1. Jason Morgan, RN, BS

2. Prolonged QT This can be a genetic condition but can also be caused by certain medications. Haldol (haliperidol) can cause prolonged QT, therefore periodic EKG’s should be done This can be cause arrhythmia's as well as Torsades

3. Torsades Can look similar to v-tach and v-fib at times Treat with 2 grams magnesium; dilute in 50 cc NS; DO NOT PUSH! (unless it’s a code)

4. A-flutter Atrial flutter is a relatively common arrhythmia that can be deleterious by impairing the cardiac output and by promoting atrial thrombus formation that can lead to systemic embolization. It is characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min. For many years, atrial flutter has been considered together with atrial fibrillation (AF). While some issues of therapy are the same, such as the restoration of sinus rhythm, the maintenance of sinus rhythm after cardioversion, slowing the ventricular rate, and prevention of systemic embolism, atrial flutter is quite distinct from atrial fibrillation Adapted from UptoDate A-flutter with RVR (rapid ventricular rate) A-flutter

5. A-Fib The RR intervals follow no repetitive pattern—they have been labeled as “irregularly irregular.” While electrical activity suggestive of P waves is seen in some leads, there are no distinct P waves. Thus, even when an atrial cycle length (the interval between two atrial activations or the P-P interval) can be defined, it is not regular and often less than 200 milliseconds (translating to an atrial rate greater than 300 beats per minute). Adapted from UptoDate

6. A-fib/flutter Is this new or old? Is the patient stable? Vital signs; cardiac output will decrease with a rapid rate Blood pressure? Mental status? Nausea? Vomiting? Dizziness? Obtain an EKG Medications Metoprolol- beta 1 adrenergic blocker Usually 5 mg IVP (by provider) Put patient on monitor Cardizem – calcium channel blocker Usually 10 mg IVP to start Put patient on monitor Cardio-version Only with new onset otherwise increased risk for clot mobilization Pre-treat with pain meds Fentanyl (short half-life)

7. Heart Block E longated PRI PACER!