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Paramedic > 119 Mod 1 (12-Lead ECG and Lab Values) > Flashcards

119 Mod 1 (12-Lead ECG and Lab Values) Flashcards

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1
Q

What is an infarct represented by?

A

Pathological Q waves

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2
Q

What kind of leads are V1 - V6

A

precordial (chest)

unipolar

positive electrodes

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3
Q

LVH confirmation _____________ the 12 lead for AMI discrimination

A

negates

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4
Q

What does the T Wave Represent

A

Ventricular Repolarization

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5
Q
A

Accelerated Junctional

inverted P wave

rate 61-100

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6
Q

What are clues of RV involvement

and what are you looking for in v4r

A

J-point elevation in III is > than II
J-point elevation in V1
J-point depression in V2

v4r - greater than 1 mm j-point elevation

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7
Q

Is the QRS wide or narrow in a hemi block?

A

can be both wide or narrow

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8
Q

Changes from Benign early repolarization are usually seen in _________ and ________ leads

A

-anterior
-lateral

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9
Q

What is this secondary control called that a COPD patient might use to breathe?

A

Hypoxic Drive

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10
Q

When do you run a V4r

A

EVERY time an ST elevation in INferior Wall (II, III, avf)

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11
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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12
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

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13
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

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14
Q

Right Coronary Artery wraps around the heart and becomes the _______________________

A

posterior descending artery

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15
Q

Describe the rhythm of sinus arrhytmia

A

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

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16
Q

What makes a Q wave physiologic?

A

< .04 seconds (less than 1 small box)

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17
Q

What lead are we looking at when placing PADs

A

Lead 2

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18
Q

Anatomically where do V8 and v9 go

(and v7)

A

v8 - 5th ics mid scapula (L) (under shoulder blade)

v9 - paravertebral border (L) (near spine)

v7 - posterior axillary line (L) (near arm pit)

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19
Q

Elevated serum lactate level is > _______

A

> 4 mmol

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20
Q

If SVT give

A

Amiodarone

150mg over 10mins

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21
Q

What does the QT interval represent

A

The amount of time it takes ventricle to depolarize and repolarize

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22
Q

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

A

0.20 seconds

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23
Q

if Tachy is regular and monomorphic

stable and wide
give _____

A

you may give

Adenosine (class I)
6mg, 12mg

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24
Q

Interventions to SPEED up the heart

A

TCP

Atropine
Epi infusion
Dopamine infusion

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25
Q

What does the S1 sound indicate

A

closing of the atrioventricular valves.
the start of systolic contraction of both ventricles. closes after blood is pushed out to both the lungs (from RV) to the body (from LV)

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26
Q

What are the DEFIBRILLATION shocks

A

200j, 300j, 360j

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27
Q

Left Coronary Artery starts as the Left main, then bifurcates into the _________ and the ___________.

A

-left circumflex
-left anterior descending artery

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28
Q

What does a pathologic wave represent?

A

Old infarct

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29
Q

What are the top 2 complaints of a woman having a MI

A

SOB
and
Weakness

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30
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

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31
Q

S wave is the negative deflection ___________ the R wave

A

after

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32
Q

what does AICD mean

A

Automatic Implantable Cardioverter Defribrillator

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33
Q

INR is a measure of what

A

Blood clotting

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34
Q

How do you identify pericarditis on an ECG? (3 things - only need 1 to confirm)

A

-diffuse ST segment elevations
-no reciprocal changes
-PR interval depressions

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35
Q

The left main of the coronary artery branches off to

A

LCX - left circumflex and LAD - left anterior descending (feeding the lateral anterior wall)

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36
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!

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37
Q

Leads II, III, and aVf look at the _______ _______

A

Inferior wall

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38
Q
A

Junctional Tachycardia

inverted P wave
rate 101-180

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39
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

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40
Q
A

Sinus Tach with 1st Degree Block

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41
Q

What BB’s does a hemi block indicate

A

it specifically indicates LBB

Anterior hemiblock - Pathological left (-30/-90)
and
Posterior -Right Axis (90/180)

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42
Q

What does Nitro and morphine do to the RV

A

reduce preload

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43
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.

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44
Q

What is the relationship between sodium and chloride levels?

A

When sodium decreases, chloride levels decrease - vice versa

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45
Q

What is the drug dose of Atropine

when do you give

A

1mg

Brady

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46
Q

Limb leads look at the ____________

Precordial (Chest) leads look at the ___________

A

Frontal plane

Horizontal plane

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47
Q

Explain depolarization vs Contraction

A

Depolarization = electrical activity only

Contraction = mechanical squeeze of the heart

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48
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

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49
Q

For 15 lead where do you move
V4
V5
V6

A

v4 - v4r
v5 - v8 - mid scapular line (L)
v6 - v9 - let pariveteral border (near spine)

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50
Q

What are two interventions that start or squeeze the heart

A

start - epi

squeeze - defib

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51
Q

1 and avL, V5 and V6 looks at what part of the heart

A

Lateral Wall

+ electrode is at the left arm (1, avL)

left lateral chest ( v5, v6)

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52
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

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53
Q

What is the drug dose of Epinephirine

when do you give

A

1:10,000 cardiac

1mg

Code

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54
Q

If you have elevation in II III and avF where might you see reciprocal change

A

I, avL, v leads

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55
Q

What is ejection fraction

A

% of blood pumped out by the left ventricle, compared to how much it holds (usually 70-75%)

BBB with QRS 170ms, ejection fraction can’t be more than 50% (chf or MI) can compensate

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56
Q

normal hematocrit levels

A

Male: 45%-52%
Female: 37-48%

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57
Q

What are two ways to find the isoelectric line

A
  1. use the T-P segment
  2. use the end of the calibration mark
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58
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

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59
Q

How can you identify Wellen’s syndrome?

A

Inverted or biphasic T-waves (usually in V2 and V3)

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60
Q
A

V Tach

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61
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.

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62
Q

Where is the ST segment

A

Between the J- point and the beginning of the T wave

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63
Q

How do you find ST elevation

A

Find the j point, find the t-p segment as your isoelectric line, and compare (move over 1 small box)

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64
Q

Pain from pericarditis (does/does not) radiate.

A

Does not

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65
Q

What fires during the PR interval?

A

The atria, AV node, bundle of His, bundle branches, and Purkinje system all fire.

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66
Q

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

A

upright

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67
Q

How do you confirm RBBB after turnsignal in V1

(with qrs over 120 & supra rhythm)

A

look at I and/or V6 for:

S wave, slurring, cupping

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68
Q

When should you do a 12 lead on a woman (top 2 reasons)

A
  1. weakness
  2. SOB
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69
Q

Define Starlings Law

A

the bigger the stretch the bigger the squeeze

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70
Q

What the augmented leads

A

avr avL avf

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71
Q

Where would you see a U wave?

A

The U wave is a small, flat wave seen after the T wave and before the next P wave.

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72
Q

For Brady what is the quick treatment atde

A

All
Trained
Dogs
Eat

Atropine
TCP
Dopamine
Epinephrine

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73
Q

Limb leads look at the heart from a __________ plane

A

frontal

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74
Q
A

SVT (no P waves seen)

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75
Q

What is the drug dose of Amiodarone

when do you give

A

300mg

2nd dose
150mg

Code

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76
Q

Treatment for Hydrogen Ion (Acidosis)

A

Sodium BiCarb

airway management
CPR

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77
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

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78
Q

Depression in aVr is indicative of _________

A

Pericarditis

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79
Q

With ROSC how should you position patient

A

Elevate head 30 degrees

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80
Q

In what part/stage of patient assessment do you recheck the interventions you have performed on your patient?

A

Re-Assessment

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81
Q

Define Supraventricular Rhythms

A

Rates over 150, narrow QRS

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82
Q
A

V-Tach

wide, bizarre QRS

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83
Q

Your coronary arteries fed when the ventricle ______________.

A

relaxes

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84
Q

Explain where the negatives and positives in Einhovens Triangle

A
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85
Q

The positive electrode looks at the ____________

A

negative electrode

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86
Q

When you find a block, hemi block what do you do next

A

PUT Pads on them to DEFIB or PACE

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87
Q

Creatinine levels

A

0.6-1.2 mg/dL

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88
Q

What class intervention is TCP according to ACLS

A

Class I

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89
Q

What are interventions to SLOW the heart

A

Synchronized Cardioversion

Defib

Adenosine
Diltiazem

Beta-Blockers (lol)
Lidocaine
Mag Sulfate

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90
Q
A

Idioventricular

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91
Q

Obtain v8 and v9 when

A

v1- v4 show st depression (two or more anatomically contiguous)

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92
Q
A

SVT

hr 160-250

cant see P waves so fast

vagal then cardiovert

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93
Q

A hemi block is also known as a

A

Fascicular Block

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94
Q

What are 2 requirements of BBB

A

Widened QRS 120ms (QRS 0.120s)
and
Supraventricular Rhythm (sinus, atrial, junctional)

look in V1 (turn signal: up or down)

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95
Q

When do you look for Posterior MI

A

when v1-v4 show ST depression (any two or more anatomically contiguous) or story is convincing

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96
Q

Low blood sodium is called ____________

A

Hyponatremia

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97
Q

What are the rates of Junctional Rhythms

and difference between junc brady and idiovent

A

Junctional Tachy Over 100
Accel Junctional 60 -100
Junctional (Escape) 40-60
Junctional Brady Below 40 (narrow QRS)

(idioventricular = wide QRS over 0.120s, below 40)

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98
Q

Define Absolute refractory period

A

heart cannot fire, not ready,

has not reached halfway up t-wave

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99
Q

Define Polarization

A

When electrical charges are balanced and ready for discharge

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100
Q

avR T wave inversion is _______, in v1 and v2 it is ________ and other leads its a sign of _________

A

normal (because of how leads are)

a normal variant

a sign of ischemia

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101
Q

What are 2 ways to find the isoelectric line?

A

-Use the TP segment

-Use the end of calibration mark

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102
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 amiodarone 150mg)

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103
Q

INR for pt on warfarin

A

3 sec

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104
Q

What is the normal range for potassium (K+)

A

3.5-5.0 mEq/L

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105
Q

As a PTs INR increases, what risk also increases?

A

Bleeding

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106
Q

What is the number 1 cause of upright avR

A

Limb lead reversal (check leads)

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107
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

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108
Q

What are the anatomical locations of

V1 - V6

A

V1 - 4th intercostal (r) strernum
V2 - 4th intercostal (L) strernum

V3 - (between v2 v4)
V4 - 5th intercostal, mid clavicular
V5 - 5th inter, anterior axillary line
V6 - 5th inter, Mid Axillary line

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109
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

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110
Q
A

Second Degree Type II

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111
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

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112
Q

Where is the negative electrode with
augmented unipolar leads

A

computer average central terminus middle

avr
avL
avf

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113
Q

AHA definition of a STEMI

A

> or equal to 1mm ST elevation in 2 or more anatomically contiguous leads

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114
Q

Left Anterior descending artery feeds the (3 things):

A

-anterior septal wall
-anterior left ventricular wall
-apex

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115
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

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116
Q

What two requirements have to be met in order to have a bundle branch block on an ECG?

A

Wide QRS

and

Supraventricular Rhythm

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117
Q

Where anatomically is v5r, v6r placed

A

v5r - 5th ics anterior axillary (right)
v6r - 5th ics mid axillary (right)

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118
Q

Which leads look at the INFERIOR wall of the heart?

A

II, III, and aVF

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119
Q

How can you identify hypokalemia on an ECG?

A

-ST depression

-prominent U-wave

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120
Q

what is the drug dose of cardizem

when do you give

A

afib or aflutter

(0.25 then 0.35)

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121
Q

Which leads look at the LATERAL wall of the heart?

A

I, aVL, V5, and V6

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122
Q
A

Atrial Fibrillation (controlled) with 2 unifocal PVC’s

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123
Q
A

V Tach 100J

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124
Q

The baseline is a straight line drawn between the _____ of one complex to the _____ of the succeeding complex.

A

TP segment–TP segment

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125
Q

What is happening during a

QRS

A

Ventricle Depolarization

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126
Q

how many small boxes is a 6 second strip

A

150

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127
Q

Low creatinine levels suggest _______ and/or ________ disease

A

Heart and/or liver

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128
Q

What are the bi-polar leads

A

I II III

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129
Q

What causes Left Ventricular Hypertrophy?

A

chronic hypertension

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130
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

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131
Q
A

Junctional Escape

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132
Q

What are two reasons for ST depression

A
  1. Ischemia
  2. reciprocal change
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133
Q

What lead is the positive lead in aVr?

A

right arm +

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134
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

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135
Q

In avR where is the positive electrode?

A

Right shoulder

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136
Q

R wave is the _____ _______________________ in the QRS complex

A

1st positive deflection

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137
Q

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

A

10

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138
Q

What is happening during a

T Wave

A

Ventricle repolarization

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139
Q
A

Sinus with PAC

early atrial activity
early p wave looks different

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140
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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141
Q

Where is the ST segment?

A

B/w J-point and beginning of the T wave

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142
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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143
Q

Pathological left axis comes with ____________ hemiblock

A

anterior

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144
Q

The normal duration for QRS interval is

A

0.06–0.11

145
Q

Chief cause of hyperkalemia?

A

renal failure

146
Q

Which axis comes with a Anterior hemiblock

A

Pathological Left

147
Q

What is an unstable hypertension

hypotension

A

hyper

180/120

hypo

90/60

148
Q

Where is the ST segment?

A

B/w J-point and beginning of the T wave

149
Q

Marginal branch feeds the (2 things):

A

-inferior left wall
-apex

150
Q

What will St elevation in v8, v9 indicate

A

that the st depression in v2 and v3 are reciprocal change

151
Q

what should you do with any change in rhythm?

A

access vital signs

level of consciousness

and abcs

152
Q

V1, V2, avR an inverted T wave is normal.

In other leads its a sign of ________.

A

Ischemia - inadequate blood to the heart

153
Q

Are the T Waves usually asymmetrical

A

Yes

154
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))

155
Q

what is normal MAP

A

need greater than 65

156
Q

What is the first intervention for a pulseless patient that shows SINUS TACHYCARDIA on the ECG monitor/defibrillator?

A

Start CPR/compressions

157
Q

What are signs of ischemia

A

St depression and T wave inversion

(note: v1 and v2 t wave inversion is normal)

158
Q

Define Ventricular rhythms

A

Wide and bizar

159
Q

What lead groups look at the:

Septal Wall

A

V1, V2 (chest leads).
+ electrodes are sternum

160
Q

Normal INR range

A

0.9 - 1.1 sec

161
Q

What wall of the heart does the Left Anterior Descending feed

A

Anterior

162
Q

What lead is the positive lead in aVl?

A

left arm +

163
Q

Whats a normal platelet count?

A

150,000-300,000

164
Q

Mechanically whats happening

P wave

QRS

Twave

A

P Wave - Atrial contraction

QRS Ventricular Contraction

T Wave Ventricular relaxation

165
Q

What are the electric measurements Defib, Sync, Pacing

A

Joules for Defib & Sync

mA (milli amps) for pacing

166
Q

What does the P wave represent?

A

SA node firing

167
Q

Leads V3 and V4 look at the _________ _________

A

Anterior wall

168
Q

Which axis comes with a Posterior hemiblock

A

Right Axis (90 to 180)

169
Q

What is leukocytosis?

A

elevated WBC count

170
Q
A

Junctional with P waves after QRS

rate 40-60 bpm

171
Q
A

V- Tach (with possible CPR artifact)

172
Q

Normal BUN levels

A

8-22 mg/dL

173
Q

-

A

A Fib

fast atrial activity, lots of f waves R_R irregular,

174
Q

Define Relative refractory period

A

top of t-wave when heart could fire again

175
Q

Define Clinical reasons

A

prehospital treatment

176
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)

177
Q

A standard 12 lead doesnt look where

A

Right ventricle and Posterior Wall

178
Q

What lead groups look at the:

Anterior Wall

A

V3, V4 (chest leads)

looks at 70% of pumping force

center of chest

+ electrodes left anterior chest

179
Q

Normal potassium levels (K)

A

3.5-5.0 mEq/L

180
Q

Reciprocal changes for II, III, and aVf would show in leads ____, ____, and ________.

A

I
aVl
V leads

181
Q

Define ischemia

A

inadequate oxygen to cardiac tissue

182
Q
A

Atrial Flutter

F waves, saws,

QRS narrow
atrial rate 250-350

183
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

184
Q
A

10 gtts/min

185
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

186
Q

How much time is

1 small box
1 large box
5 large blocks
30 large blocks

A

1 small box - 0.04
1 large box - 0.20
5 large blocks - 1 second
30 large blocks - 6 seconds

187
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
188
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

189
Q

Differentiate waves segments and intervals

A

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

190
Q

What additional leads do you use if you interpret an Inferior STEMI?

A

v4r

191
Q

What does the term hemiplegia mean?

A

Paralysis (one sided)

192
Q

What is the goal of CPR

A

cerebral resuscitation

193
Q

What is the initial dose of IV fentanyl for pain management?

A

1 mcg/kg max of 150 mcg

194
Q

What makes a Q wave pathologic? (2 things)

A

> or = to .04 seconds (greater than or equal to 1 small box)

If Q wave depth is > 1/3 height of R wave

195
Q

What is the drug dose of Diltiazem

when do you give

A

0.25mg/kg

2nd dose
0.35mg/kg

For afib and aflutter

Calcium channel blocker

Do not give chf or 3rd degree block

196
Q

Explain the relationship sodium and chloride in the blood

A

Basically where sodium goes so does chloride

197
Q

How much time is the lead views across, between each HASHMARK (in a lifepak 15)

A

2 1/2 seconds long

198
Q

Most common cause of high hematocrit

A

Dehydration

199
Q

Posterior descending artery feeds the (2 things):

A

-posterior septal wall
-inferior right ventricular wall

200
Q

Define PJC

A
  • p wave inverted
  • or p-wave missing
  • underlying rhythm needs to be mentioned
201
Q

Narcotic analgesics, such as morphine and fentanyl are controlled substances. What drug schedule do they belong to?

A

Schedule 2

202
Q

What drugs are contraindicated for SEVERE heart blocks

A

Lidocaine (and antiarrhythmics)
Procainamide

Morphine (use with caution)

203
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

204
Q

How can you identify a Left Main Artery occlusion?

A

ST elevation in aVr with ST depression elsewhere

205
Q

What wall of the heart does the Left Circumflex feed

A

Lateral wall

206
Q

What 2 situations would you use additional leads?

A

1) Inferior STEMI
2) ST depression in V1-V4

207
Q

-

A

Ventricular Tachycardia

100-250 bpm

wide tall bizarre QRS

208
Q

Normal chloride (Cl) levels

A

95-102 mEq/L

209
Q

Leads V1 and V2 look at the _________ _________

A

Septal wall

210
Q

Fentanyl

A

1 mcg/kg max dose of 200mcg

opioid analgesic

for severe pain

contra - bp >90, allergic, resp distress

211
Q

Define 2nd Degree TYPE II

A
  • PRIs are regular, with dropped beats
  • Regular or irregular
212
Q

How does oxygen rich blood get to the body

A

Oxygen rich blood goes from the lungs to the left atrium through the mitral valve to the left ventricle
through the aortic valve to the aorta to the body

213
Q

Which parts of the heart are not visible on a standard 12-lead?

A

-Right ventricle
-Posterior wall

214
Q

What do wellens waves indicate and describe how it looks on ecg

A

Narrowing of the Left Anterior Descending Artery

Deeply inverted Twaves (v2/v3)

Type A - Bi-phasic partly above iso line (t wave)

Type B - deeply below iso line (t wave)

215
Q

What are the 5 T’s

also known as

A

Tension Pneumo
Tamponade Cardiac
Toxins
Thrombosis Coronary
Thrombosis Pulmonary

probable causes

216
Q

Why determine axis (3 things)?

A

-diagnose ventricular rhythm
-diagnose/treat hemi and fascicular blocks
-ID “at risk patients”

217
Q
A

5mL

218
Q

Leads I, aVl, V5, and V6 look at the ________ ________

A

Lateral wall

219
Q

What is Wellen’s syndrome indicative of?

A

Narrowing of the left anterior descending artery

220
Q

When should you do v8 and v9

Inferior/posterior ami

A

sharp ST depression in V1, v2 (and v3)

221
Q
A

Sinus with a trigeminy of unifocal PVC’s

222
Q

What does leukocytosis indicate?

A

infection

223
Q
A

Sinus Brady with a wide QRS

224
Q

Define syncytium

A

when both the left ventricle and right ventricle contract at the same time causing (double R wave) - sign of BBB (r) in V1

225
Q
A

Sinus Tachycardia

Hr 100

226
Q

Benign early repolarization is most often seen in __________________ (gender, race), ages __________

A

african-american males
ages 20-40

227
Q

Axis deviation can be (4 things):

A

-abnormal variant
-intraventricular conduction defects
-ventricular hypertrophy
-ectopic beats

228
Q

Fluticasone

A

Trade: Flonase

Class: Inhaled Steroid

Use: Allergies, Asthma

229
Q

What is 1 beat of the heart called

A

stroke volume (ejection fraction)

230
Q

What is Pericarditis?

A

inflammation of the lining around the heart (Pericardium)

231
Q

Which leads look at the SEPTAL wall of the heart?

A

V1 and V2

232
Q

Define
the PR segment
and
the PR interval

A

PR segment = depolarization of the AV node. I.e. When current is passing through the AV node. It’s a flat line because the wave is not strong enough to be recorded on the voltmeter.

PR interval = Wave goes over the atrium and through the AV node and ends just before it activates the ventricles to depolarize.

233
Q

Right coronary artery feeds the (4 things):

A

-sinus node (50-60% of patients)
-AV node (85-90% of patients)
-Posterior descending (90% of patients)
-marginal branch

234
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

235
Q

Obtain v4r when

A

12 lead shows ST elevation in II, III, avf - inferior wall Stemi

236
Q

hat do the horizontal lines on the graph tell

A

voltage

237
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

238
Q

Define Axis

A

average direction of the spread of the depolarization wave-front through the ventricles

239
Q

What are the Unipolar leads? are the positive or negative?

A

v1 - v6, they are all positive

240
Q

Which leads look at the ANTERIOR wall of the heart?

A

V3 and V4

241
Q

What are the two requirements that have to be met in order to diagnose an ST-segment elevation myocardial infarction (STEMI) ?

A

There must be at least two contiguous leads with ST-segment elevation,

242
Q

R wave represents

A

The first positive deflection in the QRS complex

243
Q

how many chest compressions a min

A

100-120

244
Q

What leads do you need for Axis

A

NEED LEADS TO BE ON LIMBS

I, II, III

245
Q

Elevated BUN can indicate _______

A

Renal disease

246
Q

What wall of the heart does the posterior descending feed

A

Post and Inferior

247
Q

Benign early repolarization produces: (2 things)

A
  • J-point elevation “fish hook”
    -Tall T-waves
248
Q

Abnormal creatinine levels indicate __________

A

Renal dysfunction

249
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

250
Q

Normal PR interval time

A

0.12-0.20 seconds

251
Q
A

A flutter

instead of P waves there are F waves,

sawtooth or sharkfin f waves

252
Q
A

Sinus with a PJC

253
Q

Where anatomically is v4r placed

A

5th ics, mid clavicular (right side)

254
Q

What should you do on a working code ASAP

A

Defibrillate and give EPI

255
Q

What is a physiologic block?

A

it is a normal slowing or delay of the impulse as it moves from the atria to the ventricles via the AV node. This slowing is critical to coordinate the mechanical contraction of the atria with the ventricles. Without the physiologic block, the atria and ventricles would contract simultaneously.

256
Q

Nitroglycerin

A

0.4mg SL (may repeat 2 times, 5 mins)

vasodilator

for CHF, PE, chest pain (angina)

contra - bp drop 20 from dose, bp greater than 90, pulse 60-150bpm, ED drugs, hypertension meds

257
Q

Reciprocal changes for leads II, III, and avf would show in leads _________________

A

I, avL, and (all) V leads

258
Q

Coronary artery starts at the ________________________

A

Base of the aorta

259
Q

IVCD

A

if signs of BBB but nothing in 1 or V6, if theres no slurring or fat r waves

260
Q

What are signs of unstable TACHY

A

hypotension below 90/60
AMS
Shock
CP

261
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

262
Q

Flumazenil

A
263
Q

What leads show the part of the heart with 70% pumping force

A

anterior wall, v3 and v4, left anteior

264
Q

Low BUN can indicate _______

A

Liver disease

265
Q

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

A

Pacing

266
Q

3 drugs that prolong QT interval

A

-Digitalis
-Amiodarone
-Procanimide

267
Q

What is a sign of regular Chronic Stable Angina

A

Same patterns of relief - goes away each time

Change of pattern of relief is possible ACS,
plus any other additional symptoms

268
Q

Which leads are anatomically contiguous? (Are III and avF one of them?)

A

II and III

Yes - III and aVf

v2 and v3

v4 and v5

v5 and v6

269
Q

What does the S2 sound indicate

A

the closing of the semi-lunar valves once systolic contraction is complete. pulmonary and aortic valves closing.

270
Q

Is an inverted T wave normal in v1 and v2

A

yes

271
Q

Treatment for Hypovolemia

(low blood)

A

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

272
Q

When would you use v4r

A

EVERYTIME inferior wall MI is present

273
Q

What is the treatment for Inferior/RV AMI

(II, III, avf- st elevation)

A

O2
Aspirin asap
1-2 ltrs of fluid

maybe dopamine 5-20 mcg/kg/min

do not give nitro or diuretics

274
Q

Treatment for Thrombosis, Pulmonnary

A

Oxygen
Drive fast

275
Q

What does ST depression and/or T-wave depression indicate?

A

Ischemia

276
Q

What does transmural mean

A

Full thickness of the wall damage - shows ST elevation

277
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
278
Q

Q waves are significant if:

A

They are ≥ 0.03 seconds (one little block) wide
B.

They are deeper than ⅓ the height of the R wave.

279
Q

What hr qualifies as Tachycardia

A

equal to or over 150

280
Q

How can you see a pathologic Q wave

A

Q wave is wider than 1 small box/deeper than 1/3 of the R wave

281
Q

What the 3 categories for ECG

A

Non-Diagnostic - acute coronary
Ischemia - st depress, t wave inversion
STEMI

282
Q

How does blood get to the lungs

A

right atrium through the tricuspid to the right ventricle pumps oxygen poor blood through the pulmonary valve to pulmonary arteries (away to lungs)

283
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)

284
Q

Precordial leads look at the heart from a _________ plane

A

horizontal

285
Q

What is the 12 lead acronym: I SEE ALL LEADS

A

I - Inferior
See - Septal
All - Anterior
Leads - Lateral

286
Q

Define Therapeutic reasons

A

care in the hospital

287
Q

Normal range for WBCs

A

4,500 - 10,000

288
Q

Right Axis comes with __________ hemiblock

A

posterior

289
Q

What is the drug dose for Dopamine

when do you give

A

drip

5-20mcg/kg/min

Brady

290
Q

Left circumflex artery feeds the (3 things):

A

-sinus node (40-50% of patients)
-lateral left ventricular wall
-posterior left ventricular wall

291
Q

What is the dose of Atropine for Bradycardia

A

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

292
Q

How do you calculate LVH?

A

“Rule of 35”

Pick the deepest negative deflection of QRS between leads V1 and V2, and add the # of small boxes to the tallest positive QRS deflection in V5 and V6

293
Q

Define PVC

A
  • Premature ventricular complex
  • Has compensatory pause
  • If all match = unifocal; if they don’t match = multifocal
294
Q

The left main splits into both the

A

left anterior descending and the left circumflex

295
Q

Leads II, III, and aVf look at the _______ _______

A

Inferior wall

296
Q

Which leads are NOT anatomically contiguous?

A

I and II

avr and avf

v1 and v4

297
Q

When do you give EPI during a working code

A

AFTER 2nd shock

1mg EPI (0.1mg/ml) IVP

298
Q

What is it called when the R/L sides of the heart have flipped

A

Dextrocardia

299
Q

What are 2 NON Shockable Rhythms

A

PEA, ASYSTOLE

300
Q

T wave represents

A

repolarization of ventricles

301
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

302
Q

Define Einthoven’s triangle

what type of limb lead view is it

A

Bi-Polar limb leads

I, II, III

303
Q

Morphine

A

0.1mg/kg max initial dose of 20mg (2nd dose 0.05mg/kg max 10mg)

opioid analgesic

for severe pain

contra - allergic, resp distress, bp >90

304
Q

What does a biphasic T Wave in Lead III indicate

A

hyperkalemia

305
Q

Presence of low hemoglobin and low hematocrit indicates _________ until proven otherwise

A

Bleeding

306
Q

Normal sodium (Na)

A

135-145 mEq/L

307
Q

Define each part
Q
R
S

A

Q - negative deflection proceeding RS

R - First positive deflection in QRS

S - negative deflection after R Wave

(note a tiny R wave up will rule out a deep Q)

308
Q

What lead is the positive lead in aVf?

A

left leg +

309
Q

Whats the difference between Physiological Q wave and Pathological Q wave

A

Physio is NORMAL variant (less that .04)

PATHOLOGICAL is wider (greater than .04)
or depth is 1/3 x

310
Q

what should you say instead of “shock”

A

synchronized cardiovert - at 100 j

transcutaneous Pace - at 80bpm

defibrillate - at 200 j

311
Q

Right coronary artery turns into the

A

Posterior descending artery

312
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

313
Q

What lead groups look at the:

Lateral side of Left Ventricle

A

V5, V6, 1, avL

314
Q

Q wave is the negative deflection ______________ the R wave

A

preceding

315
Q

Venlafaxine

A

Trade: Effexor XR

Class: SNRI

Use: Depression

316
Q

What lead groups look at the:

Inferior Wall of the heart

A

II, III, avF. (limb leads)

inferior wall of the left ventricle

+ electrode is left leg, posterior view

317
Q

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

A

1500

318
Q

What is the most common cause of high hematocrit?

A

dehydration

319
Q

What additional leads do you use if you interpret ST depression in V1-V4? What would you be looking at with these additional leads?

A

V8 - just below the scapula
V9- just below spine

You are looking at the posterior wall of the heart

320
Q

What makes a Q wave pathologic? (2 things)

A

> or = to .04 seconds (greater than or equal to 1 small box)

If Q wave depth is > 1/3 height of R wave

321
Q

Is Depolarization the same as contraction

A

No, Depolarization is an ELECTRICAL phenomenon,

contraction is MECHANICAL and is expected to follow depolarization

322
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

323
Q

What is the drug dose of Adenosine

when do you give

A

6mg
12mg

Tachy

324
Q

Aspirin

A

324mg

platelet inhibitor

for CP, STEMI

contra - GI Bleed

325
Q

What is the atrial rate in a-flutter

A

250-350 bpm

326
Q

If you find a Bi-Fascicular Block what should you be prepared for?

A

To Pace and or Defibrillate (put on the PADS)

327
Q

Dose for adenosine

When do you give it?

A

6mg (1st dose)
12mg (2nd dose)

SVT

328
Q
A

A-fib with 2 unifocal PVCs

329
Q

Ranitidine

A

Trade: Zantac

Class: H2 Antihistamine

Use: GERD, Stomach ulcers

330
Q

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

A

no there will be more P waves

331
Q
A

Sinus with Atrial Pacing

332
Q

What are the symptoms of Inferior/RV AMI

A

Weakness and nausea - angianal equivalents

urge to defecate

JVD
Hypotension

CP

333
Q

Name one local IV site reaction or complication.

A

Infiltration

334
Q

What is bifascicular heart block?

A

a blockage of 2/3 pathways to contract the ventricles in an organized fashion

335
Q
A

SVT with wide QRS

160-250 bpm

p wave might look like steps

336
Q

What are the 2 shockable rhythms to DEFRIBRILLATE

A

V- Fib (squiggly worms)

Pulseless V-Tach (no pulse) (tombstones)

337
Q

How do you confirm LBBB after turnsignal in V1

(with qrs over 120 & supra rhythm)

A

look at I and/or v6 for:

FAT/BROAD R Waves

338
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

339
Q

What is the most common AMI

A

Inferior Wall MI is 80%

340
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

341
Q

What part of the ECG signifies the relative refractory period

A

the downslope of the T wave

342
Q
A

SVT with a wide QRS

343
Q

What is the treatment for Inferior/Posterior AMI

A

Oxygen
Aspiring asap
Nitro (0.4) sL
Fentanyl - 1meq/kg

344
Q

The normal duration for the PR interval is _____ seconds.

A

0.11 - 0.20

345
Q

How does a PT with pericarditis present?

A

sharp pain, changes with movement. Often relieves when leaning forward and worsens when lying down.

346
Q

If unstable TACHY what should you do immediately

A

Synchronized cardiovert (class I)

before IV or meds

347
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

348
Q

What is the drug dose of Lidocaine

and when do you give?

A

0.5-0.75mg/kg

Tachy

349
Q

What does ST elevation indicate?

A

STEMI (injury)

350
Q
A

Sinus Brady with 1 PVC

351
Q

What is happening during a

Pwave

A

Atrial Depolarization

352
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

353
Q

Depression in aVr indicates

A

Pericarditis

354
Q

When should you avoid Atropine

A

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

go right to pacing

355
Q

Define ST segment

A

ST segment = During the ST segment, all the ventricular myocardium is depolarized. All have positive charges. So there is nothing potential difference to be recorded by the voltmeter (ECG machine). So you have a flat line.

356
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

357
Q

What is the hr of brady

A

less than 50 (for treatment)

358
Q

Norgestimate

A

Trade: Ortho tri-cyclen

Class: Hormone

Use: Contraceptive

359
Q
A

Idioventricular

  • Rate 20-40
  • QRS wide

Paramedic (24 decks)

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