Dysrhythmias

Dysrhythmias—also called arrhythmias—occur when cardiac impulses form abnormally, travel abnormally, or both. The result may be an occasional premature beat, an inefficient atrial rhythm, a dangerously fast ventricular rhythm, or complete loss of effective cardiac output. The tracing is only half of the assessment. A patient with atrial fibrillation at a ventricular rate of 140 beats/min may be alert, normotensive, and adequately perfused; another patient with the same rate may have hypotension, pulmonary edema, or altered mental status. The second patient needs immediate electrical treatment because the rhythm is impairing circulation. Rate alone does not determine urgency. Use this sequence when a rhythm changes: 1. Check the patient before the monitor. Assess responsiveness, airway, breathing, pulse, blood pressure, oxygen saturation, mental status, and signs of poor perfusion. 2. Determine whether a pulse is present. Pulseless ventricular fibrillation and pulseless ventricular tachycardia require defibrillation; an organized rhythm with a pulse may require synchronized cardioversion instead. 3. Assess stability. Hypotension, shock, ongoing ischemic chest discomfort, acute pulmonary edema, syncope, or acute altered mental status makes the rhythm unstable. 4. Interpret the ECG...