Static Cardiology Lecture Notes

Introduction

• Format: ECG rhythm and scenario presented.
• Time Limit: 1 minute and 30 seconds per card.
• Objective: Identify ECG rhythm, provide diagnosis and treatment.

ECG Rhythm Analysis

1. Counting R Waves: Determines heart rate.
   • Example: 4 R waves = 40 bpm.
2. P Wave Examination: Presence indicates atrial initiation.
3. QRS Complex: Wide QRS may appear ventricular, but P waves suggest atrial origin.
4. R to R Interval: Consistency indicates sinus rhythm.
5. Diagnosis: Sinus bradycardia due to slow rate and consistent R to R interval.

Scenario and Context

• Patient: 63-year-old female, missed dialysis, minimally responsive.
• Vital Signs: BP 66/palp, pulse 40, respirations 5, SpO2 84%.
• Kidney Function: Essential for potassium balance; lack of dialysis leads to hyperkalemia.
• ECG Indication: Late hyperkalemia; widened QRS, peaked T waves.

Sinus Bradycardia and Hyperkalemia

• Progression: P wave may disappear, risk of ventricular dysrhythmia.
• Hyperkalemia Effects: Leads to wide QRS, peaked T waves.

ACLS Algorithm and Treatment

• Patient Status: Unstable due to low BP, altered mental status (CHAD criteria).
• Diagnosis: Unstable sinus bradycardia.
• Initial Treatment Steps:
  • Scene safety, BSI, IVO2 monitor.
  • Ventilate using BVM due to low respiration rate.
  • Consider atropine (1mg IV push).
  • Transcutaneous pacing: place pads, select rate (60-100 ppm), increase current for electrical capture.
  • Check carotid pulse for mechanical capture.
  • Vasopressors for hemodynamic control.
  • Rapid transport.

Bonus Treatment: Hyperkalemia Management

• Medications:
  • Regular insulin (10 units IV) + D50 for potassium shift.
  • Calcium chloride/gluconate (1g IV) for membrane stabilization.
  • Sodium bicarbonate for ion shift.
  • Albuterol (10-20 mg nebulized) for further potassium shift.
• Definitive Removal: Hemodialysis due to non-functioning kidneys.

Conclusion

• Channel Subscription: Encouragement to subscribe and use playlists for exam preparation.
• Continued Practice: Practice with static cardiology cards.
• Farewell Message: Have a good rest of your night.