1. Telemetry / Arrythmias Dan Crouch Kristi Kuhn Kate Lindley Ben Voss

2. Unresponsive patient in ED

3. Junctional tachycardia • Regular • Narrow complex • No P waves

4. Surgical consult for arrhythmia

5. Paroxysmal SVT (PAT) • Benign rhythm • If sustained: • Vagal maneuvers • Adenosine • DCCV

6. 70 yo AAF with palpitations

7. Premature ventricular complexes • Abnormal but usually benign • Concerns: very frequent, history of ischemia • Ask about symptoms (palpitations, “skipping a beat”) • Beta-blockers for symptomatic patients

8. Called to see sleeping patient

9. NSVT • ICM or NICM • Usually not an indication for ICD • Ask about symptoms • Use more beta-blockers

10. Patient with L-sided weakness

11. Atrial fibrillation • Irregular • No coordinated atrial activity (no P waves) • Rate control • Anticoagulation

12. Lung transplant pt with SOB

13. Atrial flutter (2:1) • Regular rhythm • Flutter circuit rate: 300 bpm • Re-entrant circuit • Diagnostic maneuvers: vagal stimulation, adenosine

14. Typical atrial flutter • “Sawtooth” pattern

15. Atrial flutter (variable block) • Regular flutter waves @ 300 bpm • Irregular ventricular response • Usually seen with AV nodal blockade • May be difficult to distinguish from coarse Afib

16. Nursing student asks for help

17. Mobitz I (Wenkebach) • Regular P waves • Lengthening P-R interval • Shortening R-R interval • Predictably dropped beats (grouped beats)

18. Patient with syncope

19. Mobitz II • Randomly dropped beats • Frequently progresses to 3rd degree AVB or complete heart block • Can be indication for pacemaker

20. 27 yo WM with syncope at work

21. Complete Heart Block • Normal sinus node activity (P waves) • No ventricular response • Pt presented with syncope while driving forklift

22. Patient with chest pain

23. Ventricular tachycardia • Wide complex tachycardias • VT until proven otherwise for patients with ischemia • Brugada criteria: only AV dissociation useful on tele • GET AN EKG!! • Non-malignant rhythm with aberrancy also possible

24. Pt missed dialysis

25. Hyperkalemia • QRS widening • Peaked T waves • Treatment: • Calcium first • Insulin/glucose, albuterol, glucagon, NaHCO3, IVF/Lasix • Kayexalate last

26. 18 yo WF postpartum

27. Torsades de pointes • Polymorphic ventricular tachycardia • Life-threatening with degeneration to VF • Usually precipitated by PVC in setting of long QT • Often associated with QT-prolonging drugs • Check for electrolyte disturbances (especially Mg)

28. Regardless of the telemetry…