00:01
Now look at these pictures
that we have here.
00:03
Why have we chosen to put that
big up by the patient's brain?
That's to help you remember
when you're studying
and you're preparing
for your exams.
00:12
And for your practice,
I want you to look at that graphic.
00:15
And remember somebody with atrial
fib or an atrial dysrhythmia,
we want to minimize their risk
of thrombo embolic stroke,
lots of big old word that
just means blood clot, right?
And because that
blood clot breaks off
and causes an embolism
to travel into the brain.
00:32
We want to do everything we can
to minimize the risk of them
developing that type of clot.
00:37
Now, when it comes to
cardiac dysfunction,
we want to get them back
into normal sinus rhythm.
00:43
Now there's multiple ways that we
can accomplish both of these goals.
00:47
So let's talk about getting them
back into normal sinus rhythm.
00:52
We can use medications
or procedures.
00:55
So medications that we're
looking at treating the patient,
we want to first prevent those
clots, right?
So there's a listing of drugs
there that could be used
warfarin, apixaban, rivaroxaban,
you go all those medications.
01:09
They're going to prevent the
patient from making clots as easily
as a patient who is not
taking those medications.
01:16
We can try medication that
controls a ventricular rate
like beta blockers or calcium
channel blockers or digoxin
that will help get a more
organized heart rhythm.
01:26
So first group of
meds prevents clots.
01:29
Second group is going to
control the ventricular rate.
01:32
Now, atrial fib, atrium might
continue to fibrillate in atrial fib,
but we can at least make
it a little more organized.
01:40
Now if we want to just go straight
back to returning sinus rhythm,
we can use amiodarone
or flecainide.
01:47
We'll cover those medications in more
detail in our pharmacology course.
01:52
Here we're just going
to give you an overview
of the medications
that we would use.
01:56
Now procedures.
01:58
Oh, these are really
interesting to assist in.
02:00
We can do electrical
cardioversion.
02:03
Thank goodness,
now we can just put patches on someone
and step away from the
patient and push the button.
02:10
We used to have to take the paddles
and put them right on the chest wall.
02:13
And that was a lot riskier
for us as a healthcare provider.
02:17
Now for using electro
cardioversion,
this is a procedure that
usually involves anesthesia
so that we can sedate the
patient watch them very closely,
they're not going to go down to surgery,
oftentimes, we can just use this in a room.
02:29
But a lot of places will have
an anesthesiologist there.
02:32
In addition to a cardiologist,
as we perform the electro conversion,
this is not something nurses
would ever do on their own.
02:41
Now, we can ablate it.
02:42
So we can zap it,
we can cauterize the areas of the heart
that are having the
most difficulty.
02:48
We can also put a little
plug called an LAA occlusion.
02:53
We'll stop blood from pooling in there,
and it'll reduce the risk of clots.
02:59
So again, our goals for PAC,
they're going to be very similar.
03:02
The goals for PAC and for
all the atrial dysrhythmias,
we're gonna want to
encourage lifestyle changes.
03:08
So anything that lowers
cardiovascular disease risk.
03:12
We're going to encourage them to
exercise, to make healthier food choices,
and be careful when
you're talking to patients
about this area of
their personal business.
03:21
Please don't be judgmental.
03:23
So instead of giving
them this image
that they're going to have to go to
a gym every day and kill themselves,
encourage them to
become more active.
03:31
Okay, that's going to be the
next step in becoming more active
and whatever that means for them,
you can help them identify it.
03:39
Make healthier choices.
03:41
Don't tell them
don't ever eat this,
and don't ever eat that
and stop eating this,
and tell them, "Hey,
let's make some healthier choices."
That will help nudge your
patient into making a change
that they can actually sustain instead
of making them feel like a failure
because they can't make instantaneous
radical lifestyle changes.
03:59
Now you want to
manage their triggers.
04:01
Now, triggers for these atrial
dysrhythmias could be stress,
smoking, caffeine,
any of those things.
04:09
Each patient may have a little
bit different type of trigger,
but help them keep a journal
or some entries to know
what are their known triggers.
04:17
We can teach them
the average ones.
04:19
But also if my patient
is not a smoker,
then smoking is not going
to be an issue for them.
04:24
So take the time to talk to them
and have listened to what they say and
what is currently part of their lifestyle.
04:33
Ask them about sleep apnea.
04:34
Now if the patient sleeps alone, they
may not know that they have sleep apnea.
04:39
But if they sleep where
someone can hear them,
ask them if they've ever been
told that they snore loudly
or they stop breathing and then
they pick up breathing again,
those are periods of apnea.
04:52
So ask them if they're aware of sleep apnea
because we definitely want to treat that.
04:56
Sleep apnea can impact cardiac function
no matter what what the dysrhythmia is.
05:02
And lastly, hypertension, right?
We don't want anyone to
experience hypertension
because it's hard on the whole rest of
the body, particularly your kidneys,
in chronic hypertension
that's untreated.
05:16
Now what we're going to do
to manage the heart rate,
we're going to see what needs to
be done for this individual patient
to manage their heart rate
and the overall workload.
05:26
Because we want to restore a normal
sinus rhythm, if at all possible.
05:32
So we talked about cardioversion
with conscious sedation,
we talked about ablation and
we talked about medications.
05:38
So why are we talking
about this again?
Because spaced repetition is the way
you help remember things in your brain.
05:46
So for cardiac dysrhythmias,
we talked about
catheter ablation,
cardioversion and medications.
05:54
Now, wait a minute,
why didn't I go left to right?
That's another study
strategy I want you to use,
I want you to mix things up.
06:02
And when you see
a list of things,
sometimes start in
the middle and go up,
and then all the way back
down and around again.
06:08
The more you can think
about your brain,
looking at a topic
from multiple angles,
the better mastery you're
going to have of that concept.
06:18
Now, we introduced
you to cardioversion.
06:19
Look at what we have here.
06:21
You see the patient.
06:22
They have the pads on them,
they've got an IV line in case we
need to use emergency medications,
and we'll also put some
type of sedation in there.
06:31
Now you have a practitioner next
to the patient is monitored.
06:36
That's really important.
06:37
You look at the machine down there,
you see atrial fib on the strip.
06:43
And now you see, that's where the
cardiovascular shock was delivered,
we put the arrow right there.
06:49
And magically the first time this
patient turns into sinus rhythm.
06:54
Now, I wish it was this simple.
06:57
Sometimes it is.
06:58
But oftentimes there needs
to be more than one shock,
we need to look at other things.
07:04
But this is the way
we'd like it all to go.
07:07
Now notice the
title of this slide.
07:10
Cardioversion with
conscious sedation,
that means the patient is
kind of their arousable.
07:16
They might be able to talk to
you but they're not really aware
and they will not
remember this procedure.
07:23
That's what we want
for the patient.
07:25
So this is actually what it
would look like in a room
if you're assisting with
cardioversion with conscious sedation.
07:33
That's why the anesthesiologist
needs to be in the room
so they can monitor conscious
sedation and respiratory.
07:41
Now, how do we do
catheter ablation?
Well, the ablation line
is going to go in ablate
or numb or deadened that tissue,
that's gonna be as problematic
with electrical conductance.
07:53
So a catheter is going to be moved
in through the veins and the heart
the physician is
going to guide that.
08:00
Now you are going to be
in the cath lab, right?
They've got some really high
tech ways to monitor the patient
and the heart and for the physician
to visualize that catheter
moving through the heart so
they can get right to the spot
that they think is the problem that's
causing the atrial dysrhythmia.
08:20
Remember that LAA occlusion?
Super cool, isn't it?
So that's like a filter
plug that stops blood
from being able to pull in
the left atrium appendage.
08:32
So why are we doing this?
Remember, that's the most likely
spot for a patient to develop clots.
08:39
So if we put an LAA
occlusion in there,
we're going to prevent
blood from pooling in there.
08:45
So we've lowered
the risk of clots
turning into strokes or other
tissue perfusion problems.
08:52
Atrial dysrhythmias,
like atrial fibrillation
can become a chronic
medical condition.
08:57
Remember,
this will significantly increase
a patient's risk for
thrombo embolic stroke.
09:03
So our treatment goals are to minimize the
risk of developing a thromboembolic stroke
through appropriate
medications and procedures.
09:11
Now, premature atrial contractions
may or may not require treatment.
09:16
Patients with PACs may have increased
risk of cardiovascular events,
including things like stroke, MIs or
the progression to atrial fibrillation.
09:25
Atrial flutter can be one of two
things, remember those P words?
Paroxysmal or in some
cases persistent.
09:33
So treatment goals, we want to minimize
the risk of a thrombo embolic stroke
so we can use medications
and procedures
to control the patient's
heart rate and rhythm.
09:44
Thank you for watching
our video series.