Perfusion Part 1 and 2

Blood Flow

Anatomy and

Electrical Pathways of the Heart

Electrical System

• Sinoatrial Node
• Atrioventricular

Node

• Bundle of His
• Perkinje Fibers

Telemetry Monitoring

• Electrodes: adult & pediatric
• Clean, dry skin
• Clip hair, never shave
• Benzoin
• Attach leads to electrode first
• Change electrodes daily
• 3 lead vs. 5 lead
• Monitor in 2 leads

oLead II: visualize SA node and atrial waves

oV1: for ventricular origin

Placement of Leads for

Telemetry Monitoring

Chest Leads

Electrocardiogram

• Maps electrical activity of the heart
• P wave, QRS complex, T wave

Segments and Intervals

Electrocardiogram

• P wave= Atrial

contraction (SA
Node)

• P-R interval= Travel

time through AV
node

• QRS complex=

Ventricular
contraction

• T wave= Ventricular

repolarization

What do we need to know

to read the strip?

1. Are all parts of the EKG complex present? Is there a

QRS for every P wave and a P wave for every QRS?

2. Measure P-R interval, QRS complex, and QT interval.

3. Determine if it is regular.

4. Determine the rate.

Reading the Strip

PR Interval

QRS Complex

QT Interval

What makes it Normal

Sinus Rhythm?

1. Is there a QRS for every P wave and a P wave for

every QRS?

2. Are the P-R interval and QRS complex WNL?
3. Is it Regular?
4. What is the rate? Is it between 60 and 100 beats

per minute?

​Some text here about the topic of discussion.

Sinus Bradycardia

Treatment?

External or Transcutaneous Pacing

Transcutaneous Pacing

Transvenous Pacing

Transvenous Pacemaker

Placement

Pacemaker

AV Sequential Pacemaker

Permanent

Pacemaker

Internal and External

Cardiac Defibrillators

Failure to Capture/

Failure to Sense

Premature Atrial Contraction

Sinus Arrhythmia

Atrial fibrillation

Atrial flutter (saw

-

tooth)

Atrial Dysrhythmias:

Risk Factors and Symptoms

• Risk factors
• Signs and Symptoms
• Increases risk of other CV disorders
• Treatment

Cardioversion

• SYNC
• Biphasic/Monophasic

Cardioversion Preparation

• Oh O2 Saturation monitor
• Say Suctioning equipment
• It IV line
• Isn't Intubation equipment
• So Sedation and possibly analgesics

Ablation and Cardioversion

• Ablation Therapy

• SVT with Cardioversion

• Client Cardioversion

• Left Atrial Appendage Closure

Atrial Dysrhythmias:

Medication Management

• If client remains in A-fib, OR is asymptomatic, they

should be on anticoagulant to prevent blood clot in atria
o warfarin (Coumadin )
o dabigatran (Pradaxa)
o apixaban (Eliquis)

• Rate control:

o Cardizem- Ca channel blockers
o Digoxin
o Beta blockers

• Conversion and Prevention:

o Flecainide (Tambocor)
o Dofetilide (Tikosyn)
o Propafenone (Rythmol)
o Amiodarone (Cordarone)
o Ibutilide (Corvert)

Tachycardias

Sinus Tachycardia

• Causes
• Cardiac output
• Treatment

Is the client stable?

SVT S

upraventricular Tachycardia

•SVT with Adenosine

•SVT Video

•Slow it down!

ST and T wave

Abnormalities

Premature Ventricular

Contractions

• PVC
• Causes
• Symptoms
• Treatment