Question: Scenario C: Mr. Farley A Few Years Ago, Mr. Farley Had Been Diagnosed With Chronic Atrial Fibrillation And Was Started On Digitalis. He’d Done Well, With A Heart Rate Running In The 70s And 80s Since Then. For The Past Few Days, However, Mr. Farley Had Felt Lousy-nothing Specific, Just “not Right,” As He Would Later Describe It. He Didn’t Think …

Scenario C: Mr. Farley A few years ago, Mr. Farley had been diagnosed with chronic atrial fibrillation and was started on digitalis. He’d done well, with a heart rate running in the 70s and 80s since then. For the past few days, however, Mr. Farley had felt lousy-nothing specific, just “not right,” as he would later describe it. He didn’t think it was important enough to bother his physician, although his wife had fussed at him to do so. Believing his problem to be related to his atrial fibrillation, Mr. Farley doubled up on his digitalis dose. If one pill a day was good, two a day had to be better, he reasoned. After five days of this, he began suffering from violent nausea and vomiting episodes. His wife dragge the reluctant Mr. Farley to the hospital. His initial rhythm strip is shown in Figure 18–9. 1. What is the rhythm in Figure 18–9? 2. What effect does this rhythm have on the atrial kick? 3. Lab tests revealed that the level of digitalis in Mr. Farley’s bloodstream was at toxic levels. Name three rhythms that can be caused by digitalis toxicity. The physician contemplated sending Mr. Farley to the CCU, but since his blood pressure was good and he looked OK, he was sent to the telemetry floor instead. His nausea was treated with medication and he was taken off digitalis. Three hours after arriving on the telemetry floor, Mr. Farley passed out in the bathroom. His wife ran to get the nurse just as the nurses, having seen his rhythm on the monitor, were running toward his room. His new rhythm is shown in Figure 18–10. 4. What is the rhythm in Figure 18–10? what FIGURE 18-9 Mr. Farley’s initial rhythm strip. CHAPTER 18. PUTTING IT ALL TOGETHER: CRITICAL THINKINGS FIGURE 18-10 Mr. Farley’s second rhythm strip. 5. The emergency team was called and CPR was initiated. What two medications would be appropriate to give at this time? 6. After successful resuscitation, Mr. Farley was transferred to the CCU, where a temporary transvenous pacemaker was inserted. What beneficial effect would the pacemaker have? 7. A few hours after the pacemaker was inserted, the nurse noticed evidence of loss of capture on the monitor. On the monitor strip in Figure 18-11, what would tell her there was loss of capture? 8. What can be done to restore capture? Capture was restored, and Mr. Johnson rested well for the next few hours. Suddenly, he went into V-tach with a heart rate of 200. The nurses could tell by the deflection of the QRS complexes that the V-tach was originating in the left ventricle, so they knew it was not induced by irritation from the pacemaker wire in the right ventricle. 9. With a pacemaker in place, what can be done to terminate the tachycardia? 10. With the V-tach now resolved, Mr. Farley was started on an amiodarone infusion to prevent a recurrence of the V-tach. What is amiodarone’s effect on the ventricle? n uli $0, 1100SM FIGURE 18-11 Mr. Farley’s third rhythm strip. १४ . XXX EL LA OD