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Code Mnagment Repaired FEB 1 2017

This document discusses code management and review of critical care drugs. It begins by outlining the objectives of reviewing ECG tracings of bradycardia. It then provides details on interpreting ECG readings such as heart rate, rhythm, and intervals. The remainder of the document describes various types of atrioventricular blocks including first, second and third degree blocks. It also reviews drugs used to treat bradycardia like atropine and defibrillators. Examples of ECG tracings are provided for different types of blocks and bradycardia. References used in compiling this information are listed at the end.

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Mr. Tauqeer Ahmed Faculty Member FUCN
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24 views22 pages

Code Mnagment Repaired FEB 1 2017

This document discusses code management and review of critical care drugs. It begins by outlining the objectives of reviewing ECG tracings of bradycardia. It then provides details on interpreting ECG readings such as heart rate, rhythm, and intervals. The remainder of the document describes various types of atrioventricular blocks including first, second and third degree blocks. It also reviews drugs used to treat bradycardia like atropine and defibrillators. Examples of ECG tracings are provided for different types of blocks and bradycardia. References used in compiling this information are listed at the end.

Uploaded by

Mr. Tauqeer Ahmed Faculty Member FUCN
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Code Management and Review of

Critical Care Drugs

Reviewed by Mehtab Jaffer

Acknowledgement Azmat Jehan


Khan
1
Objectives
 Review the ECG tracing of bradycardia.

2
Normal Sinus Rhythm

3
ECG Interpretation
Rate 3. QRS (less than 0.10 seconds
1. RR interval width (and height)
2. Heart rate axis
Rhythm R wave progression
3. PP interval abnormal Q waves
4. P wave ST segment
width, height, shape, etc. T waves
5. PR interval (0.12 - 0.20 QT interval
seconds)
U waves
4
First Degree AV Block

 Rhythm:  Regular; can be irregular


 Rate:  Usually 60-100 BPM; Rhythm dep.
 P Waves:  Upright/Normal
 P-R Interval:  > 0.20 s (200 ms); Constant
 (Q)RS Complex:  0.04-.12 s (40-120 ms)

5
6
Second Degree AV Block (Mobitz I/ Wenckebach)

 Rhythm:  Atrial: Reg.; Ventr.: Regularly irreg.


 Rate:  Atrial: Normal; Vent.: Norm./Slow
 P Waves:
 Normal: extra P waves regular
 P-R Interval:
 Not constant; progressively
Lengthens - drops beat
 (Q)RS Complex:  Usually .04-.12 s (40-120 ms)
7
Second Degree Heart Block
Mobitz Type I/(Wenkebach)

PR PR PR DROPPED BEAT

8
Second Degree AV Block (Type II)

 Rhythm:  Atrial: Reg.; Ventr.: Regular or irreg.


 Rate:  Atrial: Normal; Ventricular: Slow
 P Waves:  Normal; extra P waves
 P-R Interval:  Constant on conducted beats (2:1, 3:1,
 4:1)
 (Q)RS Complex:  Usually .04-.12 s (40-120 ms)
9
Second Degree Heart Block (2º)
Mobitz Type II

PR PR DROPPED BEAT PR

10
Third-Degree AV Block

 Rhythm:  Atrial & Ventricular: Regular


 Rate:  Atrial: Normal; Vent.: 40-60; < 40
 P Waves:  Normal: extra P waves
 P-R Interval:  No Atrial/Ventricular Relationship
 (Q)RS Complex:  <0.12 s (120 ms) Junct.;> 0.12 Ventr.

11
Third Degree Heart Block (3º)
(Complete)

P P P P P

QRS QRS
12
3rd degree AV block

13
Lets practice

14
Third Degree complete AV block

15
Sinus Bradycardia

16
Atrial Ventricular Blocks (AV Blocks)
First Degree:

PRI longer than .20 sec


There is No Block at all just a delay in conduction.
Every P wave is married to a QRS; no missed
beats.
17
18
Atropine
 Atropine is the first drug used to treat bradycardia. It is classified as
an anticholinergic drug and increases firing of the SA Node by
blocking the action of the Vagus nerve on the heart resulting in an
increased heart rate
 Indications: Asystole
– PEA (rate < 60 beats/min)
– Sinus, atrial or node Bradycardia
– Unstable hemodynamic condition
Dose: Asystole / PEA
– 3 mg I.V ., single bolus
– 6 mg via tracheal tube
Bradycardia
– 0.5 mg I.V., repeated as necessary, maximum 3 mg
19
Defibrillations
(used for pacing)

Lifepak 20 with AED &


Pacer

Packard Code master XL


Life Pack 12 AED
2/8/2017 20
References
 American Heart Association Guidelines. (2010)
 BLS & ACLS (2010). Guidelines for BLS and ACLS.
 Clinical Protocol (Rev.Date. 2003). Management of
cardiopulmonary arrest and management of crash cart
handling during Cardio pulmonary arrest. The Aga
Khan, University, Division of Nursing Services. Prot
cli-M-010.
 ENA: Sheehy's Emergency Nursing, 6th ed., Copyright
2009 Mosby, An Imprint of Elsevier.
 Morton, P.G.,& Fontaine, D.K.(2011). Critical care
nursing; a holistic approach.( 9th ed.). Philadelphia:
Lippincott Williams & Wilkins.
2/8/2017 21
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