Other tmt for dysrythmias
- Vagul maneuvers: induce vagal stimulation of the cardiac conduction system, specifically the SA and AV nodes. Although not as common, may be attempted to treat SVT. Often temporary and may cause rebound tachycardia or severe bradycardia. Assess the pt's HR, rhythm, BP, observe cardiac monitor, record strip before, during, and after.
- carotid sinus massage:physician massages carotid sinus for a few sec. Causes vagal stimulation, slowing SA and AV node conduction. Prep the pt, instruct to turn away from the side to be massaged, observe for change in cardiac rhythm.After, assess VS, and LOC. (Complications include bradydysrhthymias, asystole, VF, and cerebral damage.
nonsurgical; provides a timed electrical stimulus to the heart when either the impulse initiation or the conduction system of the heart is defective; used for patients with symptomatic atropine-refractory bradydysrhythmias (particularly 2nd degree type II and 3rd degree blocks).Have emergency equipment available in case the pt becomes unstable or goes into cardiac arrest
- Synchronous pacing (demand): sensitivity is set to pt's own beats; When the heart rate is above the set rate, the pacemaker does not fire, When it is less, the pacemaker provides electrical impulses.
- Asynchronous: fixed-rate pacing
Noninvasive temporary pacing:
application of two large external electrodes that are attached to an external pulse generator; used as an emergency measure, prophilactically when performing procedures, or transporting pts with bradycardia.
- Prep the equipment, and wash skin with soap and water
- apply electrodes according to package instructions
- Turn pacer on, set rate as ordered, establish stimulation threshold
- Set current milliamperes output 2 mA above the dose at which consistent capture is observed
- Palpate right radial or carotid pulse, and assess BP ( use right arm not left b/c they may not be accurate
- Observe for discomfort from muscle stimulation, skin irritation, and diaphoresis from the electrodes
- give analgesics or sedatives as ordered