Critical Care: Ventricular Rhythms, Asystole, PEA

I. PREMATURE VENTRICULAR CONTRACTIONS (PVCs)

  • HEART RATE: Variable
  • RHYTHM: Irregular
  • P WAVE: Normal
  • P-R INTERVAL: Normal
  • QRS WIDTH: Wide
  • INTERVENTIONS: Monitor; watch for sequences of PVCs which may lead to VTac

II. VENTRICULAR TACHYCARDIA (VTac)

  • HEART RATE: > 100
  • RHYTHM: Regular
  • P WAVES: None
  • P-R INTERVAL: None
  • QRS WIDTH: Wide
  • INTERVENTIONS: Check for pulse: if none, proceed to CPR & shock; otherwise, monitor; may need antidysrhythmics (Amiodarone, Procainamide)

III. VENTRICULAR FIBRILLATION (VFib)

  • HEART RATE: Variable, rapid
  • RHYTHM: Irregular
  • P WAVES: None
  • P-R INTERVAL: None
  • QRS WIDTH: Wild
  • INTERVENTIONS: EMERGENCY! Proceed to defibrillation, CPR & ACLS measures

IV. ASYSTOLE

  • NO heart rate; NO P waves, P-R intervals or QRS complexes
  • INTERVENTIONS: Check for causes*DO NOT shock!

V. PULSELESS ELECTRICAL ACTIVITY (PEA)

  • Any organized rhythm (other than VTac, VFib, asystole) with NO PULSE
  • INTERVENTIONS: First, CPR, intubation & ACLS measures; then look for causes
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