00:01
Third degree AV block is
called complete heart block.
00:05
Okay, this is a big deal.
00:08
This is like the atria and the
ventricles are no longer communicating.
00:12
I will never forget the
patient that we got to call,
there's going to
be a direct admit,
from the doctor's office building
that was connected to the hospital.
00:21
We expected the patient to be
over in like less than 10 minutes.
00:24
We waited, we waited, we waited.
00:28
It took her hours to get there.
00:30
When she finally
rolled into the unit,
we thought, "Well, maybe she isn't
in third degree heart block."
We hooked up to the monitor.
00:36
For sure, she was in
third degree heart block.
00:40
We said, "Ma'am,
where have you been?"
And she's like, "Well,
I wanted to do some laundry
and clean the house before
I came into the hospital."
We were like, it was crazy.
00:50
But you know, some people
are we want to be in control
and keep our lives in order.
00:55
But she legit was in
3rd-degree AV block.
00:59
Now let me explain to you
what we knew as nurses
and she didn't really see
as a problem as the patient,
otherwise she wouldn't
have gone home
and done laundry and housework
before she came to us.
01:11
Now look at these P waves.
01:15
Okay, if you plot them across.
01:19
Boy, they will plot out equally
that P is just happening
with equal distances
between P to P.
01:26
If you look at the QRS
complexes go R to R to R to R.
01:32
Yeah, they're going
fine, aren't they?
But yet, there's not a
P wave for every QRS.
01:40
They're completely
not communicating.
01:45
So you may hear people say,
the Ps march out meaning same distance,
same distance, same
distance, same distance.
01:51
Ours do the same thing.
01:53
Same distance, same distance,
same distance, same distance,
but they are not working together,
they are like disconnected.
02:03
Because in 3rd-degree AV block,
it's a complete failure
of the AV node to conduct
any impulses from the
atria to the ventricles.
02:13
That's what makes
this one different,
and obviously,
much more serious for your patient.
02:19
So we call it complete block.
02:22
3rd-degree is complete block
because there is a total failure.
02:26
The AV node doesn't conduct any impulses
from the atria to the ventricles,
and this is what makes
3rd-degree block so serious.
02:36
Now, sometimes you may hear
someone call it AV disassociation,
meaning they are disconnected,
not talking to each other.
02:43
This patient is at the highest
risk for ventricular standstill,
It can end up in
sudden cardiac death.
02:50
So while she went home and
got her house in order,
she could have gone into
sudden cardiac death at home,
which would have been horrible.
03:00
Now I tell you that story,
because she ended up being fine.
03:03
She went through treatment,
and she went back home
to clean her house again
and to do her laundry.
03:08
But this is what
could have happened.
03:11
But she's really good at talking her
husband into taking her home first,
and then bringing her back.
03:18
Now when we're looking at the blocks,
sometimes they can look a little different.
03:21
So we wanted to show you this.
03:23
Key point: No association
between the atria and ventricle.
03:27
But look, it can be on
either side of the AV node.
03:31
So if it's on the distal side,
then we can get a
wide QRS complex.
03:36
But if it's on
the proximal side,
the QRS complex is more narrow,
like you see in our illustration.
03:43
So we want to make sure you understand
that there can be kind of two locations.
03:47
It can be on which two sides.
03:51
Right, we refer to that is
distal side and proximal side.
03:57
Now look at the difference
in the QRS complexes.
04:01
Which one tends to
have a wider QRS?
Beautiful, all right,
you're really doing good tracking with us.
04:13
Wow, this is overwhelming.
04:15
All the possible causes
of 3rd-degree AV block.
04:19
But in addition to
teaching you the causes,
we're going to teach you a strategy
on the most effective way to study
when you have 12
points to remember.
04:28
We're going to show you visually
how to chunk information.
04:32
So we know causes of 3rd-degree
AV block when we look at these,
let's see if we can
chunk them together.
04:38
First, pause the video and I want you
to read through all 12 bullet points,
then come back and
restart the video.
04:52
Okay, now here's an example of
how you could chunk information.
04:56
You see that first bullet point?
Well, that's something that happened
problem in the conduction system
probably caused by
coronary artery disease.
05:05
That's kind of a big segment,
then down on the bottom
to a congenital disorder
and underlying
structural heart disease.
05:14
we can chunk those together as direct
issues with the heart muscle itself.
05:20
So we've shown you how to chunk
these first ones together,
what I want you to do is
to look at the second side
and look at how you would
group those together.
05:32
Now, this is really
tough for students.
05:34
But this is what helps you be
successful in nursing school.
05:38
First of all, your expectation
that you're going to remember,
all 12 points won't happen.
05:44
You want to remember the
most important points.
05:47
So see how we've got
the first category,
the first bullet point or we're saying a
direct damage to the conduction system.
05:55
Is there anything
on that right side
that would also be direct damage
to the to the conduction system?
No, not really, in my mind.
06:04
But what about the structural
damage from heart disease?
Well, I could kind of group together
things like post-cardiac surgery,
and cardiomyopathies.
06:14
That would be one chunk.
06:16
Now see,
is that visualized on the screen.
06:19
Cool. All right, we're starting
to eliminate some of our points.
06:23
Now, a congenital disorder means
I'm just born with something,
I could also throw that into an
underlying structural heart disease,
meaning anything that kind of
changes the actual heart itself.
06:37
So now, we've reduced our 12
points down to much fewer.
06:42
Now we've got a lot of other
things in there like Lyme disease,
rheumatologic disease,
autoimmune disease,
amyloidosis, sarcoidosis,
muscular dystrophy.
06:51
I wouldn't be able to
remember all those diseases,
I would chunk those
together as some diseases.
06:57
If you can remember
those, that's great.
07:00
But know that this is how you're
successful in nursing school,
you don't just try to
memorize everything,
you chunk information
together with understanding.
07:11
So now, you know, when you see a
test question or you see a patient,
hey, if they've had anything that
could damage their conduction system,
if they've had anything that could damage
their structure of their heart, muscle,
and then some various
and assorted diseases,
then I know that this patient is an
increased risk for 3rd-degree AV block.
07:32
So there you go.
07:33
You can't memorize everything.
07:35
But if you chunk intentionally
with understanding,
when you see it in
a test question,
you'll know if there is damage to the
heart, possible damage to the heart,
be worried about
3rd-degree AV block.
07:48
Now when we treat
AV block its pacing,
because the patient has the significantly
increased risk of ventricular standstill
and sudden cardiac death.
07:59
So back to our chart.
08:01
Third degree is the complete
failure of the impulse
from the atrioventricular
node to the ventricles.
08:08
So there's this AV disassociation
and these weird escape rhythms.
08:12
They could be junctional or ventricular,
but it's pretty bizarre looking.
08:17
How do we treat it?
It's an internal pacemaker.
08:21
Now we've talked about our
strategy and covering up the slides
and then asking
yourself questions.
08:25
Here's some examples.
08:27
So let's pretend you had
all of these covered,
you can just look away for that.
08:31
Which one is technically
not a true block?
Right.
08:37
1st-degree.
08:40
Which type of block
is usually benign?
Good.
08:46
2nd-degree type I.
08:50
What is another
name for Wenckebach.
08:55
Good.
08:56
2nd-degree type I.
09:00
Thank you for watching this
part of our video series.