EKG Quick view

9 strips to know for the Nclex

Normal sinus rhythm

Bradycardia

Ventricular Fibrillation (V Fib)

Ventricular Tachycardia (V Tach)

Atrial Fibrillation (A Fib)

Atrial Flutter (A Flutter)

SVT - Supraventricular Tachycardia

Torsades de Pointes

Asystole - flatline
5 Step
EKG INTERPRETATION

Heart rate Rhythm P wave PR interval QRS

(in seconds) (in seconds)
60 -100/min Regular Present before 0.10 - 0.20 Normal shape
each QRS, indentical (<5 small squares) < 0.12
P/QRS ratio 1:1

Heart Rate
8 x 10 = 80
1. Normal Sinus Rhythm
1 2 3 4 5 6 7 8
Rate - 60 -100
count the peaks - we have 8 here
multiply by 10 = 80 beats!

Rhythm

2. Rhythm - R peaks are evenly spaced apart. R R-R int. R R R R R R

To quickly measure this simply grab a paper

& mark 2 R peaks then just march it out.
The R peaks should be even every time.

P Wave
R R

3. P wave - which is our atria contracting

is it present? & does it have its buddy QRS?
P T P T
we need a P with QRS every time
Q Q
S S

PR interval (in seconds)

R

4. PR interval - basically measures the 0.2 sec

time it takes between atrial contractions

0.5 mV
5 mm

& ventricular contraction should be 5 mini P

boxes or less - or .10 - 2.0 seconds here. PR int.

QRS (in seconds) R-R int.

0.2 sec

5. QRS - Ventricles contracting

0.5 mV
5 mm

PR ST
seg. seg.

Is it present, upright & TIGHT! P T

Should NOT be wide should only be PR int. Q ST int.

S
3 boxes - .12 seconds here. QRS
int.
QT int.
EKG Quick view
9 strips to know for the Nclex

Normal sinus rhythm

Bradycardia

Ventricular Fibrillation (V Fib)

Ventricular Tachycardia (V Tach)

Atrial Fibrillation (A Fib)

Atrial Flutter (A Flutter)

SVT - Supraventricular Tachycardia

Torsades de Pointes

Asystole - flatline
9 ECG Strips on the NCLEX

1. Normal sinus rhythm

Treatment:
None - continue to monitor

Causes:
Being healthy

Memory tricks

Normal beat - evenly spaced

2. Bradycardia

Treatment:
BRADY Bunch Atropine ONLY if symptomatic
old TV show (slow times)
showing low perfusion (pale,
cool, clammy)
<60 Causes: ATROPINE

Vagal maneuver (bearing down),

Memory tricks
meds (CCB, Beta Blockers)
BRADYcardia
Below 60/min

3. Ventricular Fibrillation (V Fib)

Treatment:
1. V Fib - Defib #1 Defibrillation
immediately Stop CPR
to do it & before drugs!
*NO synchronization needed
2. Drugs: LAP - Lidocaine, L A P
Amiodarone, Procainamide
Causes:
Memory tricks Untreated V Tach, Post MI, LIDOCAINE
AMIODARONE
PROCAINAMIDE

E+ imbalance, proarrhythmic meds

Fib is flopping- squiggly line

4. Ventricular Tachycardia (V Tach) Memory tricks

Causes:
Post MI, Hypoxia,
Low potassium, Low magnesium
C
Treatment: C - Count a pulse
C - Cardiovert
1. Early Defibrillation! NCLEX TIP *Synchronize First
Apply defibrillator pads & Sedation
Call out & look for everyone to be

D
CLEAR!
Shock & IMMEDIATELY continue
chest compressions
Memory tricks D - Dead - NO PULSE
2. When to Shock? NCLEX TIP
D - DEFIB!!
V Tach with No pulse = Defibrillation
V Tach Tombstone pattern
*NO Synchronize
V Tach with Pulse = Cardioversion D - Don't wait
9 ECG Strips on the NCLEX II

5. Atrial Fibrillation (A Fib) Digoxin

Causes:
Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg. A T
Treatment:
Max 2.0
1. Cardioversion (after TTE to rule out clots)
*Push Synch 60
2. Digoxin - Deep Contraction
Check ATP Before giving:
A - Apical pulse 60
40 kg

T - Toxicity (Max 2.0 range) visual disturbances,

N/V, Anorexia P
P - Potassium below 3.5 - HIGHER risk for
Memory tricks toxicity
< 3.5
3. Anticoagulants: Warfarin (monitor INR, Vit.
No P wave = Fibrillation FloPPing K antidote, moderate green leafy veggies)
Potassium

K+

6. Atrial Flutter (A Flutter) Causes:

Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg.
Treatment:
DIGOXIN

1. Cardioversion (after TTE to rule out clots)

*Push Synch
2. Digoxin - Deep Contraction
Max 2.0
Check ATP Before giving: 60
A - Apical pulse 60 40 kg

T - Toxicity (Max 2.0 range) visual disturbances,

N/V, Anorexia < 3.5
K
P - Potassium below 3.5 - HIGHER risk for
Memory tricks
Potasssium

toxicity
3. Anticoagulants: Warfarin (monitor INR, Vit.
K+
A FluTTer = sawTooTh K antidote, moderate green leafy veggies)

7. SVT - Supraventricular Tachycardia KAPLAN

Which medication should be held 48-hours
Causes: prior to an elective cardioversion for SVT?
Stimulants, Strenuous exercise, hypoxia, Digoxin due to increased ventricular
irritability
heart disease
Client with SVT has the following
Treatment: assessment data: HR 200, BP 78/40, RR 30

1. Vagal Maneuver (bear down like Priority action: Synchronized

cardioversion
having a bowel movement, ice cold
stimulation)
PRIORITY
2. Adenosine - RAPID PUSH & flush
Memory tricks with NS - HR may stop
3. Cardioversion - *Push Synch
Super Fast = Supraventricular

8. Torsades de Pointes Memory tricks

M
Magnesium

Causes: Magnesium

Post MI, Hypoxia, Low magnesium Mg+

Treatment:
Magnesium Sulfate NCLEX TIP
M
Mellows out the heart
Memory tricks

Tornado Pointes
9 ECG Strips on the NCLEX III

9. Asystole - Flatline

Epinephrine, Atropine, & CPR

*NO Defibrillation
(NO shock) NCLEX TIP

Memory tricks
Assist Fully! … patient is flatlined

R R
R NCLEX Key Terms
PP PP P

Q
Q Q S
S S

1. P wave = Atrial rhythm 4. “Bizarre” - Tachycardia

3.

Question:
Asystole

2. QRS wave -Ventricular rhythm Ventricular Tachycardia

Question: “Bizarre rhythm with wide QRS complex”

Answer: Ventricular Tachycardia
“Lack of QRS complexes”
R

Q
Answer: Asystole 5. “Sawtooth” - Atrial Flutter
“Wide bizarre QRS complexes”
S

3.
Answer: V Tach

3. “Chaotic or unorganized” - Fibrillation

V Tach

Question:
A FluTTer = sawTooTh

“Chaotic rhythm with no P waves”

Answer: Atrial Fibrillation
Atrial Flutter

“CHAOTIC rhythm without QRS complexes”

Answer: Ventricular Fibrillation
Atrial Fibrillation

If you know these, you will pass the NCLEX! NCLEX TIP

Normal sinus rhythm Bradycardia Ventricular Fibrillation (V Fib)

Ventricular Tachycardia (V Tach) Atrial Fibrillation (A Fib) Atrial Flutter (A Flutter)

3.

SVT - Supraventricular Tachycardia Torsades de Pointes Asystole - flatline

Heart Sounds &
5 EKG Lead Placement

Memory Trick
APETM
Heart Sounds
“All Pigs Eat Too Much”
AORTIC PULMONIC
A - Aortic (2nd Intercostal Space
(2 Intercostal Space
nd
P - Pulmonic L Sternal Border)
R Sternal Border)
E - Erb’s point
T - Tricuspid
M - Mitral
TRICUSPID
(3nd or 4th Intercostal Space
L Sternal Border)

ERB’S POINT
(3rd Intercostal Space MITRAL
L Sternal Border) (5th Intercostal Space
Midclavicular Line)

5 EKG Lead Placement

QRS Complex

R
Memory Trick
P PR Segment ST Segment T White on Right
Smoke over Fire
Brown in the Middle
PR Interval
Grass under sky (white)
Q
S
QT Interval

Proper 12-Lead Placement for Left Side of Chest

v1 4th intercostal space to the right of the sternum

v2 4th intercostal space to the left of the sternum

v3 directly between the leads V2 & V4

v4 5th intercostal space at midclavicular line

v1 v2 v
3
v5 level with V4 at left anterior axillary line v4R v6
v4 v5

v6 level with V5 at left midaxilary line

(directly under the midpoint of the armpit)
v4R 5th intercostal space, right midclavicular line
9 ECG Strips on the NCLEX

1. Normal sinus rhythm

Treatment:
None - continue to monitor

Causes:
Being healthy

Memory tricks

Normal beat - evenly spaced

2. Bradycardia

Treatment:
BRADY Bunch Atropine ONLY if symptomatic
old TV show (slow times)
showing low perfusion (pale,
cool, clammy)
<60 Causes: ATROPINE

Vagal maneuver (bearing down),

Memory tricks
meds (CCB, Beta Blockers)
BRADYcardia
Below 60/min

3. Ventricular Fibrillation (V Fib)

Treatment:
1. V Fib - Defib #1 Defibrillation
immediately Stop CPR
to do it & before drugs!
*NO synchronization needed
2. Drugs: LAP - Lidocaine, L A P
Amiodarone, Procainamide
Causes:
Memory tricks Untreated V Tach, Post MI, LIDOCAINE
AMIODARONE
PROCAINAMIDE

E+ imbalance, proarrhythmic meds

Fib is flopping- squiggly line

4. Ventricular Tachycardia (V Tach) Memory tricks

Causes:
Post MI, Hypoxia,
Low potassium, Low magnesium
C
Treatment: C - Count a pulse
C - Cardiovert
1. Early Defibrillation! NCLEX TIP *Synchronize First
Apply defibrillator pads & Sedation
Call out & look for everyone to be

D
CLEAR!
Shock & IMMEDIATELY continue
chest compressions
Memory tricks D - Dead - NO PULSE
2. When to Shock? NCLEX TIP
D - DEFIB!!
V Tach with No pulse = Defibrillation
V Tach Tombstone pattern
*NO Synchronize
V Tach with Pulse = Cardioversion D - Don't wait
9 ECG Strips on the NCLEX II

5. Atrial Fibrillation (A Fib) Digoxin

Causes:
Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg. A T
Treatment:
Max 2.0
1. Cardioversion (after TTE to rule out clots)
*Push Synch 60
2. Digoxin - Deep Contraction
Check ATP Before giving:
A - Apical pulse 60
40 kg

T - Toxicity (Max 2.0 range) visual disturbances,

N/V, Anorexia P
P - Potassium below 3.5 - HIGHER risk for
Memory tricks toxicity
< 3.5
3. Anticoagulants: Warfarin (monitor INR, Vit.
No P wave = Fibrillation FloPPing K antidote, moderate green leafy veggies)
Potassium

K+

6. Atrial Flutter (A Flutter) Causes:

Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg.
Treatment:
DIGOXIN

1. Cardioversion (after TTE to rule out clots)

*Push Synch
2. Digoxin - Deep Contraction
Max 2.0
Check ATP Before giving: 60
A - Apical pulse 60 40 kg

T - Toxicity (Max 2.0 range) visual disturbances,

N/V, Anorexia < 3.5
K
P - Potassium below 3.5 - HIGHER risk for
Memory tricks
Potasssium

toxicity
3. Anticoagulants: Warfarin (monitor INR, Vit.
K+
A FluTTer = sawTooTh K antidote, moderate green leafy veggies)

7. SVT - Supraventricular Tachycardia KAPLAN

Which medication should be held 48-hours
Causes: prior to an elective cardioversion for SVT?
Stimulants, Strenuous exercise, hypoxia, Digoxin due to increased ventricular
irritability
heart disease
Client with SVT has the following
Treatment: assessment data: HR 200, BP 78/40, RR 30

1. Vagal Maneuver (bear down like Priority action: Synchronized

cardioversion
having a bowel movement, ice cold
stimulation)
PRIORITY
2. Adenosine - RAPID PUSH & flush
Memory tricks with NS - HR may stop
3. Cardioversion - *Push Synch
Super Fast = Supraventricular

8. Torsades de Pointes Memory tricks

M
Magnesium

Causes: Magnesium

Post MI, Hypoxia, Low magnesium Mg+

Treatment:
Magnesium Sulfate NCLEX TIP
M
Mellows out the heart
Memory tricks

Tornado Pointes
9 ECG Strips on the NCLEX III

9. Asystole - Flatline

Epinephrine, Atropine, & CPR

*NO Defibrillation
(NO shock) NCLEX TIP

Memory tricks
Assist Fully! … patient is flatlined

R R
R NCLEX Key Terms
PP PP P

Q
Q Q S
S S

1. P wave = Atrial rhythm 4. “Bizarre” - Tachycardia

3.

Question:
Asystole

2. QRS wave -Ventricular rhythm Ventricular Tachycardia

Question: “Bizarre rhythm with wide QRS complex”

Answer: Ventricular Tachycardia
“Lack of QRS complexes”
R

Q
Answer: Asystole 5. “Sawtooth” - Atrial Flutter
“Wide bizarre QRS complexes”
S

3.
Answer: V Tach

3. “Chaotic or unorganized” - Fibrillation

V Tach

Question:
A FluTTer = sawTooTh

“Chaotic rhythm with no P waves”

Answer: Atrial Fibrillation
Atrial Flutter

“CHAOTIC rhythm without QRS complexes”

Answer: Ventricular Fibrillation
Atrial Fibrillation

If you know these, you will pass the NCLEX! NCLEX TIP

Normal sinus rhythm Bradycardia Ventricular Fibrillation (V Fib)

Ventricular Tachycardia (V Tach) Atrial Fibrillation (A Fib) Atrial Flutter (A Flutter)

3.

SVT - Supraventricular Tachycardia Torsades de Pointes Asystole - flatline

Antidysrhythmics I
Cardiac Pharmacology

Class Drug Name Mainly for Image of ECG Strip

Class 1 Procainamide V Tach &
Sodium-channel blockers & Lidocaine V Fib

Class 2 Propranolol Atrial Fibrillation

Beta blockers Atrial Flutter
HTN (hypertension)

Class 3 Amiodarone V Tach &

Potassium-channel blockers V Fib

Class 4 Verapamil Atrial Fibrillation

Calcium-channel blockers Diltiazem Atrial Flutter
Nifedipine HTN (hypertension)

Others Adenosine SVT

Digoxin A Fib
(cardiac glycoside)
Atropine Symptomatic
(anticholinergic) Bradycardia

Top Missed Question

Key Points Which drugs do we teach slow

position changes due to
orthostatic hypotension?
Select all that apply.
Dizziness
?
1. Atenolol
Teach SLOW position changes 2. Atropine
3. Amiodarone
4. Amlodipine
5. Digoxin
NORMAL
HIGH
LOW

Hypotension - must reassess the BP every hour

NORMAL

6. Diltiazem
HIGH
LOW

When BP is LOW - we got to go SLOW! 7. Furosemide

MEMORY TRICK
Think ABCD start on TOP of the heart affecting atrial rhythms.
Think LAP like in your lap, since these drugs affect ventricular rhythms.

Drug Name Indication & Key Terms:

Drug Name Indication & Key Terms:
A
Atropine Symptomatic Bradycardia

L
Adenosine SVT (supraventricular tachycardia)
Lidocaine V Tach & V Fib
SE: Low BP, Low Platelets
Hypertension, SVT, Tachycardia,

B
Beta Blockers
“Propranolol” A fib & A flutter SA node

A
SE: LoL = Low BP, Low HR, bronchospasm AV node Amiodarone V Tach & V Fib
SE: Low BP, Low HR,

C
Ca Channel Blockers Hypertension, SVT, Tachycardia, Pulmonary TOXICITY!!!
“Verapamil” “Diltiazem” A fib & A flutter
SE: Low BP, Low HR, dizziness

P
Procainamide V Tach
SE: Low BP, Low Platelets
D
Digoxin A fib & Heart Failure
SE: Toxicity (NV, Vision changes)
 Antidysrhythmics II
ABCD’s - Atrial Rhythm drugs
Cardiac Pharmacology

MEMORY TRICK Notes

A
B SA node
Think ABCD start on the
TOP of the heart affecting
atrial rhythms affecting
C AV node

the SA or AV node
D L
A
P

Drug Name Indication & Key Terms: TOP MISSED Test Question
A Atropine Symptomatic Bradycardia Atropine for a client with a heart rate of 38,
bp of 88/65, reports confusion and dizziness.
Which ECG strip would show medication
effectiveness?
Puts the heart rate really HIGH like on TOP of “a PINE” tree for
60-100
atroPINE. 1.

Given for: ‘’Symptomatic Bradycardia’’ below 60 BPM with signs 8 x 10 = 80

of low oxygenation like mental status changes (confusion, 2.
Evenly Spaced
altered, agitation) or pale blue skin signs. Goal is to get back to
NORMAL sinus rhythm! 3.

<60
0₂

0₂ 4.
0₂
0₂
CORRECT

Drug Name Indication & Key Terms: 1 2

A
KEY Points

Adenosine SVT (supraventricular tachycardia)

1. Give it FAST = IV push in
1-2 seconds NCLEX TIP
2. Saline Flush immediately AFTER
DEcreases the heart rate, like putting it into a DEN (for foxes) or
Downstairs.
Given for:
SVT - Supraventricular Tachycardia
* Key points:
Know how this rhythm looks! SVT = Super Fast!
Give it FAST = IV push in 2 seconds followed by flush
Super Fast = SVT

Drug Name Indication & Key Terms:

B Beta Blockers
“Propranolol”
Hypertension, SVT, Tachycardia,
A fib & A flutter
SE: LoL = Low BP, Low HR
Common Question
What drug is causing this rhythm?

Propranolol
Beta blockers end in “-LOL”
Memory trick: Lower the 2 L’s - Low HR & Low BP
Given for: <60
Hypertension & to put the brakes on fast rhythms like SVT, tachycardia, A fib, & A flutter. 5 x 10 = 50
Side Effects: 1 2 3 4 5
• B - Bradycardia (HR below 60 BPM) & low BP
• B - Bronchospasm (avoid asthma & COPD)
• B - Blood glucose masking s/s of low sugar
• B - Bad for clients in end stage heart failure
* Orthostatic hypotension (dizziness upon standing) - teach slow position changes!
Antidysrhythmics III
ABCD’s - Atrial Rhythm Drugs
Cardiac Pharmacology

Drug Name Indication & Key Terms:

C
C C
Ca Channel Blockers Hypertension, SVT, Tachycardia, Calcium Contracts the muscles
“Verapamil” “Diltiazem” A fib & A flutter

Calcium

Ca
Since calcium contracts the muscles, when calcium blocked with CCBs, it
calms the heart
Memory Trick: CCBs lower the Couple heart vitals: HR & BP
Given for:
Hypertension, tachycardia, SVT, A Fib, & A Flutter
Side Effects:
Orthostatic hypotension (dizziness upon standing) - teach slow position changes

3 Common Questions
Q1: Intended EFFECT for Q2: Priority adverse effect Q3: Most important patient
Diltiazem? to watch for when giving teaching when giving
Amlodipine? Verapamil?
Ventricular rate decreased Dizziness Slow position changes
from 160 to 70s
Q1: Intended EFFECT for Q2: Priority adverse effect
Diltiazem? KEY WORD
to watch for when giving
Q2: Priority adverse effect Q3: Most important patient Amlodipine?
to watch for when giving teaching when giving Slow position changes
Amlodipine? Verapamil? Ventricular rate decreased Dizziness

Dizziness
160 70 beats/min Slow position changes
from 160 to 70s

Diltiazem

Drug Name Indication & Key Terms: D’s for DEEP Contraction
D Digoxin A fib & Heart Failure
SE: Toxicity (NV, Vision changes)
DIGOXIN DEEP contraction

Digoxin Digoxin
Is a TOXIN so monitor levels - under 2.0 is SAFE.
It DIGs for a deeper heart contraction to help the heart contract more
forcefully & decreases the heart rate (NOT Blood pressure), so no need
for slow position changes

Main Side Effect = Toxicity Key Sign Common NCLEX Question

Max Range 2.0 Report "dizziness & lightheaded" Q1: A client on digoxin having difficulty
1st signs of toxicity: reading a book or some type of vision
Anorexia Bradycardia problem
Nausea / Vomiting
Vision changes (difficulty reading)

Max 2.0
Digoxin
Creatinine! Over 1.3 = bad kidney
Antidysrhythmics IV
LAP - Ventricular Rhythm Drugs
Cardiac Pharmacology

L Lidocaine
SA node
Think LAP lik in your lap,
A Amiodarone AV node since these drugs affect
ventricular rhythms
L

P Procainamide A
P

Mainly give for those deadly ventricular rhythms:

• Ventricular Fibrillation (V Fib) LOW cardiac OUTput
Vfib LOW oxygen OUT to the body
• Ventricular Tachycardia (V Tach)
Vtach

0₂
Memory Trick:
Any rhythm starting with a V = VERRRY deadly.

Since the ventricles are responsible for all the Cardiac OUTPUT
meaning OXYGEN rich blood OUT TO the body, so low Cardiac OUTput
means Low oxygen OUT to the body.

Lidocaine
“Cain” Calms the ventricles. Priority
L Lidocaine Given for:
V tach, & V fib mainly, but also can work for
Key Point SVT, A fib, & A flutter.
LIDOCAINE
HYPOtension
Lidocaine Toxicity
GLASGOW COMA SCALE
EYE OPENING VERBAL RESPONSE MOTOR RESPONSE
1st
Neuro checks are a PRIORITY

Amiodarone Side Effects

A Amiodarone Typically given 2nd if Lidocaine does not
Neg. Chronotropic = Less beats
work. This is because of its life-threatening
Key Point
TOXIC effects!
<60

Pulmonary toxicity Memory trick

“dry cough & dyspnea”
“difficulty breathing while Neg. Dromo = Less Electrical impulse
ambulating”
“shortness of breath”
AMIODARONE

P Procainamide
ESTED
O NLY T
OMM
NOT C
‘’Cain’’ calms those ventricles just like Lidocaine but this drug PROCAINAMIDE

is becoming less & less popular in the hospital setting &

therefore not commonly tested.
Vasopressors
Alpha & Beta Physiology
Cardiac Pharmacology

VasoPRESSors - PRESS on the vessels

VasoPRESSors - PRESS on the blood vessels,
Goes back to the heart
Main Vasopressors
increasing blood pressure in order to squeeze
• Epinephrine
• Norepinephrine
oxygen rich blood back to the CORE of the body
• Vasopressin to perfuse the vital organs (sort of like
• Dobutamine squeezing a toothpaste bottle).
• Dopamine

Indication
Key Receptors: Alpha & Betas
Increase BP Cardiac Arrest Shock Mode of Action
NORMAL

They work by activating

HIGH
LOW
NORMAL

NORMAL
HIGH
LOW

Alpha & Beta receptors

HIGH
LOW

ACLS
Dobutamine
inside the heart & blood
vessels
Norepinephrine
EPINEPHRINE
EPINEPHRINE

Vasopressin

Alpha 1 - Constriction of Vessels

Alpha 1 - Anaconda (memory trick)
• Squeezing down the blood vessels so blood is pushed back to the heart.

Alpha Agonist
• think AGonists ADD to the BP to increase it (example: vasopressors)
Alpha Antagonists
• are ANTI constriction - less constriction = less pressure to lower BP (example: clonidine)

Beta 1 = 1 Heart
Beta Agonists - think AGonists ADD - Faster heart rate. (example: Vasopressors)
• Positive Chronotropic (chronos = time) more beats per minute.
• Positive INOtropic = more FORCEFUL beats, which increased Cardiac OUTPUT (increased
blood coming OUT of the heart to perfuse the body)

Beta Antagonists - are ANTI heart, used to decrease the HR & BP (example: beta blockers) NORMAL

• Negative Chronotropic - Less Beats

HIGH
LOW

• Negative Inotropic - Less force

Beta 2 = 2 Lungs Indication Alpha 1 Beta 1 Beta 2

Beta 2 Agonist Anaconda 1 heart 2 Lungs & Dilation
Constriction • Chrono - High HR Big Lungs
• think they ADD to the lungs - dilating • Inotropic - C.O. & Vessels
both the vessels & bronchi - like a big
BIG
Septic shock &
balloon or beach ball Epinephrine Cardiac arrest
Medium Small

(example: Vasopressors & Albuterol)

Norepinephrine Septic shock BIG Medium Small

Vasopressin
Desmopressin
Hypovolemic shock - - -
Dopamine Cardiogenic shock Med.
BIG Small

Dobutamine Cardiogenic shock Small BIG Medium

Vasopressors
Top Tested Drugs
Cardiac Pharmacology

Epinephrine & Norepinephrine Kaplan Question

1st line drug Epinephrine
Epinephrine treatment is effective if ….
(Brand: Adrenaline) Answer: BP 130/67,
Apical HR 99, Cap refill
Norepinephrine HESI Question less than 2 seconds
(Brand: Levophed)
Epinephrine Less than 2s
Key difference
Initiates heart contraction

EPINEPHRINE
Epinephrine

EPINEPHRINE
Adrenaline
Cardiac Arrest during cardiac arrest
130/67 HR 99
• Asystole
• PEA (pulseless electrical Activity)
NORMAL

Vasopressin & Desmopressin (ADH)
Vasopressin
Vasopressin - synthetic ADH
(AntiDiuretic Hormone)
• ADH - Adds Da H20
Pressin - PRESSes that BP UP
HIGH
LOW
DI - Diabetes Insipidus
Indication DI - end up DIuresing or DraIning a lot of fluid
Given for Diabetes Insipidus (DI)
where clients Drain a lot of fluid!
ADH is given to “Add Da H20” to
the body, adding fluid volume &
not affecting the constriction of
vessels.

Dobutamine & Dopamine

Indication
INOtropic
D’s for DEEP Contraction Given to treat cardiogenic shock - “INcreased cardiac contractility”
DEEP contraction Dopamine & Dobutamine
where the heart FAILS to pump! “INcreased forceful contraction”
These guys give a DEEPER heart
Dobutamine
DOPAMINE contraction, to increase that blood
out of the heart & to the body
(increasing cardiac output & BP)

HESI Question Kaplan Question

Dopamine Dopamine
Activates alpha 1 and beta 1 receptors Given for a patient with
hypotension, what indicates
Therapeutic Effects: effectiveness?
• Low doses act on dopamine
receptors 1 1 Answer: Increased cardiac output
• Moderate doses acts on beta 1
receptors
• High doses acts on alpha 1 and
ATI Question
beta 1 receptors
Dobutamine, Dopamine
Assess IV site hourly for s/s infiltration • Assess BP hourly
• Monitor vital signs

Notes
Inotropic, Chronotropic,
Dromotropic

D D D INOtropic
Digoxin Dopamine Dobutamine “INcreased cardiac contractility”
“INcreased forceful contraction”
3 D’s for DEEP contraction
Digoxin
DOPAMINE Dobutamine D - Digoxin
2.0 +
D - Dopamine
D - Dobutamine

Chronos
Clock
HR<60 Neg. Chronos - Neg time
Positive Chronos - Positive time
Faster HR - Positive Chronotropic
Lower HR - Negative Chronotropic

Dromo
Drums
Neg. Dromotropic -
stable heart rhythm

Inotropic Chronotropic Dromotropic

Drug Force of Heartbeat Rate of Heartbeat Rhythm of Heartbeat

A amiodarone + Pos. - Neg. - Neg.

B beta blockers
Atenolol - Neg. - Neg. - Neg.
C calcium CB - Neg. - Neg. - Neg.
C cardiac glycosides
+ Pos. - Neg. - Neg.
Digoxin

D dobutamine + Pos. X X
D dopamine + Pos. + Pos. X
E epinephrine + Pos. + Pos. X