Exam 5 Hot Topics: ECG Strip Interpretation and ALS Clinical Manifestations

ECG Strip Interpretation

• SVT (Supraventricular Tachycardia) is characterized by a regular rhythm, but the P wave is not usually visible.
• AFib (Atrial Fibrillation) is identified by an irregularly irregular rhythm, making it impossible to assess the P wave.
• Aflutter (Atrial Flutter) is recognized by a sawtooth P wave.
• VTach (Ventricular Tachycardia) is marked by a wide QRS, and the P wave cannot be determined.
• VFib (Ventricular Fibrillation) is characterized by a bunch of random squiggles.

Amyotrophic Lateral Sclerosis (ALS)

• Early clinical manifestations include tongue atrophy, dysphagia, weakness of hands and arms, fatigue while talking, facial twitching, and slurred speech.
• Later symptoms include the progression of all symptoms, leading to muscle weakness and paralysis.
• In the hospice stage, patients may require a ventilator, and advance directives and health provider-assisted suicide should be considered.
• Interventions and treatments focus on comfort measures and psychosocial therapy, as patients are aware of their degeneration and do not experience mental or cognitive impairment.

Guillain Barre

• Clinical manifestations include symmetric muscle weakness, flaccid paralysis without atrophy, respiratory compromise, paresthesias, pain, facial weakness, dysphagia, diplopia, difficulty speaking, labile BP, and cardiac dysrhythmias.
• Types of Guillain Barre include:
  • Ascending: weakness/paralysis begins in the lower extremities and moves up.
  • Descending: begins with facial weakness and moves down, deteriorating quickly to require ventilator support.
  • Miller-Fisher: paralysis of eye muscles, areflexia, and severe ataxia (impaired balance and coordination).
• The primary goal of interventions and treatments is to maintain respiratory function, with a focus on airway management, monitoring respiratory distress, and cardiac monitoring, as well as immunoglobulin drug therapy and plasmapheresis.

Myasthenia Gravis

• Clinical manifestations include progressive muscle weakness that improves with rest, poor posture, ocular palsies, ptosis, diplopia, respiratory compromise, loss of bowel and bladder control, and fatigue.
• Interventions and treatments involve drugs (immunosuppressant and pyridostigmine/mestinon), plasmapheresis, thymectomy, and patient teaching.
• Important considerations for Mestinon administration include giving it on time with a small amount of food to manage muscle improvement, and providing a main meal 45 minutes after administration to decrease the risk of aspiration.
• Thymectomy requires monitoring respiratory efforts, signs of pneumothorax or hemothorax, and having a bag valve mask and suction at bedside.
• Complications include cholinergic crisis (overmedicated) and myasthenic crisis (undermedicated, exacerbation of symptoms).

Systemic Lupus Erythematosus (SLE)

• Clinical manifestations include a butterfly rash, myositis (inflammation of muscles), inflamed red rash and discoid lesions, and nephritis.