Cardioversion, Pacing, Defibrillation and ACLS

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Cardioversion, Pacing, Defibrillation and ACLS
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Mr. Meyers

• 74 y/o male 164 pounds
• CC weakness and syncope
• Pulse 106 weak and irregular
• Resp 20, even and non labored
• BP 100/56

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What is the rhythm strip???

• Atrial Fibrillation
• Cant measure PR interval because you dont see
  the P-waves

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Atrial Fibrillation

• Unsynchronized and rapid electrical activity with
  atrial rate of 400-700 bpm
• Bowl of Jello
• Some atrial impulses travel through AV node -
  others are blocked - therefore ventricular rate
  is slower than atrial rate and is irregular
• Controlled vs Uncontrolled Ventricular Response
• Slow vs fast

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Problems with A-Fib

• Cardiac Decompensation
• Thrombus Formation

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Treatment of A-fib

• Medications
• Depends on Clinical status
• Stable, no Sx
• Cardioversion
• External
• Implanted

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Pacemakers Indications

• AV Blocks
• 2nd degree HR gt 40 with symptoms
• 2nd degree HR lt 40 with or without symptoms
• 3rd degree block
• Sinus node dysfunction

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Review of Blocks Matter of Degree.

• 1st Degree A slowing of conduction, PR interval
  prolonged gt than .20
• 2nd Degree
• Type 1 ( Wenkebach)- a progressive prolongation
  until a QRS is blocked, benign
• Type 2 ( Mobitz II) ( Classical) -More P Waves
  than QRSs, can deteriorate to no QRSs, ? no
  Venrtricular activity
• 3rd degree P waves and QRSs, NO RELATIONSHIP,
  Ventricular rate slow Chronic Vs Acute

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Function of Pacemaker

• Assess cardiac activity
• The sensing function
• When the sensing wire sends the signal that the
  heart has not initiated the impulse the Pacemaker
  will
• Emit an electrical impulse to stimulate
  contraction
• Capture -causes Depolarization to occur

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Various Settings...

• To Pace Atria, Ventricles or Both
• To Sense Atria, Ventricles or both
• Facts Pulse generator--Lithium battery, sealed
  metal container encasing electronic circuits
• Pacemaker Life 10 years, battery can be
  replaced if needed

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Complications

• Failure to discharge
• Failure to capture
• Failure to sense
• Ventricular irritability

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ACLS..

• Advanced Cardiac Life Support
• Takes over where Basic Cardiac Life Support
  leaves off
• World Wide Standardization of Training and Care
• First developed in Seattle in late 1960s
• Now Field personnel, hospital, clinics, dentists
• Keeps evolving
• --newest equipment Automatic Defibrillators
• ACLS Major revision, updated, changed in 2000

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RECAP...

• Electrical therapy to Heart
• Cardioversion- to change whats there
• Defibrillate- to take fibrillation away ( for V
  Fib)
• Pacemakers
• Spikes before whichever chamber they are pacing
• 10 year battery life
• Importance of standardization ACLS