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Recognizing heartrhythm disturbances in PSG
Ann Ryckx
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Arrhythmias Any change in the normal sequence of the electrical impulses from the sinus node (SA) to the ventricles can cause arrhythmia
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P-wave: contraction of the atria
QRS-complex: contraction of the ventricles T-wave: recovery of the ventricles
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ECG in PSG Mostly only 1 channel
Recognition of heartrhythm disturbances Not a diagnostic tool for other heartpathologies s.a. signs of ischaemia
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Tachy-arrhythmia (too fast: > 100 bpm) Brady-arrhyhthmia (too slow: < 60 bpm)
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Atrial arrhythmia An atrial arrhythmia is an arrhythmia caused by
a dysfunction of the sinus node or the development of another atrial pacemaker within the heart tissue that takes over the rhythm of the sinus node
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Sinus Tachykardia A condition in which the heart rate is faster than 100 beats per minute because the sinus node is sending out electrical impulses at a rate faster than usual
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Supraventricular tachycardia = paroxysmal atrial tachycardia
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AF: Atrial fibrillation
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Atrial flutter The electrical signals come from the atria at a fast but even rate. When the signals from the atria are coming at a faster rate than the ventricles can respond to, the ECG pattern develops a "sawtooth" pattern, showing two or more flutter waves between each QRS complex.
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Atrial extra systoly = premature beat
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Ventricular arrhythmia
A ventricular arrhythmia is an arrhythmia caused by a dysfunction of the sinus node an interruption in the conduction pathways the development of another pacemaker
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Atrial ventricular Block AV Block
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Atrial ventricular AV Block 1st degree
Prolonged pr-interval (>200 msec)
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Atrial ventricular AV Block 2nd degree
Wenckebach. Progressive prolongation PR interval until a p-wave is blocked Mobitz Type II: pr-interval constant, evt. shorter after a p-wave block
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Atrial ventricular AV Block 3d degree
No atrial impulses reach the ventricles Possibly lifethreatening if the subsidiary pacing in the ventricles is not sufficiant
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Ventricular tachycardia
!! Life threatening !!
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PVC: Premature ventricular complexe
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Bigeminy
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Trigeminy
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Multifocal PVC
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Ventricular tachycardia
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Ventricular flutter !! Emergency !!
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Ventricular fibrillation
!! Emergency !!
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Asystoly !! Emergency !!
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CPR Cardio Pulmonary Resuscitation
Newest guidelines
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Step 1: check consciousness
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Step 2: call for help
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ABCD of basic life support
Airways B Breathing C Check circulation D Defibrillation
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Check and free the upper airway
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Hyperextension, lift the chin
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Close the nose, hyperextension
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2 breaths, deep and slow
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Check the circulation: carotis
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Automatic External Defibrillation (AED)
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No circulation: No AED available
Basic Life Support 15 compressions on the chest 2 breaths Same rhythm, even if 2 reanimators
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Check for the lower ribs
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Lower third of the sternum
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Arms stretched, 4-5 cm impression, rhythm 100/min.
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15 compressions / 2 breaths
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No circulation AED available
In case of fibrillation or ventricular tachycardia connect the patient to the AED , perform analysis Without pulse: defibrillation Repeat ABC No result: restart BLS and defibrillation after 1 minute No fibrillation: BLS
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Automatic External Defibrillation (AED)
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Automatic External Defibrillation (AED)
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Safetyposition after reanimation
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THANKS !!
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Reanimation child > 8 years old
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Hyperextension, mouth to mouth breathing
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Reanimation child < 8 years old
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Reanimation pediatrics
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Hyperextension
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Hyperextension: push to chinbones forward
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Mouth to nose breathing
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