hey everyone it's nurse Sarah and in this video I'm going to be going over premature junctional contractions also known as premature junctional complexes so let's get started pjc's are early contractions that originate from a focal point around that AV Junction rather than the SA node so that's why we call them premature junctional contractions or complexes and whenever they occur they're going to cause these random beads to appear early within that underlying rhythm so two big things I want you to walk away with pjc's number one they are premature early contractions that are just going to happen within that underlying Rhythm secondly is that it's going to have p-wave issues and those p-wave issues that it's going to have are going to be similar to those junctional rhythms that we went over before if you want to watch my whole reviews on junctional rhythms you can access it up there so the issues that the PE wave is going to have could be any of the following number one that P wve can be concealed hence you ain't going to see it it's hiding somewhere within that QRS complex or the P wve could be after the QRS complex it could be before the QRS complex now if it was before it it's going to be really close hanging out to that QRS complex which is going to lead your PR interval to be less than12 seconds and if you look at leads avf 2 and three it's going to appear inverted now you may be wondering what's the difference between a pjc and those junctional Escape beats well it all centers around a pause so with pjc's we know that these are premature contractions that are just going to happen randomly whenever a folky point in the AV Junction decides to fire so because of that they're not going to have a pause before the actual pjc however on the flip side with those junctional Escape beats a pause is going to occur before the junctional beat and the reason for that is because those Escape beats are in a sense helping your heart Escape cardiac stand still or cardiac death because your SA node is working too slowly and so all of a sudden it's like hey you're going to fire and it doesn't fire so the AV Junction takes over but there's that little pause that had happened before the AV Junction took over with its beat so now let's talk about some characteristics of pjc's so whenever you're looking at that Rhythm overall with those random pjc's thrown in there that overall rhythm is going to be irregular because those pjc's have prematurely occurred however on the underlying Rhythm it should be regular the rates are going to vary depending on one type of Rhythm you have under line and those p waves are going to have issues that we talked about earlier however the p waves on the underlying Rhythm they should be normal now your PR interval on the underlying Rhythm should be normal so we're talking about .12 to20 seconds however with the pjc's PR interval it may not even be there that you can even assess it because let's say the p wve is behind the QRS or it's concealed but sometimes it can appear in front of the QRS at pjc's but it's going to be so close to that QRS complex that your PR interval will be less than .12 seconds your QRS complex should be normal should be less than 1.2 seconds but it's going to occur early whenever you have the pjc and the QT interval in the t-wave will be normal so here we have an example of a pjc so we have our underlying Rhythm as normal sonus rhythm with a couple pjc's that have decided to show up so here we have sinus be sinus be and then bam premature junctional contraction and notice our little p-wave there he's inverted and he's close to that Qs complex so if you measure that PR interval it's less than 0.12 seconds it's about one 0 seconds and then we have four more sonus speeds and then boom all of a sudden we have another pjc and look it's p-wave is concealed it's hidden within that QRS complex now what are the causes of pjc's well remember this new Moni created Junction so J is for junction we're specifically talking about the a junction it has increased automaticity and this can occur from deox and toxicity so this AV Junction is just overly excited and it's just randomly throwing out these premature contractions and this is actually one of the most common causes of pjc's the doox and toxicity using alcohol node injury we're talking about the AV node is damaged this could happen due to surgery or infection congenital defects in that Junction tobacco use imbalance of electrolytes like potassium calcium or magnesium oxygen deprivation which could have occurred because a patient had my cardial infarction we had limited blood flow to the heart hence that nodal tissue in there or hypoxia and then lastly it can occur naturally in some patients so now let's talk about the treatment for pjc's a lot of times pjc's are harmless because patients will just have them randomly and they don't have them frequently so they're asymp atic they become a problem when you're having them frequently because it could lead to a lower cardiac output where your body is not being profused with enough blood flow by your heart and that can lead to symptoms like chest pain palpitations fluttering in the chest if they were severe enough it could even lower the blood pressure so whenever that starts to happen we start to get concerned so we want to look for those potential causes so try to recall the pneumonic Junction and the healthcare provider will need to treat the cause and we play a role with educating the patient because there are some modifiable factors that the patient can modify to help decrease these pjc's from occurring so it could include smoking sensation limiting alcohol intake avoiding caffeine and balancing electrolyte levels so making sure they're staying hydrated plus look at their medication history are they on let's say maybe diuretics because that can really alter electrolyte levels now let's say that you do notice these pjc's in your patient and you look at their medication history and they are taking dexin well you want to notify the healthcare provider and they can order a dexin level on them a normal level is about .5 to 2 nanog per milliliter so anything greater we can be in toxic territory so you'd want to hold the medication see what the healthcare provider wants you to do and then remember for testing purposes what's the antidote for de join it is digifab okay so that wraps up this review on PJ and if you'd like to test your knowledge on this material that we just learned you can access a free quiz via the link in the description below