窦性心律失常的诊断和治疗课件

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1、SinusRhythms:DysrhythmiaRecognition&ManagementDeptofEMSProfessionsTempleCollegeSinusRhythmsPossibilitiesNormalSinusRhythm(SinusRhythm)SinusBradycardiaSinusTachycardiaSinusArrhythmiaSinusArrestSinusRhythmsExpectedECGRhythmMostdonotresultinalteredphysiologySinusrhythmmeansPacemakersiteisinthe

2、Sinoatrial(SA)nodeCharacteristicsofallsinusrhythmsaresimilarNormalSinusRhythmCharacteristicsPacemakersite:SAnodeRate:60-100bpmPwaves:areuprightinleadII,alllookalikePRinterval:generallyconstant;0.12-0.20secondsR-Rinterval:usuallyregularQRScomplexes:usuallynormalappearingand<0.12seconds,maybe

3、widePtoQRSRelationship:onePwaveprecedeseachQRScomplexAnalyzetheRhythmNormalSinusRhythmPathophysiologyNonespecifictotheECGrhythmitselfNormalandexpectedECGrhythmManagementTreatthepatient!SinusBradycardiaCharacteristicsSameasNSRwithONEexceptionRate:<60bpmAnalyzetheRhythmSinusBradycardiaPathoph

4、ysiologyGenerallyaresultofsomeothercauseExcessiveparasympathetictoneonSAnodeDecreaseinsympathetictoneonSAnode(blockade)AdministrationofcalciumchannelblockersDigitalistoxicityDiseaseoftheSAnode(sicksinussyndrome)AcuteinferiorMIHypothyroidismHypothermiaHypoxia(later)PhysicalconditioningSinusB

5、radycardiaSymptomaticPresentationVariableSeverepresentationmayresultinDizziness,lightheadedness,alteredmentalstatus,orsyncopeSOBCPHypotension/ShockPulmonarycongestionAcuteMISinusBradycardiaManagementFirstStepsafterABCDsSymptomaticorAsymptomaticIfsymptomatic,thenStableorUnstableAlteredmental

6、statusSevererespiratorydifficultyShock/HypoperfusionAttempttoIdentifytheCauseImplementCause-Specifictreatments,ifapplicableAsymptomaticBradycardiaPrimaryABCD-Assess&TreatInitiallySecondaryABCD-Reassess&FurtherTreatmtIV/O2/ECGMonitor/12leadECGDifferentialDiagnosisTreatthecauseIF2°or3°AVB,the

7、nPlaceTCPinstandbymodeSymptomaticBradycardiaPrimaryABCD-Assess&TreatInitiallySecondaryABCD-Reassess&FurtherTreatmtIV/O2/ECGMonitor/12leadECGDifferentialDiagnosisCausespecifictreatment,ifapplicableAtropine0.5mgIVq3-5min,max0.04mg/kgTCPDopamine5–20mcg/kg/m