AACN advanced critical care
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In the electrocardiogram, the QT interval represents the time it takes the ventricular myocardium to repolarize. Prolongation of the QT interval indicates congenital or acquired abnormality of cardiac membrane channels. In the critical care setting, acquired long QT interval most commonly results from administration of common pharmacologic agents, including some antiarrhythmics and antibiotics. ⋯ Warning signs of impending sustained torsades de pointes include occurrence of polymorphic ventricular ectopic complexes, T-wave alternans, and nonsustained polymorphic ventricular tachycardia. Measurement and documentation of the QT interval, corrected for heart rate (QTc), is an important component of cardiac monitoring in the critical care setting. When prolonged QTc occurs in patients at risk, specific clinical interventions must be implemented to prevent the occurrence of torsades de pointes.
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Review Case Reports
Pulling it all together: case studies on ECG monitoring.
Advanced practice nurses and expert staff nurses are in a position to improve the way patients' electrocardiograms (ECGs) are monitored in hospital units. Recently published practice standards recommend the best practices for arrhythmia, ischemia, and QT-interval ECG monitoring. Two case studies are presented here to illustrate how expert nurses can teach staff to incorporate the practice standards into their clinical practice. As nurses become more expert in ECG monitoring, it is expected that they will detect ECG abnormalities earlier, and patients will have more timely treatment and better outcomes.
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Review Case Reports
ST-segment monitoring: putting standards into practice.
ST-segment monitoring is one key reason that continuous electrocardiographic monitoring is performed in hospitals, and can help with early detection of myocardial ischemia for at-risk patients. Although ST-segment monitoring research, guidelines, and expert consensus statements have been published, ST-segment monitoring has not been implemented in all appropriate clinical areas. The purpose of this article is to present relevant research, review the latest practice standards, and discuss issues important to nurses wishing to implement ST-segment monitoring.
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Review
ECG monitoring after cardiac surgery: postoperative atrial fibrillation and the atrial electrogram.
Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. beta-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. ⋯ Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.