Rythym question - page 2
Ok folks I'm stumped. I monitored a pt who I'd have liked to have in my unit, not on the floor on tele, and who had a rythym I've never seen the likes of before. I'll describe it, and y'all tell... Read More
Sep 7, '08The cardiologist called it sick sinus syndrome. BP 130's/80's. No vasopressors, and the pvc's were not all the same. All pointed the same direction, but some were big, "normal" looking things and some were rather squashed looking. The patient was stable, talkative, and had decent symptom relief by the time I saw her.
I don't get ready access to materials to copy once they've left my monitoring shift, so likelihood of posting is less than that of my house sprouting wings, unfortunately. You know how it is with education- bosses like it their way. I do still intend to have her chart pulled back out so I can get another good look, and I requested an actual inservice. :-) If I see the cardiologist when he's not in a huge hurry I will ask him as well.
Having turned it over a bit more in my brain, I see now that yes, I should have seen second degree block. Which is fine, but what messes with my head now is why the pvc's (what ever in this fine world you wanna call them) wind up in the spot they do. I'd even be okay with second degree with bigeminy if the darn things would just not be glued to the tail end of a sinus beat. I really think her block is progressive and it's gonna be third degree at some point in the not so far off future.
Well anyhow I've probably beaten this poor horse, er rythym, to death. Gotta sleep now!
Sep 7, '08Sick sinus?!!! Yes to marked bradycardia, sinus pauses or periods of sinus arrest... but then sick sinus alternates that paroxysms of rapid atrial arrhythmias, especially atrial flutter or a-fib.... aka brady-tachy syndrome. During the periods of brady sometimes junctional escape rhythms commonly occur and AV block is also often associated with sick sinus (which is why I was asking about inverted p's related to retrograde conduction)... but hmmm... I didn't see anything about the rapid rhythms in the original post.... causes of sick sinus include inflammatory cardiac disease, cardiomyopathy, sclerodegenerative processes involving both the sinus and AV nodes, drugs like beta blockers, calcium channel blockers, dig, amio, propafenone and adenosine. Bummer about getting the strip posted... and I hear you about the education and management liking it that way...on my old unit I recently heard from an insider at a management meeting that they weren't going to orient all the nurses to recovering the post op CABGs because then they'd all have an advanced skill set and some of them would leave... geezzz.... just unbelievable isn't it?
Sep 7, '08Yupp, just nonsense... I couldn't believe it when I heard it... what they don't realize is that the good nurses elevate themselves wherever they are and if a unit or a hospital is an impediment to such they go elsewhere... leave anyway... and the problem isn't solved on administration's end in the outcome...good nurses will seek out the experiences they want and need...This is why my old unit is stocked with agency and travelers... no one in the hospital wants to work there...