By Lippincott Williams & Wilkins
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Extra info for ACLS Review Made Incredibly Easy
P wave: Absent. • PR interval: Unmeasurable. • QRS complex: Duration unmeasurable. • T wave: Unmeasurable. • QT interval: Unmeasurable. indd 46 Myocardial ischemia Acute MI Untreated VT Underlying heart disease Acid–base imbalance Electric shock 10/7/2011 4:18:04 PM RECOGNIZING ATRIOVENTRICULAR BLOCKS 47 • Severe hypothermia • Electrolyte imbalances, such as hypokalemia, hyperkalemia, and hypercalcemia What to look for • • • • • Absent pulse, heart sounds, and blood pressure Dilated pupils Loss of consciousness Rapid development of cyanosis Seizures (occasional) How it’s treated • Perform CPR until a defibrillator or an automated external defibrillator is available.
Interatrial tract (Bachmann’s bundle) SA node Interatrial septum AV node AV bundle (Bundle of His) Right and left bundle branches Interventricular septum Purkinje fibers Cardiac conduction begins in the sinoatrial (SA) node and proceeds through the cardiac conduction system. (See Cardiac conduction system) Key points Sinoatrial node The SA node is the heart’s natural pacemaker. It’s located on the endocardial surface of the right atrium near the superior vena cava. When the SA node fires, it sends an impulse throughout the right and left atria that results in an atrial contraction.
If the distance varies, the rhythm is irregular. Use the same method to measure the distance between the P waves (the P-P interval) and determine whether the atrial rhythm is regular or irregular. Calipers method With the ECG strip on a flat surface, place one point of the calipers on the peak of the R wave of two consecutive QRS complexes. Then adjust the legs and place the other point on the peak of the next R wave, as shown. This distance is the R-R interval. Next, pivot the first point of the calipers toward the third R wave and note whether it falls on the peak of that wave.
ACLS Review Made Incredibly Easy by Lippincott Williams & Wilkins