this ppt briefly explains you about cardiac monitor ,important cardiac arrhythmia , ecg representation , cushings triad etc...

1. PREPARED BY
MURUGESH HJ
RN, ICU 02 ( KFCH JAZAN )
SAUDI ARABIA
COMMON SIGNS &
ABNORMALITIES ; CAN
DETECT THROUGH CARDIAC
MONITOR & ECG CARDIAC
ARRHYTHMIA

2. As a Intensive care Nurse it’s a essentially required quality to analyze the common abnormalities what we
can seen in cardiac monitor.
Cardiac monitor is equipment usually used to monitor patients both cardio-electric ( heart rate & ecg)
& haemodynamical status of the patient ( BP, RR, SPO2)…
Modern cardiac monitor will have more specialties so we can use for cvc pressure, IAP, ICP pressure
monitoring purpose etc……
lets start our small brief discussion ..
INTRODUCTION

3. CUSHINGS SIGN OR RISED ICP
ICP NORMAL RANGE (5-15MMHG)
BRADYCARDIA – HEART RATE IS <50B/MI
HYPERTENSION –BP IS >180/90MMHG
BRADYPNEA RR IS <10B/MIN OR TACHYPNEA >10B/MIN
OR
IRREGULAR RESPIRATION
SEPSIS
HYPOTENSION –BP <90/40MMHG
FEVER OR HYPERTHERMIA –TEMPERATURE 38d c OR
ABOVE
TACHYCARDIA – HR IS > 100B/MIN
IMPORTANT SIGNS CAN SEEN IN CARDIAC
MONITOR…..

4. PULSE RATE OR HEART RATE :
The normal range used in an adult is between 60 to 100 beats/minute with rates above
100 beats/minute and rates below 60 beats per minute, referred to as tachycardia and
bradycardia, respectively.
Changes in the rate of the pulse, along with changes in respiration are called sinus
arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and
slows down during expiration. Irregularly irregular pattern is more commonly indicative
of processes like atrial flutter or atrial fibrillation. We should also be checking for the
radial and the femoral pulse simultaneously. If there is any delay between the pulses, it
could indicate conditions like the coarctation of the aorta. Assessing the volume of the
pulse is equally essential. A low volume pulse could be indicative of inadequate tissue
perfusion.
The most common sites of measuring the peripheral pulses are the radial pulse, ulnar
pulse, brachial pulse in the upper extremity, and the posterior tibialis or the dorsalis pedis
pulse as well as the femoral pulse in the lower extremity.
During CPR usually measure the carotid pulse in the neck for adult.
VITAL SIGNS …

5. DESATURATION –
IF SPO2 GOES LESS THAN 100-85% ( DEPENDS ON PATIENT CONDITION OR
DOCTORS ADVICE)
BLOOD PRESSURE- HYPOTENSION –
BP FALLS BELOW THAN 90/42MMHG OR BP MAP LESS THAN 60MMHG ( DEPENDS
ON CONDITION OR DOCTORS ADVICE )
HYPERTENSION –
BP MORE THAN 140/90MMHG OR MAP MORE THAN 105MMHG(DEPENDS ON
CONDITION
OR DOCTORS ADVICE)
Parameter Normal range
Systolic blood pressure (SBP) 90-140 mmHg
Diastolic blood pressure (DBP) 60-90 mmHg
NORMAL BP MAP 70-105 mmHg
***** Mean arterial pressure (MAP) CALUCULATION FORMMULA ***MAP = DP + 1/3(SP – DP) ***
example DP -69MMHG, SP -103MMHG ,
MAP = 69+(103-69)1/3MMHG
MAP= 69+34/3
MAP = 80.3MMHG
VITAL SIGNS ….

6. The respiratory rate is the number of breaths per minute. The normal breathing rate is
about 12 to 20 breaths per minute in an average adult.
Tachypnea :is described as a respiratory rate of more than 20 breaths per minute that
could occur in physiological conditions like exercise, emotional changes, or pregnancy.
Pathological conditions like pain, pneumonia, pulmonary embolism, asthma, foreign
body aspiration, anxiety conditions, sepsis, carbon monoxide poisoning, and diabetic
ketoacidosis can also present with tachypnea.
Bradypnea :described as ventilation less than 12 breaths per minute can be seen due to
worsening of any underlying respiratory condition leading to respiratory failure or due to
usage of central nervous system depressants like alcohol, narcotics, benzodiazepines, or
metabolic derangements.
Apnea is the complete cessation of airflow to the lungs for a total of 15 seconds. It
appears in cardiopulmonary arrests, airway obstructions, the overdose of narcotics, and
benzodiazepines.
RESPIRATION RATE …

7. TEMPERATURE
Temperature is one of the most important vital signs for all patients, including intensive
care units (ICU).
HYPERTHERMIA OR Fever: in ICU is defined as a temperature of = 101degrees F
(38.3 degrees C ). It can be either infectious or non-infectious in origin. The fever in the
ICU could merely be a continued manifestation of the disease/disorder that prompted the
ICU admission or could result from certain unique etiologies in the ICU.
HYPOTHERMIA:
Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans.
Symptoms depend on the temperature.
*** In mild hypothermia, there is shivering and mental confusion.
*** In moderate hypothermia, shivering stops and confusion increases.
*** In severe hypothermia, there may be hallucinations and paradoxical undressing, in
which a person removes their clothing, as well as an increased risk of the heart stopping
VITAL SIGNS

8. HYPERKALEMIA-
BASED ON POTASSIUM VALUE; 3 VARIATIONS
*** PEAKED T WAVES
*** LOSS OF P WAVE
*** PROGRESSIVE WIDENING OF QRS COMPLEX
HYPOKALEMIA-
*** T WAVE INVERSION
*** ST DEPRESSION
*** PROMINENT U WAVE
ECG COMPARISON FOR HYPERKALEMIA &
HYPOKALEMIA…..

9. HYPERKALEMIA….
HYPERKALEMIA
This ECG displays many of the features of hyperkalemia
*** Prolonged PR interval
***Broad, bizarre QRS complexes — these merge with both the
preceding P wave and subsequent T wave.
****Peaked T waves.
This patient had a serum K+ of 9.3
HYPOKALEMIA
***The earliest electrocardiogram (ECG) change associated with
hypokalemia is a decrease in the T-wave amplitude
***As potassium levels decline further, ST-segment depression and T-
wave inversions are seen, while the PR interval can be prolonged along
with an increase in the amplitude of the P wave

10. Multi Ion Disturbances ECG Abnormality
Hypocalcemia and
hyperkalemia
Peaked T wave,
prolonged ST segment.
Hypocalcemia,
hyperkalemia, and
hypomagnesemia
Peaked T wave, U wave,
prolongation of the
segment between the
peak of the T wave and
the next P wave
(“tee‐pee” sign).
ECG CHANGES DURING ELECTROLYTES
IMBALANCE ….

11. What are the ECG changes in hypomagnesemia?
magnesium concentrations of 6-12 mg/dL (5-10 mEq/L) result in characteristic
ECG changes, including similar to those of hyperkalemia. prolongation of the
PR interval, increased duration of QRS complex, prolonged QT interval,
delayed intraventricular condiction, and increased height of the T wave,
changes
Hypomagnesemia can cause cardiac arrhythmia. Changes in
electrocardiogram findings include prolongation of conduction and slight ST
depression..SO IMMEDIATE ELECTROLYTE CORRECTION ITS VERY
IMPORTANT
HYPOMAGNESEMIA…..

12. SODIUM LEVEL ( 135-145MEQ/L )
Sodium. Increased (hypernatremia) and decreased (hyponatremia) sodium levels do not have any effect
on the ECG, nor cardiac rhythm, or impulse conduction
ELECTROLYTES ….

13. A heart arrhythmia (uh-RITH-me-uh) is an irregular heartbeat. Heart rhythm
problems (heart arrhythmias) occur when the electrical signals that
coordinate the heart's beats don't work properly. The faulty signaling causes
the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly.
Heart arrhythmias may feel like a fluttering or racing heart and may be
harmless. However, some heart arrhythmias may cause bothersome
TYPES
TACHYCARDIA :- HEART RATE MORE THAN 120B/MIN ….
BRADYCARDIA :- HEART RATE LESS MORE THAN 60B/MIN ….
CARDIAC ARRHYTHMIA….

14. they may include:
Palpitations (a feeling of skipped heartbeats, fluttering, or "flip-flops")
Pounding LIKE in chest
Dizziness or feeling lightheaded
Fainting
Shortness of breath
Chest pain or tightness
Weakness or fatigue (feeling very tired)
Anxiety
Blurry vision
Sweating
WHAT ARE THE SYMPTOMS OF ARRHYTHMIA?

15. Heart disease
>.The wrong balance of electrolytes (such as sodium or potassium) in blood
>.Heart injury or changes such as reduced blood flow or stiff heart tissue
>.Healing process after heart surgery
>.Infection or fever
>.Certain medications
>.Av node malfunctioning
>.Strong emotions, stress, or surprise
>.Things in daily life like alcohol, tobacco, caffeine, or exercise
WHAT CAUSES ARRHYTHMIA?

16. 1.ATRIAL ARRTHYTHMIA:-
1.(a)Atrial tachycardia.
1(b) Atrial flutter
1(c)Atrial fibrillation (Afib)
1(d)AV nodal reentrant tachycardia
2. VENTRICULAR ARRHYTHMIA:-
2(a)Ventricular Tachycardia
2(b)Ventricular Fibrillation
3.Supraventricular tachycardia (SVT)
COMMON CARDIAC ARRHYTMIA…

17. 01.SINUS TACHYCARDIA:-
Heart rate is >120b/min , visible pulse ,anxiety may be a cause
02.ATRIAL TACHYCARDIA:-
Atrial tachycardia is a fast heartbeat (arrhythmia)
It's a type of supraventricular tachycardia (SVT). During an atrial tachycardia
episode, the heart rate increases to more than 100 beats a minute before
returning to a typical heart rate of around 60 to 80 beats a minute
03.ATRIAL FIBRILLATION :-
Atrial fibrillation (A-fib) is an irregular and often very rapid heart rhythm
(arrhythmia) that can lead to blood clots in the heart. A-fib increases the risk
of stroke, heart failure and other heart-related complications.
During atrial fibrillation, the heart's upper chambers (the atria) beat
chaotically and irregularly — out of sync with the lower chambers (the
ventricles) of the heart.
CARDIAC ARRHYTHMIA :-

18. CARDIAC ARRHYTHMIA :-
AV nodal reentrant tachycardia
Atrioventricular nodal reentrant tachycardia (AVNRT) is a type of paroxysmal
supraventricular tachycardia that results due to the presence of a reentry
circuit within or adjacent to the AV node.
The diagnosis of AVNRT requires visualization on an electrocardiogram
(ECG)
VENTRICULAR TACHYCARDIA:
Ventricular tachycardia is a heart rhythm problem (arrhythmia) caused by irregular
electrical signals in the lower chambers of the heart (ventricles). This condition may
also be called V-tach or VT.
A healthy heart typically beats about 60 to 100 times a minute at rest.

19. Ventricular Fibrillation
Ventricular fibrillation is a type of irregular heart rhythm (arrhythmia). During
ventricular fibrillation, the lower heart chambers contract in a very rapid and
uncoordinated manner. As a result, the heart doesn't pump blood to the rest of the
body
P-SUPRAVENTRICULAR TACHYCARDIA ( PSVT) :-Paroxysmal supraventricular
tachycardia (PSVT) is a type of abnormal heart rhythm, or arrhythmia. It occurs when
a short circuit rhythm develops in the upper chamber of the heart. This results in a
regular but rapid heartbeat that starts and stops abruptly.
CARDIAC ARRHYTHMIA :-

20. https://www.hopkinsmedicine.org/health/conditions-and-diseases/paroxysmal-supraventricular-
tachycardia
https://www.mayoclinic.org/diseases-conditions/ventricular-fibrillation/symptoms-causes/syc-20364523
https://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia
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3.Levy N, Sturgess J, Mills P. "Pain as the fifth vital sign" and dependence on the "numerical pain scale" is being abandoned in the
US: Why? Br J Anaesth. 2018 Mar;120(3):435-438. [PubMed]
4.Smith GB, Prytherch DR, Jarvis S, Kovacs C, Meredith P, Schmidt PE, Briggs J. A Comparison of the Ability of the Physiologic
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a Range of Adverse Clinical Outcomes. Crit Care Med. 2016 Dec;44(12):2171-2181.
[PubMed] Chamorro C, Romera MA, Balandin B. Fever in critically ill patients. Crit Care Med. 2008
Nov;36(11):3129-30; author reply 3130. [PubMed]
REFERANCE …

21. WITH EARLY DETECTION CAN TAKE EARLY MEASURESS SO --
***REQUIRED TO MONITOR VITAL SIGNS HOULRY , ALONG WITH INTAKE OUTPUT
CHART ( AS PER ICU PROTOCAL)
***IF YOU FOUND ANY CARDIAC ABNORMALITY PLEASE INFORM DOCTOR
IMMEDIATELY
***IMPROPER LEEDS APPLICATION MAY GIVE , WRONG READINGS PLEASE
COUNTER CHECK ALWAYS
****ECG ABNORMALITY INFORM DOCTORS IMMEDIATELY, TO CONFIRM PLEASE
ASK & TAKE 12 LEEDS ECG
NURSING RESPONSIBILITY

22. THANK YOU ALL