ARRHYTHMIAS (CONTINUED) • Pulsus paradoxus (an abnormal inspiratory drop in

Key treatments systemic

Atrial fibrillation blood pressure greater than 15 mm Hg)
• Antiarrhythmics (if client is stable): amiodarone • Restlessness
(Cordarone), • Upright, leaning forward posture
digoxin (Lanoxin), diltiazem (Cardizem), Key test results
procainamide, verapamil • Chest X-ray shows slightly widened mediastinum
(Calan) and cardiomegaly.
• Synchronized cardioversion (if client is unstable) • Echocardiography records pericardial effusion with
Asystole signs of
• Cardiopulmonary resuscitation (CPR) right ventricular and atrial compression.
• Advanced cardiac life support (ACLS) protocol for • ECG may reveal changes produced by acute
endotracheal pericarditis. This
intubation and possible transcutaneous pacing test rarely reveals tamponade but is useful to rule out
• Antiarrhythmics: atropine, epinephrine per ACLS other
protocol cardiac disorders.
Ventricular fibrillation Key treatments
• CPR • Surgery: pericardiocentesis (needle aspiration of the
• Defibrillation pericardial
• ACLS protocol for endotracheal intubation cavity) or surgical creation of an opening to drain fluid,
• Antiarrhythmics: amiodarone (Cordarone), thoracotomy
epinephrine, lidocaine • Adrenergic agent: epinephrine
(Xylocaine), magnesium sulfate, procainamide, • Inotropic agent: dopamine
vasopressin Key interventions
per ACLS protocol If the client needs pericardiocentesis
Ventricular tachycardia • Keep a pericardial aspiration needle attached to a
• CPR, if pulseless 50-ml
• Defibrillation syringe by a three-way stopcock, an ECG machine,
• Antiarrhythmics: amiodarone (Cordarone), and an
epinephrine, lidocaine emergency cart with a defibrillator at the bedside.
(Xylocaine), magnesium sulfate, procainamide Make sure the
• ACLS protocol for endotracheal intubation, if equipment is turned on and ready for immediate use.
pulseless • Position the client at a 45- to 60-degree angle.
Key interventions Connect the
• If the client’s pulse is abnormally rapid, slow, or precordial ECG lead to the hub of the aspiration
irregular, needle with an
watch for signs of hypoperfusion, such as alligator clamp and connecting wire. When the needle
hypotension and touches
altered mental status. the myocardium during fluid aspiration, an ST-
• When life-threatening arrhythmias develop, rapidly segment elevation
assess the or premature ventricular contractions appear.
level of consciousness, respirations, and pulse. • Monitor blood pressure and central venous pressure
• Initiate CPR, if indicated. (CVP)
• If trained, perform defibrillation early for ventricular during and after pericardiocentesis to monitor for
tachycardia complications
and ventricular fibrillation. such as hypotension, which may indicate cardiac
• Administer medications as needed, and prepare for chamber
medical puncture.
procedures (for example, cardioversion) if indicated. • Watch for complications of pericardiocentesis, such
• Provide adequate oxygen and reduce the heart’s as ventricular
workload, fibrillation, vasovagal response, or coronary artery or
while carefully maintaining metabolic, neurologic, cardiac chamber puncture.
respiratory, If the client needs a thoracotomy
and hemodynamic status. Follow ACLS protocol for • Explain the procedure to the client. Tell him what to
endotracheal expect
intubation. postoperatively (chest tubes and chest tube drainage
CARDIAC TAMPONADE system,
Key signs and symptoms administration of oxygen). Teach him how to turn,
• Muffled heart sounds on auscultation deep-breathe,
• Narrow pulse pressure and cough.
• Jugular vein distention • Maintain the chest tube drainage system and be
alert for complications,
such as hemorrhage and arrhythmias.