11) 15 lead ECG

Question 1

Axis)
Normal axis:
Lead views:

Answer 1

= Direction of travel of electrical impulses moving in heart
= downward & toward the left (way heart sits) 0 to +90
= L1-3 + QRS, + camera at flow of electricity

Question 2

Axis) Phycological seen w/:
Lead 1 view:
Lead 2 view:
Lead 3 view:

Answer 2

= not big deal (younger, obese, athletes, preganent)
= up / positive
= can show upward or halfway deflection
= down / negative

Question 3

Axis) Pathological L-Axis:
Remember:

Answer 3

= Suggests anterior hemiblock, “Up down down”
=Hemi 1 of BBB of L blocked (post only feed by LAD)Electricity, 4x > likely arrest w/ hemiblock & “chest pain”, LAFB most common & concerning

Question 4

Axis) Extreme Right deviation :
Origin:
Leads, I, II, III
Caused by:
VT criteria:

Answer 4

= impulse coming from ventricles to R-atrium “aint right”
= Indeterminate axis, Usually ventricular in origin
= Down/- in all three leads 1-3
= VT} ventricular rhythms/PVCs,
= V6 -, & +1

Question 5

Axis) Right-Deviation:

Associated w/:

Lead views:
Causes:

Answer 5

= “Right ax aint right” (posterior fascicular block) Rare occurrence in adults (sometimes seen in kids)
= Almost always pathological, Associated w/ posterior hemiblock, Massive PEs & MI can show
= Lead I down & Lead III up “Down down up”
= PE, RVH, LPFB, RHF, COLD, Dextrocardia, Ectopic beats, Pulmonary HTN, Normal in children, Pulmonary valve stenosis

Question 6

HB) Fascicular Block (Hemiblock):
ECG diagnosis:
Occlusion of:
Mortality rate when w/ AMI:

Answer 6

= block of 1 of the 2 fascicles of L-bundle (LAD)
= Based on Pathological L-axis deviation
= LMCA partial occlusion or LAD occlusion
= 4x higher (Proximal occlusion until proven otherwise)

Question 7

HB) Posterior Hemiblock:
Axis:
Severity & mortality:

Answer 7

= (usually dub block) not common, silent killer
= Right axis deviation
= Very high mortality w/ AMI & Serious prob/ involving 2 coronary arteries

Question 8

Sgarbossa’s Criteria:
Discordice:
LBBB & V pacer discordice is:

Answer 8

= ventricular pacer & LBBB} 1 & 2!, 3 eh so smith modified
= big neg QRS w/ Monst T = opposites
= NORMAL (concordance bad)

Question 9

Ventricles contract:
Atriums contract:

Answer 9

= inferior to superior
= superior to inferior

Question 10

LBBB) QRS & ST Segment:
between the QRS complex & ST-Seg/:
If QRS is pointing up, ST- Seg/:
If QRS is pointing down, ST- Seg/:

Answer 10

= QRS>0.12Secs, V1 QRS neg/ & broad, V6 QRS + & broad
= Discordant (commonly L-deviation) “2dry repolar/ changes”
= should be pointing down
= should be pointing up

Question 11

Sgarbossa Criteria) #1:
Criteria #2:

Answer 11

= STE ≥1mm concordant w/ QRS direction in ANY lead

Question 12

Sgarbossa Criteria) Criteria #2:

Answer 12

= ST Depression ≥1mm concordant in leads V1, V2 or V3. (non progressive precordial)

Question 13

Sgarbossa Criteria) Why do we need it?
Used for:

Answer 13

= LBBB normally causes STE, even when there’s no acute MI.
= Predict AMI even w/ LBBB or ventricular pacer (doesnt need 2 congitual leads)

Question 14

Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:

3 points “def an MI:

Weakest Predictor – 2 points:

Answer 14

= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead

Question 15

Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:

3 points “def an MI:

Weakest Predictor – 2 points:

Answer 15

= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead

Question 16

Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:

3 points “def an MI:

Weakest Predictor – 2 points:

Answer 16

= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead

Question 17

Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:

3 points “def an MI:

Weakest Predictor – 2 points:

Answer 17

= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead

Question 18

Sgarbossa Criteria) STRONGEST PREDICTOR – 5 points:

3 points “def an MI:

Weakest Predictor – 2 points:

Answer 18

= criteria 1} ”dead on money having MI” STE ≥1mm concordant w/ QRS direction in any lead
= Criteria 2} “Def an MI” ST Segment Depression ≥1mm concordant in leads V1, V2 or V3.
= Criteria 3} STE ≥5mm discordant w/ QRS direction in any lead

Question 19

Sgarbossa Criteria) Smith -modified:
Formula:

Answer 19

= measuring over sizing.
= ST/QRS Ratio >0.2 criteria 3

Question 20

3rd-degree heart block, ECG findings

Answer 20

P waves and QRS complexes are completely independent

Question 21

Sgarbossa’s criteria is only utilized w/ what:

Answer 21

Left Bundle Branch Block & Ventricular pacer

Question 22

Regular rhythm at 50 BPM, QRS > 0.12 seconds, no P waves

Answer 22

Accelerated Idioventricular Rhythm

Question 23

Most 2 common cause of PEA in adult cardiac arrest?

Answer 23

Hypovolemia & Hypoxia

Question 24

Med 1st-line treatment for stable SVT?

Answer 24

Adenosine

Question 25

(tachycardia, A-Flutter w/ RVR, AF w/ RVR) which is most likely to respond to synchronized cardioversion?

Answer 25

Atrial fibrillation w/ RVR

Question 26

Correct initial dose of adenosine for SVT?
correct 2nd dose of adenosine for SVT?

Answer 26

6 mg rapid IV push
12 mg rapid IV push

Question 27

PT w/ chest pain, diaphoresis, & shortness of breath. Their 12-lead ECG shows STE in leads II, III, & aVF. likely indicates:

Answer 27

Inferior Wall MI

Question 28

HR 180, BP 85/40, chest pain, & AMS. ECG shows a regular wide-complex Tachycardia. What is the most appropriate initial treatment?

Answer 28

A synchronized DC countershock

Question 29

PT w/ a new onset of substernal chest pain. 12-lead ECG shows ST depression in V1 & V2. likely indicates:

Answer 29

Posterior Wall MI

Question 30

Initial dose of Diltiazem?

Answer 30

0.25 mg/kg Slow IV with a max dose of 20 mg

Question 31

Meds should be administered first in a witnessed VF arrest?

Answer 31

Epinephrine