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Paramedic Cardiology: Understanding Cardiac Rhythms and Conditions, Exams of Cardiology

Massachusetts Institute of Technology (MIT)Cardiology

This comprehensive overview covers various cardiac rhythms and conditions encountered by paramedics. It includes definitions, descriptions, and characteristics of different cardiac rhythms, as well as information on pulseless electrical activity and 12-lead ECG. The document also outlines algorithms for cardiac arrest management, making it an invaluable resource for paramedics, emergency medical personnel, and healthcare professionals.

Typology: Exams

2023/2024

Available from 08/01/2024

DrShirley
DrShirley 🇺🇸

3.7

(3)

3K documents

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Paramedic Cardiology
1. PR Interval Length .12 to .20 seconds
2. QRS Complex
Length
Less than or equal to .12 seconds
3. PR interval mea-
surement
Start of P to start of Q
4. Normal Sinus
Rhythm - Descrip-
tion & Characteris-
tics
Description: Normal rhythm of the heart
Rate: 60-100 beats per minute
Rhythm: Regular
P Waves: Normal in shape, upright, before the QRS
PR Interval: 0.12 - 0.20 Seconds and constant
QRS Complex: Normal morphology, lasts 0.12 seconds
or less.
5. Sinus Bradycardia-
Description & Char-
acteristics
Description: Results from the slowing of the SA node.
Rate: Less than 60 beats per minute
Rhythm: Regular
P Waves: Uniform P wave in front of the QRS complex
PR Interval: 0.12 - 0.20 Seconds; constant
QRS Complex: Less than or equal to 0.12 seconds
6. Sinus Tachycardia-
Description & Char-
acteristics
Description: Increased rate of SA node discharge
Rate: 100-150 beats per minute
Rhythm: Regular
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Paramedic Cardiology

  1. PR Interval Length .12 to .20 seconds
  2. QRS Complex Length Less than or equal to .12 seconds
  3. PR interval mea- surement Start of P to start of Q
  4. Normal Sinus Rhythm - Descrip- tion & Characteris- tics Description: Normal rhythm of the heart Rate: 60-100 beats per minute Rhythm: Regular P Waves: Normal in shape, upright, before the QRS PR Interval: 0.12 - 0.20 Seconds and constant QRS Complex: Normal morphology, lasts 0.12 seconds or less.
  5. Sinus Bradycardia- Description & Char- acteristics Description: Results from the slowing of the SA node. Rate: Less than 60 beats per minute Rhythm: Regular P Waves: Uniform P wave in front of the QRS complex PR Interval: 0.12 - 0.20 Seconds; constant QRS Complex: Less than or equal to 0.12 seconds
  6. Sinus Tachycardia- Description & Char- acteristics Description: Increased rate of SA node discharge Rate: 100-150 beats per minute Rhythm: Regular

P Waves: Uniform P wave in front of every QRS com- plex PR Interval: 0.12 - 0.20 seconds QRS Complex: Less than or equal to 0.12 seconds

  1. Sinus Arrhythmia- Description & Char- acteristics Description: Results from variation in RR Interval Rate: 60-100 (varies with respirations - intrathoracic pressure changes) Rhythm: Irregular (variations in the RR interval) P Waves: Upright and normal in morphology PR Interval: 0.12 - 0.20 seconds QRS Complex: Less than or equal to 0.12 seconds Pacemaker Site: SA Node
  2. Wandering Atrial Pacemaker - De- scription & Charac- teristics Description: The passive transfer of pacemaker sites from the SA node to other latent pacemakers in the atria and AV junction. Rate: Usually with a normal range (60-100) but can be slower Rhythm: Occasionally irregular (RR interval can fluctu- ate) P Waves: Polymorphic (Morphology changes from beat to beat; P waves may disappear entirely) PR Interval: Varies (can be below 0.12, normal at 0. to 0.20 seconds, or above 0.20 seconds) QRS Complex: Less than or equal to 0.12 seconds

P Wave: Not discernible. Atrial activity referred to as f waves PRI: Cannot be measured QRS: Less than 0.12 seconds

  1. Atrial Flutter - De- scription & Charac- teristics Description: The atria becomes so irritable that it be- gins firing faster than 250 bpm Rate: Atrial rate is between 250 and 350bpm. Ventricu- lar rate will depend on the ratio of impulses conducted through to the ventricles Rhythm: Regular or irregular (depends if the AV node is able to conduct impulses through in a consistent pattern) P Waves: Produces a series of well defined P waves, but not every one is followed by QRS. Shows as shark- toothed (F Wave). PR Interval: Cannot be measured QRS Complex: Less than 0.12 seconds
  2. Premature Junc- tional Complex - De- scription & Charac- teristics Description: An irritable focus in the AV junction that fires prematurely and produces a single ectopic beat Regularity: Irregular (due to ectopic beat) Rate: Varies (based on underlying rhythm) P Waves: Will be inverted; can fall before, during, or after the QRS complex PRI: Can only be measured if the P wave precedes the QRS complex; if measurable, will be less than 0.

seconds QRS: Less than 0.12 seconds

  1. Junctional Escape Rhythm - Descrip- tion & Characteris- tics Description: When higher pacemaker site fails, the AV junction is left with pacemaking responsibility. Regularity: Regular Rate: 40- 60 bpm P Waves: Will be inverted; can fall before or after QRS complex or it can be hidden within the QRS complex. PRI: Can be measured only if the P wave precedes the QRS complex. If measurable, will be less than 0. seconds. QRS: Less than 0.12 seconds
  2. Junctional Tachycardia/Accel- erated Junctional Rhythm - Description & Characteristics Description: An irritable focus in the AV junction speeds up to override the SA node for control of the heart. Rhythm: Regular Rate:
    • 60-100 = Accelerated Junctional Rhythm
    • 100-150 = Junctional Tachycardia P Waves: The P waves can come before or after the QRS complex, or it can be lost within the QRS complex. If visible, the P wave will be inverted PRI: If the P wave precedes the QRS Complex, the PRI will be less than 0.12 seconds. If the P wave falls within the QRS or follows it, there will be no PRI QRS: Less than 0.12 seconds.
  1. Quadrigeminy A pattern of three normal beats followed by one PVC.
  2. Grouped Beating When PVCs fall into a pattern with the surrounding normal beats.
  3. Ventricular Tachy- cardia (VT) - De- scription & Charac- teristics Description: If the myocardium is extremely excitable, the ventricular focus could speed up and override high- er pacemaker sites. Regularity: Normally regular Rate: 150- P Waves: Missing PRI: - QRS: Wide and bizarre, measuring at least 0.12 sec- onds or more. Often difficult to differentiate between the QRS and T wave.
  4. Ventricular Fibril- lation- Description and Characteristics Description: In cases of extreme ventricular irritability, the electrical foci in the ventricles can begin firing in a chaotic and inefficient way. Regularity: Irregular Rate: Can't be determined P Waves: None discernible PRI: - QRS: None discernable
  5. Idioventricular Rhythm - Description & Characteristics Description: In the absence of a higher pacemaker, the ventricles initiate a regular impulse to take control of the heart.

Regularity: regular Rate: 20-40bpm, can drop below 20 P Waves: None PRI: None QRS: Wide and bizarre; 0.12 seconds or more

  1. Asystole - Descrip- tion & Characteris- tics Description: When all electrical activity ceases. Regularity: N/A Rhythm: None P Waves: None PRI: N/A QRS: None
  2. Pulseless Electrical Activity (PEA) - De- scription & Charac- teristics
  3. Which Leads on the 12-Lead Show the Left Anterior De- scending?

1. V

2. V

3. V

4. V

  1. Which Leads on the 12-Lead Show the Right Coronary Artery?
    1. Lead 2
    2. Lead 3
    3. aVF
  2. Which Leads on the 12-Lead Show the Left Circumflex?
    1. Lead 1
    2. aVL
  1. Shock
  • 200 First, 300 Second, 360 Third and Subsequent
  1. CPR for 2 Minutes
  • Amiodarone at 300mg first dose, 150mg second dose
  • Treat reversable causes
  1. Repeat at Step 3
  2. ACLS Reversable Causes
  3. Hypovolemia
  4. Hypoxia
  5. Hydrogen Ions (Acidosis)
  6. Hypo-/Hyperkalemia
  7. Hypothermia
  8. Tension Pneumothorax
  9. Tamponade (Cardiac)
  10. Toxins
  11. Thrombosis (Pulmonary)
  12. Thrombosis (Coronary)
  13. Adult Suspected Stroke Algorithm Critical EMS Assessments and Actions:
  • Support ABCs, provide O2 if needed
  • Perform prehospital stroke assessment
  • Establish last known normal
  • Triage to stroke center
  • Alert hospital
  • Check glucose if possible
  1. Acute Coronary Syndrome Algo- rithm EMS Assessment and Care and Hospital Prep:
  • Monitor, support ABCs. Be prepared to give O2 and defibrillation
  • Administer aspirin and consider oxygen, nitro, and morphine if needed
  • Obtain 12-lead ECG; if ST elevation notify hospital
  • Consider prehospital fibrinolysis
  1. Adult Bradycardia With A Pulse Algo- rithm
  2. Assess appropriateness for clinical condition
  3. Identify and Treat Underlying Cause
  • Maintain patent airway; assist breathing as necessary
  • Oxygen if hypoxemic
  • Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
  • IV access
  • 12-lead ECG if available; don't delay therapy
  1. Check if the bradycardia is causing hypotension, al- tered mental status, shock, ischemic chest discomfort, or acute heart failure.
  • If Yes -> Move to Step 4
  • If No -> Monitor and Observe
  1. Administer 0.5mg Atropine every 3 to 5 minutes up to 3.0mg
  • If ineffective provide transcutaneous pacing OR 2-20mcg/kg/min dopamine infusion OR 2-10mcg/min Epinephrine infusion
  1. Adult Tachycardia With Pulse Algo- rithm
  2. Assess appropriatenes for clinical condition
  3. Identify and Treat Underlying Cause
  • Maintain patent airway; assist breathing as necessary
  • Oxygen if hypoxemic
  • Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
  1. Check if the tachycardia is causing hypotension, al- tered mental status, shock, ischemic chest discomfort, or acute heart failure.
  • If Yes -> Provide Synchronized Cardioversion
  • Consider Sedation
  • If regular narrow complex, consider adenosine
  • If No -> Move to Step 4