Sa node arrhythmias
- 1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dysrhythmias Originating in the SA Node Sinus Bradycardia Sinus Tachycardia Sinus Dysrhythmia Sinus Arrest
- 2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dysrhythmias Originating in the SA Node NormalQRS NormalPRI Upright and normalP Waves SA node Pacemaker Site RegularRhythm Less than 60Rate Sinus Bradycardia Rules of Interpretation
- 3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dysrhythmias Originating in the SA Node Sinus Bradycardia – Etiology Increased parasympathetic (vagal) tone, intrinsic disease of the SA node, drug effects May be a normal finding in healthy, well-conditioned persons – Clinical Significance Decreased cardiac output, hypotension, angina, or CNS symptoms In healthy, well-conditioned person, may have no significance
- 4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sinus Bradycardia Treatment – Treat if hypotension or ventricular irritability is present – Prepare for transcutaneous pacing Atropine may be considered if delay in pacing
- 5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Bradycardia Algorithm Click here to view the Bradycardia Algorithm. Reproduced with permission from “2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Care,” Circulation 2005, Volume 112, IV-68. © 2005 American Heart Association.
- 6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ NormalQRS NormalPRI Upright and normalP Waves SA node Pacemaker Site RegularRhythm Greater than 100Rate Sinus Tachycardia Rules of Interpretation Dysrhythmias Originating in the SA Node
- 7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dysrhythmias Originating in the SA Node Sinus Tachycardia – Etiology Results from an increased rate of SA node discharge Potential causes include exercise, fever, anxiety, hypovolemia, anemia, pump failure, increased sympathetic tone, hypoxia, or hypothyroidism – Clinical Significance Decreased cardiac output for rates >140 Very rapid rates can precipitate ischemia or infarct – Treatment Treatment is directed at the underlying cause
- 8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ NormalQRS NormalPRI Upright and normalP Waves SA node Pacemaker Site IrregularRhythm 60–100Rate Sinus Dysrhythmia Rules of Interpretation Dysrhythmias Originating in the SA Node
- 9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dysrhythmias Originating in the SA Node Sinus Dysrhythmia – Etiology Often a normal finding, sometimes related to the respiratory cycle May be caused by enhanced vagal tone – Clinical Significance Normal variant – Treatment Typically, none required
- 10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ NormalQRS NormalPRI Upright and normalP Waves SA node Pacemaker Site IrregularRhythm Normal to slowRate Sinus Arrest Rules of Interpretation Dysrhythmias Originating in the SA Node
- 11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dysrhythmias Originating in the SA Node Sinus Arrest – Etiology Occurs when the sinus node fails to discharge May result from ischemia of the SA node, digitalis toxicity, excessive vagal tone – Clinical Significance Frequent or prolonged episodes may decrease cardiac output and cause syncope Prolonged episodes may result in escape rhythms – Treatment None if patient is asymptomatic Treat symptomatic bradycardia
- 12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ NormalQRS NormalPRI Upright and normal P Waves SA node Pacemaker Site IrregularRhythm Normal to slowRate Sinus Block Rules of Interpretation Dysrhythmias Originating in the SA Node
- 13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sinus Block – Etiology Occurs when the sinus node fires on time but the impulse is blocked before it exits the sinus node Ischemia, digitalis toxicity, excessive vagal tone – Clinical significance Prolonged episodes may compromise cardiac output Escape rhythms may develop – Treatment None if patient is asymptomatic Treat symptomatic bradycardia Dysrhythmias Originating in the SA Node
- 14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ NormalQRS NormalPRI Upright and normalP Waves SA node Pacemaker Site IrregularRhythm Normal to slowRate Sinus Pause Rules of Interpretation Dysrhythmias Originating in the SA Node
- 15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sinus Pause – Etiology Occurs when the sinus node fails to discharge for a brief period Ischemia, digitalis toxicity, excessive vagal tone – Clinical significance May compromise cardiac output Escape rhythms – Treatment None if patient is asymptomatic Treat symptomatic bradycardia Dysrhythmias Originating in the SA Node
- 16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ NormalQRS NormalPRI Upright and normalP Waves SA node Pacemaker Site IrregularRhythm Extremely variableRate Sick Sinus Syndrome Rules of Interpretation Dysrhythmias Originating in the SA Node
- 17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sick Sinus Syndrome – Etiology A combination of dysrhythmias Occurs when the sinus node is diseased or ischemic Ischemia, digitalis toxicity – Clinical significance May compromise cardiac output Escape rhythms – Treatment None if patient is asymptomatic Treat symptomatic bradycardia Dysrhythmias Originating in the SA Node