118 Mod 5 (ECG) Flashcards
1
Q
-
A
Ventricular Tachycardia
100-250 bpm
wide tall bizarre QRS
2
Q
for working code what are the first steps
A
call for help
CPR
Give O2
attach monitor/pads
3
Q
Define Irriability
A
random points firing signals trying to take over
It is when a site speeds up (other than SA) and takes over as pacemaker
4
Q
What is the dose of Atropine for Bradycardia
A
Atropine 1mg every (q) 3-5mins max of 3mg
5
Q
A
A flutter
instead of P waves there are F waves,
sawtooth or sharkfin f waves
6
Q
To get the accurate rate you would count small squares between R-R and divide by
A
1500
7
Q
Ecg graph paper will show a straight line if…
A
If no current is flowing, or if the forces balance each other out.
8
Q
The AV node is my gate keeper. I am throwing a lot of signals at it from all different foci in both atria. The AV node will let 152 signals through in one minute.
A
Uncontrolled a-fib (A-fib with RVR (rapid ventricular response))
9
Q
how much time is between the two heavy lines on a graph
A
0.20 seconds
10
Q
When treating Tachy
what questions should you ask
A
is the patient
stable or unstable
qrs wide or narrow
is the rhythm reg or irreg
11
Q
A
A-Fib
f waves, irregular R-R
350-600 bpm Atrial rate
multiple sources trying to fire in the atrium other than SA Node
lots of squiggles
12
Q
what are the first things to do with BRADY
Besides stable or unstable. Actual steps to do.
A
assist breathing, O2
ECG, bp, pulse ox
IV
bgL
assess PERFUSION
13
Q
Define R on T
A
situation where stimulation could put heart into v-tach
- PVC hits on relative refractory
- Vulnerable to sending into v-tach
14
Q
A
A fib, with bigeminy of PVC’s
afib - f waves, irregular R-R
350-600 bpm Atrial rate
multiple sources trying to fire in the atrium other than SA Node
lots of squiggles
PVC - premature ventricular contractions, wide bizarre, early
15
Q
A
Accelerated Junctional
inverted P wave
rate 61-100
16
Q
What is the drug dose of Amiodarone
when do you give
A
300mg
2nd dose
150mg
Code
17
Q
What class intervention is TCP according to ACLS
A
Class I
18
Q
Treatment for Hydrogen Ion (Acidosis)
A
Sodium BiCarb
airway management
CPR
19
Q
Is Depolarization the same as contraction
A
No, Depolarization is an ELECTRICAL phenomenon,
contraction is MECHANICAL and is expected to follow depolarization
20
Q
Define PJC
A
- p wave inverted
- or p-wave missing
- underlying rhythm needs to be mentioned
21
Q
Mechanically whats happening
P wave
QRS
Twave
A
P Wave - Atrial contraction
QRS Ventricular Contraction
T Wave Ventricular relaxation
22
Q
Define Relative refractory period
A
top of t-wave when heart could fire again
23
Q
CHB are
A
3rd Degree heart block and Complete AV block
24
Q
My patient has no pulse. I am 1 ectopic focus in the right ventricle that is sending signals regularly at 140bpm.
A
Pulseless V-Tach
25
what is the drug dose of cardizem
when do you give
.35mg/kg IV
tachy
26
What are the two functions of cells in the heart?
(also what are their two actions)
Electrical, conductive
Mechanical, contracting
27
How many seconds are in one hash mark
How many are on a full sheet (2 hash marks)
3 seconds x2
6 seconds total sheet
28
Steps for Sync Cardio Vert
For unstable Tachy
- Press Sync
- Marker over every R wave
- Settings
A-fib: 120-200J -> 200J -> 300 -> 360J
A-flutter: 100J -> 200J -> 300J -> 360J
SVT w/narrow QRS: 100J -> 200J -> 300J -> 360J
V-tach: 100J -> 200J -> 300J -> 360J
29
What do the vertical lines on the graph tell
time
30
SVT
hr 160-250
cant see P waves so fast
vagal then cardiovert
31
Define PVC
- Premature ventricular complex
- Has compensatory pause
- If all match = unifocal; if they don’t match = multifocal
32
What are the electric measurements Defib, Sync, Pacing
Joules for Defib & Sync
mA (milli amps) for pacing
33
When can you terminate CPR
after 30 minutes
(15 two minute CPR cycles)
VF, pVT, PEA with ETC02 less than 15 mmHg
34
I have NO discernible P waves or QRS waves and look erratic. Cardiac output plummeted when I switched to this rhythm.
V-Fib
35
Where are Coronary arteries located
Epicardium
36
What lead are we looking at when placing PADs
Lead 2
37
as far as H's and T's
If narrow complex
think about ________
obstructive causes
38
What are the 6 H's
also known as
Hypovolemia
Hypoxia
Hydrogen Ions (Acidosis)
Hypo and Hyper Kalemia
Hypothermia
probable causes
39
Idioventricular
- Rate 20-40
- QRS wide
40
what is normal MAP
need greater than 65
41
V-Tach
wide, bizarre QRS
42
What is happening during a
QRS
Ventricle Depolarization
43
What are 2 NON Shockable Rhythms
PEA, ASYSTOLE
44
if Tachy is regular and monomorphic
stable and wide
give _____
you may give
Adenosine (class I)
6mg, 12mg
45
Steps for Pacing
- Pads on
- Limb leads on
- Set pace to 80 for adults
- Increase mA until electrical capture achieved
- Then palpate femoral pulse and increase until mechanical capture
- Then add 10% to final setting
- Patient codes, turn pacing off
46
A-fib with 2 unifocal PVCs
47
Atrial Flutter
F waves, saws,
QRS narrow
atrial rate 250-350
48
Parasympathetic Stimulation causes
Decreased:
Slows DOWN HR
AV conduction
Decreased Irritability
only affects the atria
49
What starts the flow of electrical current in the heart
Positive and Negative electrical charges exchange places across the cell membrane
50
What else should you monitor during ECG
Pulse/Pleth wave from SPO2
and physical pulse
51
How do you find cardiac output
Stroke volume x HR
52
What happens if one branch of the nervous system is blocked?
The other will influence the heart
53
What is the hr of brady
less than 50 (for treatment)
54
What is happening during a
PRI
Delay in AV node
55
Which nervous system slows the heart
Which nervous system speeds the heart up
Slows DOWN the heart - Parasympathetic
Speeds - Sympathetic
56
SVT with a wide QRS
57
How does on demand pacing work
pacer kicks in when hr drops below a certain amount
58
Treatment for Tension Pneumothorax
needle decompression
59
Where are the + and - leads in Einthovens Triangle
60
Second Degree Type II
61
Treatment for Thrombosis, Coronary
MI, clot in coronary artery
no much we can do
62
For Brady what is the quick treatment atde
All
Trained
Dogs
Eat
Atropine
TCP
Dopamine
Epinephrine
63
According to Maryland how many EPI's can you give
according to AHA
maryland - 4
AHA - unlimited
64
what should you do with any change in rhythm?
access vital signs
level of consciousness
and abcs
65
What is happening during a
Pwave
Atrial Depolarization
66
Treatment for Hypovolemia
(low blood)
IV Fluid (20mL per kg)
Vasopressors (Dopamine, Epi)
67
Define 2nd Degree TYPE II
- PRIs are regular, with dropped beats
- Regular or irregular
68
What are the 5 T's
also known as
Tension Pneumo
Tamponade Cardiac
Toxins
Thrombosis Coronary
Thrombosis Pulmonary
probable causes
69
how many small boxes is a 6 second strip
150
70
What are the two doses of EPI
1:1,000 = 1mg in 1mL for allergic reaction
1:10,000 = 1mg in 10mL or 0.1mg/mL for cardiac (brown box)
71
Treatment for Toxins
1 organophosphate
2 beta blocker OD
3 TCA OD
4 opioid OD
1 Atropine for organophosphate poisoning
2 beta blocker OD = glucagon
3 TCA OD = sodium bicarb
4 opioid OD = naloxone
72
What is the target ETCO2
35-40 mmHg
73
What are the 5 parts of analysis for heart rhythms
1. Rhythm, regular
2. Rate
3. P Waves
4. P-R Interval
5. QRS
74
What is the drug dose of Diltiazem
when do you give
0.25mg/kg
2nd dose
0.35mg/kg
75
What is the drug dose of Adenosine
when do you give
6mg
12mg
Tachy
76
Define Ventricular rhythms
Wide and bizar
77
Sinus Brady with 1 PVC
78
SVT (no P waves seen)
79
What must occur for the heart to contract
muscle cells must receive electrical stimulus
80
What are the rules/guidelines of a Second Degree Type II
Impulses are blocked at the AV node so some P waves stand alone. P-R is constant and NORMAL
P waves are present but there are dropped QRS's because the impulse is blocked
81
What are the 2 shockable rhythms to DEFRIBRILLATE
V- Fib (squiggly worms)
Pulseless V-Tach (no pulse) (tombstones)
82
What is the 2nd med you give for a shockable rhythm
Amiodarone (anti arrhythmic) 300mg (first dose)
if torsades give mag sulfate 1-2g
83
Lead and Electrodes
A lead is a single view of the heart
often from several electrodes
84
What class intervention is Dopamine and Epinephrine Infusions
Class IIb
85
What is the dose for Dopamine
What is the dose for Epinephrine
Dopamine
5-20mcg/kg/min
Epinephrine
2-10mcg/min
Dopamine can be added to Epi or used alone
86
What should you do first with Tachy patient
Identify H's and T's
Support abcs
Give O2
ECG, Vitals
87
What are two interventions that start or squeeze the heart
start - epi
squeeze - defib
88
What is happening during a
T Wave
Ventricle repolarization
89
what do you do with the energy level if....
you go from a perfusing to a NON perfusing rhythm
never decrease the energy level
from defi to SVT stay at 300
90
Define Polarization
When electrical charges are balanced and ready for discharge
91
how many chest compressions a min
100-120
92
Sympathetic Stimulation causes
Increased:
Speeds UP HR
AV conduction
Increased Irritability
affects both atria and ventricles
93
Define Escape
signal above not working, pacemaker below takes over, safety net
is when the SA node slows down or fails and a lower site assumes pacemaking responsibility
94
After ROSC but comatose
patient should receive...
Targeted temperature management. 89.6-96.8 F (32-36 C)
Treat H's and T's
95
What does the parts of conduction does the Parasympathetic influence
Only the atria
(i.e., the SA node, the intraatrial, and internodal pathways, and the AV junction)
96
Sinus with PAC
early atrial activity
early p wave looks different
97
With ROSC how should you position patient
Elevate head 30 degrees
98
-
A Fib
fast atrial activity, lots of f waves R_R irregular,
99
Treatment for Tamponade, Cardiac
pericardial centesis,
draw off fluid
drive fast, fluid boluses
pressure inside of the heart needs to be greater
100
Sinus with Atrial Pacing
101
Explain depolarization vs Contraction
Depolarization = electrical activity only
Contraction = mechanical squeeze of the heart
102
My underlying rate is 70. My PRI is .22s. I have P, QRS & T waves which all look the same.
Sinus with 1st degree Heart block
103
what does the PR segment represent
delay in the AV node
104
What do you do for Bradycardia with a 2nd Degree or 3rd Degree block
Pacing
105
Does a TYPE II second degree block have the same P waves for every QRS
no there will be more P waves
106
Define Atrial Pacers
Ventricular Pacer
Sequential Pacer
Atrial Pacers
- Spike on rhythm before p-wave
Ventricular Pacer
- Spike before QRS
Sequential Pacer
- Spike before both
107
What is the goal of CPR
cerebral resuscitation
108
When an arrhythmia is irregular, you should determine the heart rate by counting the number of R waves divided by
10
109
when do you give a sedative for pacing?
what do you give/dose
when they are conscious
versed/midazolam 5mg (2.5mg if over 69 y/o)
110
what do you do with the energy level if....
you go from a NON perfusing to a perfusing rhythm
you may start at a lower energy setting
111
What is the compression rate for CPR
100-120 compression per min
112
Absolute refractory period vs relative refractory period
absolute - heart cant accept any stim
relative - some cells are capable of responding
113
Atrial Fibrillation (controlled) with 2 unifocal PVC's
114
Describe the rhythm of sinus arrhytmia
its irregular it increases with each inspiration and decreases with each expiration
115
What are interventions to SLOW the heart
Synchronized Cardioversion
Defib
Adenosine
Diltiazem
Beta-Blockers (lol)
Lidocaine
Mag Sulfate
116
What is an unstable hypertension
hypotension
hyper
180/120
hypo
90/60
117
Define Repolarization
switch back to ready state
is the return of electrical charges to their original state of readiness
sodium leaves to go back outside and potassium returns to come inside
118
What class intervention is Atropine according to ACLS
Class IIa
119
What is the terms for multiple PVC's
2 PVCs = couplet
3 PVCs = triplet
4 PVCs or more = run of PVCs
120
if electrical current flows toward the positive electrode with deflection be upright or downward
upright
121
Treatment for Hypothermia
passive rewarming
attempt to defibrillate ONCE until patient warms up
122
Differentiate waves segments and intervals
waves are deflections
segments are straight lines
intervals include both waves and segments
123
The SA Node fires and then travels via the
Intraatrial and Internodal pathways
to the AV Node
124
Junctional with P waves after QRS
rate 40-60 bpm
125
How would you differentiate between junctional focus and ventricular focus in CHB
Junctional focus-QRS complex is less than 0.12 second: rate 40-60 bpm. With ventricular focus, QRS is 0.12 second or more and rate 20-40 bpm.
126
as far as H's and T's
if wide complex
think about _________
toxins or metabolic causes
127
what role should not be multi tasked
airway manager
128
What are the most important organs to perfuse
heart
brain
kidneys
129
What is 1 beat of the heart called
stroke volume (ejection fraction)
130
Treatment for Thrombosis, Pulmonnary
Oxygen
Drive fast
131
What are the DEFIBRILLATION shocks
200j, 300j, 360j
132
How do you fix Sinus Tachycardia
You fix the underlying problem
might be fever, hypovolemia
133
What is the treatment sequence for BRADYCARDIA
Atropine 1mg every (q) 3-5mins max of 3mg
TCP (pacing) start at 80bpm
DO NOT DELAY PACING FOR IV
Dopamine Infusion or Epi
134
Interventions to SPEED up the heart
TCP
Atropine
Epi infusion
Dopamine infusion
135
Define Depolarization
sodium and potassium switch
It is the discharge of energy that accompanies the transfer of electrical charges across the cell membrane
136
Define
Excitability
Automaticity
Contractility
Extensibility
Conductivity
Excite = response to electric
Contractility = squeeze
Auto = create impulse
extense = stretch,expand
conduct = pass electric
137
What is the drug dose of Lidocaine
and when do you give?
0.5-0.75mg/kg
Tachy
138
When should you avoid Atropine
When there is a high degree block
(2nd type II, 3rd Degree)
go right to pacing
139
How do you treat PEA
CPR - compressions
IV/IO access
1mg Epinephrine (0.1mg/mL) IVP every 3/5 mins
ETT and Capno
140
Define Supraventricular Rhythms
Rates over 150, narrow QRS
141
What are the parts of the ECG doing
P wave
PRI
QRS
Twave
P wave - Atrial Depolarization
PRI - Atrial Depolarization and delay through AV node
QRS - Ventricular depolarization
T Wave - Ventricular RE polarization
142
What should you say instead of "give epi"
im going to administer...
1mg of epinephrine .01 mg per mL concentration every 3-5 mins IV push
143
Treatment for Hypoxia
and signs?
Good bagging, airway management
early signs (rat);
restlessness
anxiety
tachy
late signs (bed):
brady
extreme restless
dyspnea (severe)
144
What are signs of unstable TACHY
hypotension below 90/60
AMS
Shock
CP
145
3rd Degree AV Block
Complete heart block no relationship between P and QRS
QRS can be both narrow or wide
P-R interval varries
146
My rate is 30bpm. My complexes are regular (they all march out). I have NO P waves and my QRS is >.18s
idioventricular
147
What are the 3 types of pacemakers & how do we know the difference when viewing these EKG’s?
a. Atrial- Pacer spike followed by p wave & normal QRS
b. Ventricular-Pacer spike followed by wide QRS
c. AV Sequential/ Dual-Pacer spike followed by p wave AND pacer spike followed by wide QRS
148
Accelerated Junctional with unifocal PVC's
PVC - early ventricular, unifocal because they look the same
junctional originates from av junction,
Junctional and hr is 60-100 so it’s accelerated junctional!
149
What are the 3 Inherent rates of the conduction system
SA Node 60-100 bpm
AV Junction 40-60 bpm
Ventricles 20-40 bpm
150
List the (6) areas of the conduction system in order which the impulse travel through the heart
1. SA Node
2. Intratrial and Intrernodal Pathways
3. AV Node
4. Bundle of His
5. Bundle Branches
6. Purkinje Fibers
151
To get the accurate rate you would count LARGE squares between R-R and divide by
300
152
Sinus Brady with a wide QRS
153
What is the heart cell's ability to convey electric signals
Conductivity
154
V- Tach (with possible CPR artifact)
155
Post arrest should ETT when
EARLY PLACEMENT
156
What are the 3 junctional (escape) rhythms
Junctional rhythm 40-60
Accelerated junctional rhythm 60-100
Junctional tach 100-180
157
My rate is 80. I have a complex with ‘normal’ morphology (P, QRS & T waves) followed by a complex with a QRS of .14s and no p wave! This pattern continues.
Ventricular Bigeminy
158
If SVT give
Amiodarone
150mg over 10mins
159
what should you say instead of "shock"
synchronized cardiovert - at 100 j
transcutaneous Pace - at 80bpm
defibrillate - at 200 j
160
Does an inverted P mean junctional?
No, atrial rhythms can also have inverted P waves if the impulse originated low enough in the atria.
You can differentiate between the two by looking at the PRI; in a junctional rhythm it will be less than 0.12 second.
161
with ROSC
wide QRS (H's and T's)
narrow QRS (H's and T's)
wide - toxins, metabolic
narrow - obstructive, tamponade, tension pneumothorax
162
What can you give a TACHY patient if you have IV access and the rhythm is regular and narrow
you may give
Adenosine (class I)
6mg, 12mg
163
If unstable TACHY what should you do immediately
Synchronized cardiovert (class I)
before IV or meds
164
3rd Degree Block
atrial contractions are 'normal'
but no electrical conduction is conveyed to the ventricles. The ventricles then generate
their own signal through an 'escape mechanism' from a focus somewhere within the
ventricle.
165
Define Absolute refractory period
heart cannot fire, not ready,
has not reached halfway up t-wave
166
Where does blood flow through the heart
Superior/Inferior VC -> R Atria -> Tricuspid valve -> R Ventricle -> Pulmonary artery ->
Lungs ->
Pulmonary veins -> L Atria -> Mitral valve -> L Ventricle -> Aorta
167
Accelerated Junctional
Can’t see the p waves so it’s junctional and the hr is 80
60-100 accelerated
40-60 junctional escape
100-180 junctional tachy
168
Where is sodium and potassium during ready state
Sodium is outside and potassium is on the inside
169
What parts of conduction does the Sympathetic influence
The atria
(i.e., the SA node, the intraatrial, and internodal pathways, and the AV junction)
and the ventricles
170
What is the drug dose for Dopamine
when do you give
drip
5-20mcg/kg/min
Brady
171
What hr qualifies as Tachycardia
equal to or over 150
172
What is the drug dose of Atropine
when do you give
1mg
Brady
173
How many lines are between the bold lines on ECG paper
4
174
what does AICD mean
Automatic Implantable Cardioverter Defribrillator
175
If STABLE narrow Tachy
how do you treat
(and if wide)
IV, 12lead
Vagal Maneuvers (blow into
Give Adenosine 6/12
(if wide give beta blocker or calcium channel blocker = Diltiazem)
176
Treatment for Hypo-HyperKalemia
Hypo - not much (needs potasium)
Hyper -
CA- SIGH - K
1 Calcium Chloride
2 Albuterol
Hco3 - sodium bicarb
I insulin
G glucose (dextrose)
3 Hemodialysis
Kayexelate
1 Stablize/ 2shift /3excrete
177
H and T are most important with
PEA
Cardiac Arrest
178
SVT with wide QRS
160-250 bpm
p wave might look like steps
179
Which nervous system has two branches that control the heart
What are the two branches
Autonomic
Sympathetic and Parasympathetic
180
hat do the horizontal lines on the graph tell
voltage
181
My rate is 30bpm. My complexes have a ‘normal’ morphology of P, QRS & T waves that all look the same. I am a regular rhythm.
Sinus Brady
182
Sinus Tachycardia
Hr 100
183
What is the drug dose of Epinephirine
when do you give
1:10,000 cardiac
1mg
Code
184
What is the target pulse ox for ROSC
92-98%
185
When do you give EPI
AFTER 2nd shock
1mg EPI (0.1mg/ml) IVP
186
Junctional Tachycardia
inverted P wave
rate 101-180
187
ACLS Classes
Class 1 - strong evidence
Class 2a Moderate
Class 2b weak
Class 3 NO BENEFIT
188
Idioventricular Rhythm
Here are the rules for Idioventricular Rhythm (Figure 78):
Regularity: usually regular
Rate: 20–40 bpm; can drop below 20 bpm
P Waves: none
PRI: none
QRS: wide and bizarre; 0.12 second or more
189
What part of the ECG signifies the relative refractory period
the downslope of the T wave
190
What is the atrial rate in a-flutter
250-350 bpm
191
What should you do on a working code ASAP
Defibrillate and give EPI
192
What is a mega code
It is a total of four rhythms. initial and 3 changes
(one will be Vfib or pulseless V-Tach)
193
What are the ECG rules
- Are there p-waves
o Are they present?
o Are they 1:1 QRS?
o Are they upright?
o Do they look the same/ alike?
- Regular or irregular
o R-R the same?
o Extra beats? Are they early or late?
o Are PRIs the same?
- Rate
o R-R interval, count the boxes / 1500
o Count complete cycles x 10 (if 6 sec strip)
o Triplicate method (least accurate)
o Are the p-waves the same rate as R waves? (3rd deg.)
- QRS
o Wide or narrow?
o What do they look like? Do they look alike?
o Equal duration?
- PRI
o 0.12 – 0.20
