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118 Mod 5 (ECG) Flashcards

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1
Q

-

A

Ventricular Tachycardia

100-250 bpm

wide tall bizarre QRS

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2
Q

for working code what are the first steps

A

call for help
CPR
Give O2
attach monitor/pads

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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

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4
Q

What is the dose of Atropine for Bradycardia

A

Atropine 1mg every (q) 3-5mins max of 3mg

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5
Q
A

A flutter

instead of P waves there are F waves,

sawtooth or sharkfin f waves

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6
Q

To get the accurate rate you would count small squares between R-R and divide by

A

1500

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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.

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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))

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9
Q

how much time is between the two heavy lines on a graph

A

0.20 seconds

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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

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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

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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

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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
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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

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15
Q
A

Accelerated Junctional

inverted P wave

rate 61-100

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16
Q

What is the drug dose of Amiodarone

when do you give

A

300mg

2nd dose
150mg

Code

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17
Q

What class intervention is TCP according to ACLS

A

Class I

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18
Q

Treatment for Hydrogen Ion (Acidosis)

A

Sodium BiCarb

airway management
CPR

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19
Q

Is Depolarization the same as contraction

A

No, Depolarization is an ELECTRICAL phenomenon,

contraction is MECHANICAL and is expected to follow depolarization

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20
Q

Define PJC

A
  • p wave inverted
  • or p-wave missing
  • underlying rhythm needs to be mentioned
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21
Q

Mechanically whats happening

P wave

QRS

Twave

A

P Wave - Atrial contraction

QRS Ventricular Contraction

T Wave Ventricular relaxation

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22
Q

Define Relative refractory period

A

top of t-wave when heart could fire again

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23
Q

CHB are

A

3rd Degree heart block and Complete AV block

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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

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25
Q

what is the drug dose of cardizem

when do you give

A

.35mg/kg IV

tachy

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26
Q

What are the two functions of cells in the heart?

(also what are their two actions)

A

Electrical, conductive

Mechanical, contracting

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27
Q

How many seconds are in one hash mark

How many are on a full sheet (2 hash marks)

A

3 seconds x2

6 seconds total sheet

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28
Q

Steps for Sync Cardio Vert

A

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

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29
Q

What do the vertical lines on the graph tell

A

time

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30
Q
A

SVT

hr 160-250

cant see P waves so fast

vagal then cardiovert

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31
Q

Define PVC

A
  • Premature ventricular complex
  • Has compensatory pause
  • If all match = unifocal; if they don’t match = multifocal
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32
Q

What are the electric measurements Defib, Sync, Pacing

A

Joules for Defib & Sync

mA (milli amps) for pacing

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33
Q

When can you terminate CPR

A

after 30 minutes

(15 two minute CPR cycles)

VF, pVT, PEA with ETC02 less than 15 mmHg

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34
Q

I have NO discernible P waves or QRS waves and look erratic. Cardiac output plummeted when I switched to this rhythm.

A

V-Fib

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35
Q

Where are Coronary arteries located

A

Epicardium

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36
Q

What lead are we looking at when placing PADs

A

Lead 2

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37
Q

as far as H’s and T’s
If narrow complex
think about ________

A

obstructive causes

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38
Q

What are the 6 H’s

also known as

A

Hypovolemia
Hypoxia
Hydrogen Ions (Acidosis)
Hypo and Hyper Kalemia
Hypothermia

probable causes

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39
Q
A

Idioventricular

  • Rate 20-40
  • QRS wide
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40
Q

what is normal MAP

A

need greater than 65

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41
Q
A

V-Tach

wide, bizarre QRS

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42
Q

What is happening during a

QRS

A

Ventricle Depolarization

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43
Q

What are 2 NON Shockable Rhythms

A

PEA, ASYSTOLE

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44
Q

if Tachy is regular and monomorphic

stable and wide
give _____

A

you may give

Adenosine (class I)
6mg, 12mg

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45
Q

Steps for Pacing

A
  • 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
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46
Q
A

A-fib with 2 unifocal PVCs

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47
Q
A

Atrial Flutter

F waves, saws,

QRS narrow
atrial rate 250-350

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48
Q

Parasympathetic Stimulation causes

A

Decreased:
Slows DOWN HR
AV conduction
Decreased Irritability

only affects the atria

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49
Q

What starts the flow of electrical current in the heart

A

Positive and Negative electrical charges exchange places across the cell membrane

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50
Q

What else should you monitor during ECG

A

Pulse/Pleth wave from SPO2

and physical pulse

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51
Q

How do you find cardiac output

A

Stroke volume x HR

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52
Q

What happens if one branch of the nervous system is blocked?

A

The other will influence the heart

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53
Q

What is the hr of brady

A

less than 50 (for treatment)

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54
Q

What is happening during a

PRI

A

Delay in AV node

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55
Q

Which nervous system slows the heart

Which nervous system speeds the heart up

A

Slows DOWN the heart - Parasympathetic

Speeds - Sympathetic

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56
Q
A

SVT with a wide QRS

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57
Q

How does on demand pacing work

A

pacer kicks in when hr drops below a certain amount

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58
Q

Treatment for Tension Pneumothorax

A

needle decompression

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59
Q

Where are the + and - leads in Einthovens Triangle

A
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60
Q
A

Second Degree Type II

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61
Q

Treatment for Thrombosis, Coronary

A

MI, clot in coronary artery

no much we can do

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62
Q

For Brady what is the quick treatment atde

A

All
Trained
Dogs
Eat

Atropine
TCP
Dopamine
Epinephrine

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63
Q

According to Maryland how many EPI’s can you give

according to AHA

A

maryland - 4

AHA - unlimited

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64
Q

what should you do with any change in rhythm?

A

access vital signs

level of consciousness

and abcs

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65
Q

What is happening during a

Pwave

A

Atrial Depolarization

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66
Q

Treatment for Hypovolemia

(low blood)

A

IV Fluid (20mL per kg)
Vasopressors (Dopamine, Epi)

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67
Q

Define 2nd Degree TYPE II

A
  • PRIs are regular, with dropped beats
  • Regular or irregular
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68
Q

What are the 5 T’s

also known as

A

Tension Pneumo
Tamponade Cardiac
Toxins
Thrombosis Coronary
Thrombosis Pulmonary

probable causes

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69
Q

how many small boxes is a 6 second strip

A

150

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70
Q

What are the two doses of EPI

A

1:1,000 = 1mg in 1mL for allergic reaction

1:10,000 = 1mg in 10mL or 0.1mg/mL for cardiac (brown box)

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71
Q

Treatment for Toxins

1 organophosphate
2 beta blocker OD
3 TCA OD
4 opioid OD

A

1 Atropine for organophosphate poisoning

2 beta blocker OD = glucagon

3 TCA OD = sodium bicarb

4 opioid OD = naloxone

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72
Q

What is the target ETCO2

A

35-40 mmHg

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73
Q

What are the 5 parts of analysis for heart rhythms

A
  1. Rhythm, regular
  2. Rate
  3. P Waves
  4. P-R Interval
  5. QRS
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74
Q

What is the drug dose of Diltiazem

when do you give

A

0.25mg/kg

2nd dose
0.35mg/kg

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75
Q

What is the drug dose of Adenosine

when do you give

A

6mg
12mg

Tachy

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76
Q

Define Ventricular rhythms

A

Wide and bizar

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77
Q
A

Sinus Brady with 1 PVC

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78
Q
A

SVT (no P waves seen)

79
Q

What must occur for the heart to contract

A

muscle cells must receive electrical stimulus

80
Q

What are the rules/guidelines of a Second Degree Type II

A

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
Q

What are the 2 shockable rhythms to DEFRIBRILLATE

A

V- Fib (squiggly worms)

Pulseless V-Tach (no pulse) (tombstones)

82
Q

What is the 2nd med you give for a shockable rhythm

A

Amiodarone (anti arrhythmic) 300mg (first dose)

if torsades give mag sulfate 1-2g

83
Q

Lead and Electrodes

A

A lead is a single view of the heart

often from several electrodes

84
Q

What class intervention is Dopamine and Epinephrine Infusions

A

Class IIb

85
Q

What is the dose for Dopamine

What is the dose for Epinephrine

A

Dopamine
5-20mcg/kg/min

Epinephrine
2-10mcg/min

Dopamine can be added to Epi or used alone

86
Q

What should you do first with Tachy patient

A

Identify H’s and T’s

Support abcs
Give O2
ECG, Vitals

87
Q

What are two interventions that start or squeeze the heart

A

start - epi

squeeze - defib

88
Q

What is happening during a

T Wave

A

Ventricle repolarization

89
Q

what do you do with the energy level if….

you go from a perfusing to a NON perfusing rhythm

A

never decrease the energy level

from defi to SVT stay at 300

90
Q

Define Polarization

A

When electrical charges are balanced and ready for discharge

91
Q

how many chest compressions a min

A

100-120

92
Q

Sympathetic Stimulation causes

A

Increased:
Speeds UP HR
AV conduction
Increased Irritability

affects both atria and ventricles

93
Q

Define Escape

A

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
Q

After ROSC but comatose
patient should receive…

A

Targeted temperature management. 89.6-96.8 F (32-36 C)

Treat H’s and T’s

95
Q

What does the parts of conduction does the Parasympathetic influence

A

Only the atria

(i.e., the SA node, the intraatrial, and internodal pathways, and the AV junction)

96
Q
A

Sinus with PAC

early atrial activity
early p wave looks different

97
Q

With ROSC how should you position patient

A

Elevate head 30 degrees

98
Q

-

A

A Fib

fast atrial activity, lots of f waves R_R irregular,

99
Q

Treatment for Tamponade, Cardiac

A

pericardial centesis,

draw off fluid

drive fast, fluid boluses

pressure inside of the heart needs to be greater

100
Q
A

Sinus with Atrial Pacing

101
Q

Explain depolarization vs Contraction

A

Depolarization = electrical activity only

Contraction = mechanical squeeze of the heart

102
Q

My underlying rate is 70. My PRI is .22s. I have P, QRS & T waves which all look the same.

A

Sinus with 1st degree Heart block

103
Q

what does the PR segment represent

A

delay in the AV node

104
Q

What do you do for Bradycardia with a 2nd Degree or 3rd Degree block

A

Pacing

105
Q

Does a TYPE II second degree block have the same P waves for every QRS

A

no there will be more P waves

106
Q

Define Atrial Pacers
Ventricular Pacer
Sequential Pacer

A

Atrial Pacers
- Spike on rhythm before p-wave

Ventricular Pacer
- Spike before QRS

Sequential Pacer
- Spike before both

107
Q

What is the goal of CPR

A

cerebral resuscitation

108
Q

When an arrhythmia is irregular, you should determine the heart rate by counting the number of R waves divided by

A

10

109
Q

when do you give a sedative for pacing?

what do you give/dose

A

when they are conscious

versed/midazolam 5mg (2.5mg if over 69 y/o)

110
Q

what do you do with the energy level if….

you go from a NON perfusing to a perfusing rhythm

A

you may start at a lower energy setting

111
Q

What is the compression rate for CPR

A

100-120 compression per min

112
Q

Absolute refractory period vs relative refractory period

A

absolute - heart cant accept any stim

relative - some cells are capable of responding

113
Q
A

Atrial Fibrillation (controlled) with 2 unifocal PVC’s

114
Q

Describe the rhythm of sinus arrhytmia

A

its irregular it increases with each inspiration and decreases with each expiration

115
Q

What are interventions to SLOW the heart

A

Synchronized Cardioversion

Defib

Adenosine
Diltiazem

Beta-Blockers (lol)
Lidocaine
Mag Sulfate

116
Q

What is an unstable hypertension

hypotension

A

hyper

180/120

hypo

90/60

117
Q

Define Repolarization

A

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
Q

What class intervention is Atropine according to ACLS

A

Class IIa

119
Q

What is the terms for multiple PVC’s

A

2 PVCs = couplet
3 PVCs = triplet
4 PVCs or more = run of PVCs

120
Q

if electrical current flows toward the positive electrode with deflection be upright or downward

A

upright

121
Q

Treatment for Hypothermia

A

passive rewarming

attempt to defibrillate ONCE until patient warms up

122
Q

Differentiate waves segments and intervals

A

waves are deflections
segments are straight lines
intervals include both waves and segments

123
Q

The SA Node fires and then travels via the

A

Intraatrial and Internodal pathways

to the AV Node

124
Q
A

Junctional with P waves after QRS

rate 40-60 bpm

125
Q

How would you differentiate between junctional focus and ventricular focus in CHB

A

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
Q

as far as H’s and T’s
if wide complex
think about _________

A

toxins or metabolic causes

127
Q

what role should not be multi tasked

A

airway manager

128
Q

What are the most important organs to perfuse

A

heart
brain
kidneys

129
Q

What is 1 beat of the heart called

A

stroke volume (ejection fraction)

130
Q

Treatment for Thrombosis, Pulmonnary

A

Oxygen
Drive fast

131
Q

What are the DEFIBRILLATION shocks

A

200j, 300j, 360j

132
Q

How do you fix Sinus Tachycardia

A

You fix the underlying problem

might be fever, hypovolemia

133
Q

What is the treatment sequence for BRADYCARDIA

A

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
Q

Interventions to SPEED up the heart

A

TCP

Atropine
Epi infusion
Dopamine infusion

135
Q

Define Depolarization

A

sodium and potassium switch

It is the discharge of energy that accompanies the transfer of electrical charges across the cell membrane

136
Q

Define

Excitability
Automaticity
Contractility
Extensibility
Conductivity

A

Excite = response to electric

Contractility = squeeze

Auto = create impulse

extense = stretch,expand

conduct = pass electric

137
Q

What is the drug dose of Lidocaine

and when do you give?

A

0.5-0.75mg/kg

Tachy

138
Q

When should you avoid Atropine

A

When there is a high degree block
(2nd type II, 3rd Degree)

go right to pacing

139
Q

How do you treat PEA

A

CPR - compressions
IV/IO access

1mg Epinephrine (0.1mg/mL) IVP every 3/5 mins

ETT and Capno

140
Q

Define Supraventricular Rhythms

A

Rates over 150, narrow QRS

141
Q

What are the parts of the ECG doing

P wave

PRI

QRS

Twave

A

P wave - Atrial Depolarization

PRI - Atrial Depolarization and delay through AV node

QRS - Ventricular depolarization

T Wave - Ventricular RE polarization

142
Q

What should you say instead of “give epi”

A

im going to administer…

1mg of epinephrine .01 mg per mL concentration every 3-5 mins IV push

143
Q

Treatment for Hypoxia

and signs?

A

Good bagging, airway management

early signs (rat);
restlessness
anxiety
tachy

late signs (bed):
brady
extreme restless
dyspnea (severe)

144
Q

What are signs of unstable TACHY

A

hypotension below 90/60
AMS
Shock
CP

145
Q
A

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
Q

My rate is 30bpm. My complexes are regular (they all march out). I have NO P waves and my QRS is >.18s

A

idioventricular

147
Q

What are the 3 types of pacemakers & how do we know the difference when viewing these EKG’s?

A

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
Q
A

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
Q

What are the 3 Inherent rates of the conduction system

A

SA Node 60-100 bpm
AV Junction 40-60 bpm
Ventricles 20-40 bpm

150
Q

List the (6) areas of the conduction system in order which the impulse travel through the heart

A
  1. SA Node
  2. Intratrial and Intrernodal Pathways
  3. AV Node
  4. Bundle of His
  5. Bundle Branches
  6. Purkinje Fibers
151
Q

To get the accurate rate you would count LARGE squares between R-R and divide by

A

300

152
Q
A

Sinus Brady with a wide QRS

153
Q

What is the heart cell’s ability to convey electric signals

A

Conductivity

154
Q
A

V- Tach (with possible CPR artifact)

155
Q

Post arrest should ETT when

A

EARLY PLACEMENT

156
Q

What are the 3 junctional (escape) rhythms

A

Junctional rhythm 40-60

Accelerated junctional rhythm 60-100

Junctional tach 100-180

157
Q

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.

A

Ventricular Bigeminy

158
Q

If SVT give

A

Amiodarone

150mg over 10mins

159
Q

what should you say instead of “shock”

A

synchronized cardiovert - at 100 j

transcutaneous Pace - at 80bpm

defibrillate - at 200 j

160
Q

Does an inverted P mean junctional?

A

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
Q

with ROSC

wide QRS (H’s and T’s)

narrow QRS (H’s and T’s)

A

wide - toxins, metabolic

narrow - obstructive, tamponade, tension pneumothorax

162
Q

What can you give a TACHY patient if you have IV access and the rhythm is regular and narrow

A

you may give

Adenosine (class I)
6mg, 12mg

163
Q

If unstable TACHY what should you do immediately

A

Synchronized cardiovert (class I)

before IV or meds

164
Q
A

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
Q

Define Absolute refractory period

A

heart cannot fire, not ready,

has not reached halfway up t-wave

166
Q

Where does blood flow through the heart

A

Superior/Inferior VC -> R Atria -> Tricuspid valve -> R Ventricle -> Pulmonary artery ->

Lungs ->

Pulmonary veins -> L Atria -> Mitral valve -> L Ventricle -> Aorta

167
Q
A

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
Q

Where is sodium and potassium during ready state

A

Sodium is outside and potassium is on the inside

169
Q

What parts of conduction does the Sympathetic influence

A

The atria
(i.e., the SA node, the intraatrial, and internodal pathways, and the AV junction)

and the ventricles

170
Q

What is the drug dose for Dopamine

when do you give

A

drip

5-20mcg/kg/min

Brady

171
Q

What hr qualifies as Tachycardia

A

equal to or over 150

172
Q

What is the drug dose of Atropine

when do you give

A

1mg

Brady

173
Q

How many lines are between the bold lines on ECG paper

A

4

174
Q

what does AICD mean

A

Automatic Implantable Cardioverter Defribrillator

175
Q

If STABLE narrow Tachy

how do you treat

(and if wide)

A

IV, 12lead
Vagal Maneuvers (blow into
Give Adenosine 6/12

(if wide give beta blocker or calcium channel blocker = Diltiazem)

176
Q

Treatment for Hypo-HyperKalemia

A

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
Q

H and T are most important with

A

PEA
Cardiac Arrest

178
Q
A

SVT with wide QRS

160-250 bpm

p wave might look like steps

179
Q

Which nervous system has two branches that control the heart

What are the two branches

A

Autonomic

Sympathetic and Parasympathetic

180
Q

hat do the horizontal lines on the graph tell

A

voltage

181
Q

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.

A

Sinus Brady

182
Q
A

Sinus Tachycardia

Hr 100

183
Q

What is the drug dose of Epinephirine

when do you give

A

1:10,000 cardiac

1mg

Code

184
Q

What is the target pulse ox for ROSC

A

92-98%

185
Q

When do you give EPI

A

AFTER 2nd shock

1mg EPI (0.1mg/ml) IVP

186
Q
A

Junctional Tachycardia

inverted P wave
rate 101-180

187
Q

ACLS Classes

A

Class 1 - strong evidence

Class 2a Moderate
Class 2b weak

Class 3 NO BENEFIT

188
Q
A

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
Q

What part of the ECG signifies the relative refractory period

A

the downslope of the T wave

190
Q

What is the atrial rate in a-flutter

A

250-350 bpm

191
Q

What should you do on a working code ASAP

A

Defibrillate and give EPI

192
Q

What is a mega code

A

It is a total of four rhythms. initial and 3 changes

(one will be Vfib or pulseless V-Tach)

193
Q

What are the ECG rules

A
  • 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

Paramedic (24 decks)

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