1. - Unstable pt= pt presenting w/ any S/S of CNS, CVS, or respiratory system (eg chest pain, shortness of breath, hypotension, or confusion) . -1st step in ALL palpable ventricular arrythmia is Synchronized Defibrillation - Epinephrin(IV) in 1:10,000 is for Rx. of heart rate and blood pressure. - Epinephrin(SC) in 1:1000 of inhaled is used to Rx. Anaphylaxis respiratory distress.
  2. Tachycardia>100
    1. "QRS" complex is wide=MORE than 0.12 sec.= VENTRIVCULAR pathology
      1. No palpable Pulse, No breathing=Dead Pt.!
        1. Hx. of lightning or electrical injury
          1. Asystole = flat line EKG
          2. Rx. I.Epinephrine, II.Atropine, III.transcutaneous pacing
        2. Pulseless Electrical activity=normal EKG
        3. Ventricular fibrilation
          1. Rx. 1st: unsynchronized defibrillation(x3)
          2. 2nd: II.Epinephrine OR vasopressin , III.Defibrilate. IV.intubate, V.Defibrilate, VI.Amioderone or lidocain, VII. Procainamide
          3. Ejection fraction less then 35% OR positive arrhythmia induction on electro-physiology study
          4. Rx. Automated Implantable Cardiac Defibrillator
        4. Ventricular tachycardia can present dead or Alive with a palpable pulse= HR is 120 or more & 3 ventricular beats or more
          1. Dead Pt.
          2. Alive w/ palpable pulse
          3. UNStable
          4. Rx. 1st: Synchronized defibrillation
          5. stable
          6. Rx. I. Amioderon, II.Lidocain, III.Procainamide
          7. Long term Rx. for V.Tach is I. Beta-Blocker,II.AICD
      2. Palpable pulse = pt. is alive and breathing
        1. Hx. Heart Block, lithium, TCA, Porcainamide, a/w sudden audiatory of visual sti(eg : phone ringing)
          1. Torsade de Pontes=EKG with elevation of "QT"
          2. Stable
          3. Rx.MgSo4
          4. Unstable
          5. Rx.Unsynchronized defibrillation
        2. Hx. Atrial Arrhythmia (Epstein anomaly), trans-position of the great vessels, S/S: loud S1
          1. EKG= sluffed upstroke "QRS" deflection aka "Delta"-waves & short "PR' less than 0.12 sec.
          2. Dx. WPW= Wolff-Parkenson White Synd.
          3. Rx.Short term: Procainamide; Long term: Ablation
    2. any "QRS" complex is narrow = LESS than 0.12 sec. is a/w ATRIAL pathology
      1. IRREGULAR PULSE
        1. Hx. Respiratory Disease
          1. EKG= "P' wave has varying forms, a/w COPD & Resp. Failure
          2. Dx. Multi-focal Atrial Tachycardia
          3. Rx. the Respiratory disease will Rx. the arrhythmia
        2. EKG= 350 to 500 ATRIAL beats, May have some "QRS" that are more than 0.12s
          1. Dx. Atrial Fibrilation
          2. both atrial Fibrillation & Flutter have the same Rx.
          3. Acute
          4. Unstable
          5. Rx. Synchronized shock
          6. Stable
          7. Hx. Migraine, or CVS, or thyroid disease,
          8. Rx. Beta-Blocker= Propanolol (PO)
          9. Hx. depression, COPD, or asthma
          10. Rx. Ca-Channel Blocker
          11. Hx. low or boarder line blood pressure
          12. Rx. Digoxin
          13. Chronic is atrial arrhythmia for 2 or more days
          14. less than 60 y. of age
          15. Rx. Asprin
          16. more than 60 y of age
          17. Rx. Warfarin
          18. LONG term Rx is Cardiac Ablation
      2. REGULAR PULSE
        1. EKG=240 to 300 Atrial beat, "P" wave is saw tooth- shaped, 2:1 Atrio-Ventricular block
          1. Dx. Atrial Flutter
        2. EKG= 130 to 220 that SUDDENLY starts & Stops
          1. Dx. Supraventricular Tachycardia
          2. Rx.
          3. Chronic
          4. Acute
          5. I. Vagal Stimulation maneuvers II. Adenosin x 3 III. Same as the Rx. of an Acute stable pt with atrial fibrillation or flutter.
  3. Bradycardia<60
    1. EKG=constant "R-R" w/ SUDDEN dropped "QRS"
    2. S/S Canon "a" wave on JVP
      1. Rx. 1st: Atropin 2nd Pacemaker(IV)
    3. ANY type of bradycardia S/S on P/E (eg palpable bradycardia with SOB or pain) = Must be treated