Rhythm StripsJessica Wagner
UMSON
EKG Grid
Ventricular Rate
1st method: Count the number of QRS complexes over the 6 second and then multiply by 10
The 2nd method uses the small boxes. Count the number of small boxes for a typical R-R interval. Divide this number into 1500 to determine heart rate.
In the second image, the number of small boxes for the R-R interval is 22.5. The heart rate is 1500/21.5, which is 69.8.
Ventricular Fibrillation
• Fibrillation is an uncontrolled twitching or
quivering of muscle fibers (fibrils). When it
occurs in the lower chambers of the heart, it
is called ventricular fibrillation
• During VF, blood is not pumped from the
heart Sudden cardiac death results
• NO pulse
http://health.nytimes.com/health/guides/disease/ventricular-fibrillation/overview.html
Causes of VF• Conditions that can lead to VF include:
– Ischemia of the heart muscle
– Electrocution accidents or injury to the heart
– Heart attack (#1 cause!)
– Heart disease that is present at birth (congenital)
– Heart muscle disease, including cardiomyopathies
– Heart surgery
– Narrowed coronary arteries
– Sudden cardiac death (commotio cordis), typically occurring
in athletes after an injury over the surface of the heart
Risk Factors
• Smoking
• Diabetes
• Hypertension
Symptoms• A person who has a VF episode can suddenly collapse or
become unconscious, because the brain and muscles
have stopped receiving blood from the heart.
• The following symptoms may occur within minutes to 1
hour before the collapse:
– Chest pain
– Dizziness
– Nausea
– Rapid heartbeat
– Shortness of breath
Diagnosing V Fib
• NEVER from a 12-lead EKG b/c it will look the
same as asytole
• Cardiac monitor will show a very disorganized
heart rhythm
• Go in the room and check on your patient
(pulses?)
• “There is nothing to measure because your
patient is dead… you better be doing CPR”
Treatment• VF is a medical EMERGENCY! TX STAT
or death
• If person has VF episode at home: 911
– Place person’s head and neck in line with
the rest of their body to make breathing
easier
– Start CPR by doing chest compressions
• Continue until person is alert or help arrives
Treatment
• (#1) VF is treated by delivering a quick electric
shock through the chest using a device called an
external defibrillator
• The electric shock can immediately restore the
heartbeat to a normal rhythm, and should be
done as quickly as possible
• Many public places now have these machines
(AED)
Treatment• An implantable cardioverter defibrillator (ICD) is a device that
can be implanted in the chest wall of people who are at risk for
this serious rhythm disorder
• The ICD can help prevent sudden cardiac death by quickly
sending an electrical shock when ventricular fibrillation occurs
• Medicines may be given to control the heartbeat and heart
function after 3 defibrillation attempts (i.e. amiodarone,
vasopressin, epinepherine)
– Antiarrhythmics agents: raise fibrillation and defibrillation threshold
– Anticholinergic agents: reduce vagal activity improves conduction
– Vasopressor agents: augment blood flow