Editing Medical-Surgical Nursing (section)

=== Dysrhythmias ===

Atrial fibrillation produces an irregularly irregular rhythm with no discernible P waves and a pulse deficit between apical and radial rates. Blood pools in the fibrillating atria, so the major risk is thromboembolic stroke; anticoagulation is central to management. Rate control and, in selected patients, rhythm control or ablation follow.

Ventricular tachycardia with a pulse in an unstable patient calls for synchronized cardioversion; without a pulse it is treated as cardiac arrest with defibrillation and cardiopulmonary resuscitation. Ventricular fibrillation is always pulseless and requires immediate defibrillation. Asystole and pulseless electrical activity are not shockable; they are treated with compressions, epinephrine, and correction of reversible causes.

Symptomatic bradycardia is treated with atropine, and if that fails, with transcutaneous pacing.