3rd DEGREE HEART BLOCK

Complete heart block The atria are not coordinated with ventricular activity; Therefore the atria are not effectively emptying into the ventricles; All impulses are blocked in the AV node and impulses are prevented from reaching the ventricles P waves are present BUT do not precede every QRS complex; There is no relationship between the P wave and QRS complex QRS width varies depending on the ventricular escape rhythm The altered rate may compromise cardiac output cause bradycardia and hypotension. Reduced effectiveness of atrial emptying may also compromise cardiac output Clinical symptoms Dizzy, nauseous, hypotensive, poorly perfused. Caused by AMI, cardiac toxicity, congenital deformity, infections, hypoxia, post-surgical complications (mitral valve replacement) As a nurse: notify team; Give IV atropine (0.5mg minjet), commence transcutaneous pacing. May start IV Isoprenaline

VENTRICULAR FIBRILLATION
Emergency life threatening Primary rhythm in sudden cardiac arrest Condition in which there is un coordinated contraction of the cardiac muscle of the ventricles of the heart, making them quiver RATHER than contracting properly Ventricular muscles twitch randomly rather than contracting in a co ordinated fashion (from the apex of the heart) to outflow of the ventricles. The ventricles fail to pump blood into the arteries and systemic circulation Rhythm, irregular, chaotic, P waves not visible, PR not measurable, QRS complex is wide, bizarre irregularly, shaped fibrillation waves If the arrhythmia continues and not treated can lead to asystole death Nil cardiac output Symptomatic unconsciousness / pulseless IMMEDIATE DEFIRBALLATION WITNESSED (Shock 3 times) UNWITNESSED (shock once and then commence CPR)

TEMPORARY PACING
A pacemaker that delivers an electrical stimulus to either the atrial and or ventricular muscle mass resulting in depolarisation using an artificial pulse generating a pacing system Indications: Sick sinus syndrome, AV block, heart failure, slow AF, Brady arrhythmias, cardiac arrest, sinus node dysfunction, sinus pauses A pacemaker has two jobs 1) sensing 2) pacing Transvenous endocardial - inserted via venous vascular system either the superior approach via SVC from the subclavian jugular or antecubital veins or the inferior approach via the IVC from the femoral vein Transcutaneous external pads requiring high voltage Transthoracic pacing leads into RV through anterior chest wall The pacemaker senses cardiac intrinsic activity than responds by inhibiting a pacing stimulus or fire (an electrical impulse at a specific rate that excites endocardial cells and produces a wave of depolarization in the myocardium) Pacing spike indicates the electrical impulses sent by the pacemaker to the cardiac muscle

MODS (Multiple organ dysfunction syndrome)

Altered organ dysfunction in acutely ill patient requiring medical intervention to achieve homeostasis Presence of altered organ function in acutely ill patientswhere homeostasis cannot be maintained without intervention Usually involves more than 2 organs; Chances of survival is diminished as the number of organs involved Usually caused from infection, injury, hypo perfusion, or hyper metabolism Multiple degree of organ dysfunction to completely irreversible organ failure The primary cause triggers an uncontrolled inflammatory response Sepsis is the most common cause 1/3 patients have no primary cause

SYSTEMATIC INFLAMMATORY RESPONSE SYDNROME (INFECTION)

SPESIS

SEVERE SEPSIS

MODS