del for the heart. If there is no power, that won’t work.

Reflecting: Evaluating Patient Outcomes:

• ECG Interpretation =Identify underlying cause!
• Algorhythm
• Monitor for signs of ↑ Cardiac Output
  • Rhythm stabilized
  • Vitals Stable
  • Good Mentation
  • Heart/Lung Sounds Normal

Linchpins (Key Points):

• Notice
  • Assessing signs of ↓ Cardiac Output
• Interpret
  • ECG
• Respond
  • Treating underlying cause
  • NO pulse = Immediate CRP
  • Follow Pathways
• Reflect
  • Return Stable Rhythm