119 Mod 1 (12-Lead ECG and Lab Values) Flashcards
1
Q
What is an infarct represented by?
A
Pathological Q waves
2
Q
What kind of leads are V1 - V6
A
precordial (chest)
unipolar
positive electrodes
3
Q
LVH confirmation _____________ the 12 lead for AMI discrimination
A
negates
4
Q
What does the T Wave Represent
A
Ventricular Repolarization
5
Q
A
Accelerated Junctional
inverted P wave
rate 61-100
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
7
Q
Is the QRS wide or narrow in a hemi block?
A
can be both wide or narrow
8
Q
Changes from Benign early repolarization are usually seen in _________ and ________ leads
A
-anterior
-lateral
9
Q
What is this secondary control called that a COPD patient might use to breathe?
A
Hypoxic Drive
10
Q
When do you run a V4r
A
EVERY time an ST elevation in INferior Wall (II, III, avf)
11
Q
Which nervous system slows the heart
Which nervous system speeds the heart up
A
Slows DOWN the heart - Parasympathetic
Speeds - Sympathetic
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
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
14
Q
Right Coronary Artery wraps around the heart and becomes the _______________________
A
posterior descending artery
15
Q
Describe the rhythm of sinus arrhytmia
A
its irregular it increases with each inspiration and decreases with each expiration
16
Q
What makes a Q wave physiologic?
A
< .04 seconds (less than 1 small box)
17
Q
What lead are we looking at when placing PADs
A
Lead 2
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)
19
Q
Elevated serum lactate level is > _______
A
> 4 mmol
20
Q
If SVT give
A
Amiodarone
150mg over 10mins
21
Q
What does the QT interval represent
A
The amount of time it takes ventricle to depolarize and repolarize
22
Q
how much time is between the two heavy lines on a graph
A
0.20 seconds
23
Q
if Tachy is regular and monomorphic
stable and wide
give _____
A
you may give
Adenosine (class I)
6mg, 12mg
24
Q
Interventions to SPEED up the heart
A
TCP
Atropine
Epi infusion
Dopamine infusion
25
What does the S1 sound indicate
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)
26
What are the DEFIBRILLATION shocks
200j, 300j, 360j
27
Left Coronary Artery starts as the Left main, then bifurcates into the _________ and the ___________.
-left circumflex
-left anterior descending artery
28
What does a pathologic wave represent?
Old infarct
29
What are the top 2 complaints of a woman having a MI
SOB
and
Weakness
30
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
31
S wave is the negative deflection ___________ the R wave
after
32
what does AICD mean
Automatic Implantable Cardioverter Defribrillator
33
INR is a measure of what
Blood clotting
34
How do you identify pericarditis on an ECG? (3 things - only need 1 to confirm)
-diffuse ST segment elevations
-no reciprocal changes
-PR interval depressions
35
The left main of the coronary artery branches off to
LCX - left circumflex and LAD - left anterior descending (feeding the lateral anterior wall)
36
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!
37
Leads II, III, and aVf look at the _______ _______
Inferior wall
38
Junctional Tachycardia
inverted P wave
rate 101-180
39
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
40
Sinus Tach with 1st Degree Block
41
What BB's does a hemi block indicate
it specifically indicates LBB
Anterior hemiblock - Pathological left (-30/-90)
and
Posterior -Right Axis (90/180)
42
What does Nitro and morphine do to the RV
reduce preload
43
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.
44
What is the relationship between sodium and chloride levels?
When sodium decreases, chloride levels decrease - vice versa
45
What is the drug dose of Atropine
when do you give
1mg
Brady
46
Limb leads look at the ____________
Precordial (Chest) leads look at the ___________
Frontal plane
Horizontal plane
47
Explain depolarization vs Contraction
Depolarization = electrical activity only
Contraction = mechanical squeeze of the heart
48
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
49
For 15 lead where do you move
V4
V5
V6
v4 - v4r
v5 - v8 - mid scapular line (L)
v6 - v9 - let pariveteral border (near spine)
50
What are two interventions that start or squeeze the heart
start - epi
squeeze - defib
51
1 and avL, V5 and V6 looks at what part of the heart
Lateral Wall
+ electrode is at the left arm (1, avL)
left lateral chest ( v5, v6)
52
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
53
What is the drug dose of Epinephirine
when do you give
1:10,000 cardiac
1mg
Code
54
If you have elevation in II III and avF where might you see reciprocal change
I, avL, v leads
55
What is ejection fraction
% 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
56
normal hematocrit levels
Male: 45%-52%
Female: 37-48%
57
What are two ways to find the isoelectric line
1. use the T-P segment
2. use the end of the calibration mark
58
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
59
How can you identify Wellen's syndrome?
Inverted or biphasic T-waves (usually in V2 and V3)
60
V Tach
61
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.
62
Where is the ST segment
Between the J- point and the beginning of the T wave
63
How do you find ST elevation
Find the j point, find the t-p segment as your isoelectric line, and compare (move over 1 small box)
64
Pain from pericarditis (does/does not) radiate.
Does not
65
What fires during the PR interval?
The atria, AV node, bundle of His, bundle branches, and Purkinje system all fire.
66
if electrical current flows toward the positive electrode with deflection be upright or downward
upright
67
How do you confirm RBBB after turnsignal in V1
(with qrs over 120 & supra rhythm)
look at I and/or V6 for:
S wave, slurring, cupping
68
When should you do a 12 lead on a woman (top 2 reasons)
1. weakness
2. SOB
69
Define Starlings Law
the bigger the stretch the bigger the squeeze
70
What the augmented leads
avr avL avf
71
Where would you see a U wave?
The U wave is a small, flat wave seen after the T wave and before the next P wave.
72
For Brady what is the quick treatment atde
All
Trained
Dogs
Eat
Atropine
TCP
Dopamine
Epinephrine
73
Limb leads look at the heart from a __________ plane
frontal
74
SVT (no P waves seen)
75
What is the drug dose of Amiodarone
when do you give
300mg
2nd dose
150mg
Code
76
Treatment for Hydrogen Ion (Acidosis)
Sodium BiCarb
airway management
CPR
77
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
78
Depression in aVr is indicative of _________
Pericarditis
79
With ROSC how should you position patient
Elevate head 30 degrees
80
In what part/stage of patient assessment do you recheck the interventions you have performed on your patient?
Re-Assessment
81
Define Supraventricular Rhythms
Rates over 150, narrow QRS
82
V-Tach
wide, bizarre QRS
83
Your coronary arteries fed when the ventricle ______________.
relaxes
84
Explain where the negatives and positives in Einhovens Triangle
85
The positive electrode looks at the ____________
negative electrode
86
When you find a block, hemi block what do you do next
PUT Pads on them to DEFIB or PACE
87
Creatinine levels
0.6-1.2 mg/dL
88
What class intervention is TCP according to ACLS
Class I
89
What are interventions to SLOW the heart
Synchronized Cardioversion
Defib
Adenosine
Diltiazem
Beta-Blockers (lol)
Lidocaine
Mag Sulfate
90
Idioventricular
91
Obtain v8 and v9 when
v1- v4 show st depression (two or more anatomically contiguous)
92
SVT
hr 160-250
cant see P waves so fast
vagal then cardiovert
93
A hemi block is also known as a
Fascicular Block
94
What are 2 requirements of BBB
Widened QRS 120ms (QRS 0.120s)
and
Supraventricular Rhythm (sinus, atrial, junctional)
look in V1 (turn signal: up or down)
95
When do you look for Posterior MI
when v1-v4 show ST depression (any two or more anatomically contiguous) or story is convincing
96
Low blood sodium is called ____________
Hyponatremia
97
What are the rates of Junctional Rhythms
and difference between junc brady and idiovent
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)
98
Define Absolute refractory period
heart cannot fire, not ready,
has not reached halfway up t-wave
99
Define Polarization
When electrical charges are balanced and ready for discharge
100
avR T wave inversion is _______, in v1 and v2 it is ________ and other leads its a sign of _________
normal (because of how leads are)
a normal variant
a sign of ischemia
101
What are 2 ways to find the isoelectric line?
-Use the TP segment
-Use the end of calibration mark
102
If STABLE narrow Tachy
how do you treat
(and if wide)
IV, 12lead
Vagal Maneuvers (blow into
Give Adenosine 6/12
(if wide give amiodarone 150mg)
103
INR for pt on warfarin
3 sec
104
What is the normal range for potassium (K+)
3.5-5.0 mEq/L
105
As a PTs INR increases, what risk also increases?
Bleeding
106
What is the number 1 cause of upright avR
Limb lead reversal (check leads)
107
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
108
What are the anatomical locations of
V1 - V6
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
109
How do you treat PEA
CPR - compressions
IV/IO access
1mg Epinephrine (0.1mg/mL) IVP every 3/5 mins
ETT and Capno
110
Second Degree Type II
111
What are the 3 Inherent rates of the conduction system
SA Node 60-100 bpm
AV Junction 40-60 bpm
Ventricles 20-40 bpm
112
Where is the negative electrode with
augmented unipolar leads
computer average central terminus middle
avr
avL
avf
113
AHA definition of a STEMI
> or equal to 1mm ST elevation in 2 or more anatomically contiguous leads
114
Left Anterior descending artery feeds the (3 things):
-anterior septal wall
-anterior left ventricular wall
-apex
115
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
116
What two requirements have to be met in order to have a bundle branch block on an ECG?
Wide QRS
and
Supraventricular Rhythm
117
Where anatomically is v5r, v6r placed
v5r - 5th ics anterior axillary (right)
v6r - 5th ics mid axillary (right)
118
Which leads look at the INFERIOR wall of the heart?
II, III, and aVF
119
How can you identify hypokalemia on an ECG?
-ST depression
-prominent U-wave
120
what is the drug dose of cardizem
when do you give
afib or aflutter
(0.25 then 0.35)
121
Which leads look at the LATERAL wall of the heart?
I, aVL, V5, and V6
122
Atrial Fibrillation (controlled) with 2 unifocal PVC's
123
V Tach 100J
124
The baseline is a straight line drawn between the _____ of one complex to the _____ of the succeeding complex.
TP segment–TP segment
125
What is happening during a
QRS
Ventricle Depolarization
126
how many small boxes is a 6 second strip
150
127
Low creatinine levels suggest _______ and/or ________ disease
Heart and/or liver
128
What are the bi-polar leads
I II III
129
What causes Left Ventricular Hypertrophy?
chronic hypertension
130
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
131
Junctional Escape
132
What are two reasons for ST depression
1. Ischemia
2. reciprocal change
133
What lead is the positive lead in aVr?
right arm +
134
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
135
In avR where is the positive electrode?
Right shoulder
136
R wave is the _____ _______________________ in the QRS complex
1st positive deflection
137
When an arrhythmia is irregular, you should determine the heart rate by counting the number of R waves divided by
10
138
What is happening during a
T Wave
Ventricle repolarization
139
Sinus with PAC
early atrial activity
early p wave looks different
140
What are the 6 H's
also known as
Hypovolemia
Hypoxia
Hydrogen Ions (Acidosis)
Hypo and Hyper Kalemia
Hypothermia
probable causes
141
Where is the ST segment?
B/w J-point and beginning of the T wave
142
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
143
Pathological left axis comes with ____________ hemiblock
anterior
144
The normal duration for QRS interval is
0.06–0.11
145
Chief cause of hyperkalemia?
renal failure
146
Which axis comes with a Anterior hemiblock
Pathological Left
147
What is an unstable hypertension
hypotension
hyper
180/120
hypo
90/60
148
Where is the ST segment?
B/w J-point and beginning of the T wave
149
Marginal branch feeds the (2 things):
-inferior left wall
-apex
150
What will St elevation in v8, v9 indicate
that the st depression in v2 and v3 are reciprocal change
151
what should you do with any change in rhythm?
access vital signs
level of consciousness
and abcs
152
V1, V2, avR an inverted T wave is normal.
In other leads its a sign of ________.
Ischemia - inadequate blood to the heart
153
Are the T Waves usually asymmetrical
Yes
154
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.
Uncontrolled a-fib (A-fib with RVR (rapid ventricular response))
155
what is normal MAP
need greater than 65
156
What is the first intervention for a pulseless patient that shows SINUS TACHYCARDIA on the ECG monitor/defibrillator?
Start CPR/compressions
157
What are signs of ischemia
St depression and T wave inversion
(note: v1 and v2 t wave inversion is normal)
158
Define Ventricular rhythms
Wide and bizar
159
What lead groups look at the:
Septal Wall
V1, V2 (chest leads).
+ electrodes are sternum
160
Normal INR range
0.9 - 1.1 sec
161
What wall of the heart does the Left Anterior Descending feed
Anterior
162
What lead is the positive lead in aVl?
left arm +
163
Whats a normal platelet count?
150,000-300,000
164
Mechanically whats happening
P wave
QRS
Twave
P Wave - Atrial contraction
QRS Ventricular Contraction
T Wave Ventricular relaxation
165
What are the electric measurements Defib, Sync, Pacing
Joules for Defib & Sync
mA (milli amps) for pacing
166
What does the P wave represent?
SA node firing
167
Leads V3 and V4 look at the _________ _________
Anterior wall
168
Which axis comes with a Posterior hemiblock
Right Axis (90 to 180)
169
What is leukocytosis?
elevated WBC count
170
Junctional with P waves after QRS
rate 40-60 bpm
171
V- Tach (with possible CPR artifact)
172
Normal BUN levels
8-22 mg/dL
173
-
A Fib
fast atrial activity, lots of f waves R_R irregular,
174
Define Relative refractory period
top of t-wave when heart could fire again
175
Define Clinical reasons
prehospital treatment
176
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)
177
A standard 12 lead doesnt look where
Right ventricle and Posterior Wall
178
What lead groups look at the:
Anterior Wall
V3, V4 (chest leads)
looks at 70% of pumping force
center of chest
+ electrodes left anterior chest
179
Normal potassium levels (K)
3.5-5.0 mEq/L
180
Reciprocal changes for II, III, and aVf would show in leads ____, ____, and ________.
I
aVl
V leads
181
Define ischemia
inadequate oxygen to cardiac tissue
182
Atrial Flutter
F waves, saws,
QRS narrow
atrial rate 250-350
183
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
10 gtts/min
185
Define Depolarization
sodium and potassium switch
It is the discharge of energy that accompanies the transfer of electrical charges across the cell membrane
186
How much time is
1 small box
1 large box
5 large blocks
30 large blocks
1 small box - 0.04
1 large box - 0.20
5 large blocks - 1 second
30 large blocks - 6 seconds
187
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
188
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
189
Differentiate waves segments and intervals
waves are deflections
segments are straight lines
intervals include both waves and segments
190
What additional leads do you use if you interpret an Inferior STEMI?
v4r
191
What does the term hemiplegia mean?
Paralysis (one sided)
192
What is the goal of CPR
cerebral resuscitation
193
What is the initial dose of IV fentanyl for pain management?
1 mcg/kg max of 150 mcg
194
What makes a Q wave pathologic? (2 things)
> or = to .04 seconds (greater than or equal to 1 small box)
If Q wave depth is > 1/3 height of R wave
195
What is the drug dose of Diltiazem
when do you give
0.25mg/kg
2nd dose
0.35mg/kg
For afib and aflutter
Calcium channel blocker
Do not give chf or 3rd degree block
196
Explain the relationship sodium and chloride in the blood
Basically where sodium goes so does chloride
197
How much time is the lead views across, between each HASHMARK (in a lifepak 15)
2 1/2 seconds long
198
Most common cause of high hematocrit
Dehydration
199
Posterior descending artery feeds the (2 things):
-posterior septal wall
-inferior right ventricular wall
200
Define PJC
- p wave inverted
- or p-wave missing
- underlying rhythm needs to be mentioned
201
Narcotic analgesics, such as morphine and fentanyl are controlled substances. What drug schedule do they belong to?
Schedule 2
202
What drugs are contraindicated for SEVERE heart blocks
Lidocaine (and antiarrhythmics)
Procainamide
Morphine (use with caution)
203
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
How can you identify a Left Main Artery occlusion?
ST elevation in aVr with ST depression elsewhere
205
What wall of the heart does the Left Circumflex feed
Lateral wall
206
What 2 situations would you use additional leads?
1) Inferior STEMI
2) ST depression in V1-V4
207
-
Ventricular Tachycardia
100-250 bpm
wide tall bizarre QRS
208
Normal chloride (Cl) levels
95-102 mEq/L
209
Leads V1 and V2 look at the _________ _________
Septal wall
210
Fentanyl
1 mcg/kg max dose of 200mcg
opioid analgesic
for severe pain
contra - bp >90, allergic, resp distress
211
Define 2nd Degree TYPE II
- PRIs are regular, with dropped beats
- Regular or irregular
212
How does oxygen rich blood get to the body
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
Which parts of the heart are not visible on a standard 12-lead?
-Right ventricle
-Posterior wall
214
What do wellens waves indicate and describe how it looks on ecg
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
What are the 5 T's
also known as
Tension Pneumo
Tamponade Cardiac
Toxins
Thrombosis Coronary
Thrombosis Pulmonary
probable causes
216
Why determine axis (3 things)?
-diagnose ventricular rhythm
-diagnose/treat hemi and fascicular blocks
-ID "at risk patients"
217
5mL
218
Leads I, aVl, V5, and V6 look at the ________ ________
Lateral wall
219
What is Wellen's syndrome indicative of?
Narrowing of the left anterior descending artery
220
When should you do v8 and v9
Inferior/posterior ami
sharp ST depression in V1, v2 (and v3)
221
Sinus with a trigeminy of unifocal PVC's
222
What does leukocytosis indicate?
infection
223
Sinus Brady with a wide QRS
224
Define syncytium
when both the left ventricle and right ventricle contract at the same time causing (double R wave) - sign of BBB (r) in V1
225
Sinus Tachycardia
Hr 100
226
Benign early repolarization is most often seen in __________________ (gender, race), ages __________
african-american males
ages 20-40
227
Axis deviation can be (4 things):
-abnormal variant
-intraventricular conduction defects
-ventricular hypertrophy
-ectopic beats
228
Fluticasone
Trade: Flonase
Class: Inhaled Steroid
Use: Allergies, Asthma
229
What is 1 beat of the heart called
stroke volume (ejection fraction)
230
What is Pericarditis?
inflammation of the lining around the heart (Pericardium)
231
Which leads look at the SEPTAL wall of the heart?
V1 and V2
232
Define
the PR segment
and
the PR interval
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
Right coronary artery feeds the (4 things):
-sinus node (50-60% of patients)
-AV node (85-90% of patients)
-Posterior descending (90% of patients)
-marginal branch
234
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
235
Obtain v4r when
12 lead shows ST elevation in II, III, avf - inferior wall Stemi
236
hat do the horizontal lines on the graph tell
voltage
237
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
238
Define Axis
average direction of the spread of the depolarization wave-front through the ventricles
239
What are the Unipolar leads? are the positive or negative?
v1 - v6, they are all positive
240
Which leads look at the ANTERIOR wall of the heart?
V3 and V4
241
What are the two requirements that have to be met in order to diagnose an ST-segment elevation myocardial infarction (STEMI) ?
There must be at least two contiguous leads with ST-segment elevation,
242
R wave represents
The first positive deflection in the QRS complex
243
how many chest compressions a min
100-120
244
What leads do you need for Axis
NEED LEADS TO BE ON LIMBS
I, II, III
245
Elevated BUN can indicate _______
Renal disease
246
What wall of the heart does the posterior descending feed
Post and Inferior
247
Benign early repolarization produces: (2 things)
- J-point elevation "fish hook"
-Tall T-waves
248
Abnormal creatinine levels indicate __________
Renal dysfunction
249
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
250
Normal PR interval time
0.12-0.20 seconds
251
A flutter
instead of P waves there are F waves,
sawtooth or sharkfin f waves
252
Sinus with a PJC
253
Where anatomically is v4r placed
5th ics, mid clavicular (right side)
254
What should you do on a working code ASAP
Defibrillate and give EPI
255
What is a physiologic block?
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
Nitroglycerin
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
Reciprocal changes for leads II, III, and avf would show in leads _________________
I, avL, and (all) V leads
258
Coronary artery starts at the ________________________
Base of the aorta
259
IVCD
if signs of BBB but nothing in 1 or V6, if theres no slurring or fat r waves
260
What are signs of unstable TACHY
hypotension below 90/60
AMS
Shock
CP
261
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
Flumazenil
263
What leads show the part of the heart with 70% pumping force
anterior wall, v3 and v4, left anteior
264
Low BUN can indicate _______
Liver disease
265
What do you do for Bradycardia with a 2nd Degree or 3rd Degree block
Pacing
266
3 drugs that prolong QT interval
-Digitalis
-Amiodarone
-Procanimide
267
What is a sign of regular Chronic Stable Angina
Same patterns of relief - goes away each time
Change of pattern of relief is possible ACS,
plus any other additional symptoms
268
Which leads are anatomically contiguous? (Are III and avF one of them?)
II and III
Yes - III and aVf
v2 and v3
v4 and v5
v5 and v6
269
What does the S2 sound indicate
the closing of the semi-lunar valves once systolic contraction is complete. pulmonary and aortic valves closing.
270
Is an inverted T wave normal in v1 and v2
yes
271
Treatment for Hypovolemia
(low blood)
IV Fluid (20mL per kg)
Vasopressors (Dopamine, Epi)
272
When would you use v4r
EVERYTIME inferior wall MI is present
273
What is the treatment for Inferior/RV AMI
(II, III, avf- st elevation)
O2
Aspirin asap
1-2 ltrs of fluid
maybe dopamine 5-20 mcg/kg/min
do not give nitro or diuretics
274
Treatment for Thrombosis, Pulmonnary
Oxygen
Drive fast
275
What does ST depression and/or T-wave depression indicate?
Ischemia
276
What does transmural mean
Full thickness of the wall damage - shows ST elevation
277
What are the 5 parts of analysis for heart rhythms
1. Rhythm, regular
2. Rate
3. P Waves
4. P-R Interval
5. QRS
278
Q waves are significant if:
They are ≥ 0.03 seconds (one little block) wide
B.
They are deeper than ⅓ the height of the R wave.
279
What hr qualifies as Tachycardia
equal to or over 150
280
How can you see a pathologic Q wave
Q wave is wider than 1 small box/deeper than 1/3 of the R wave
281
What the 3 categories for ECG
Non-Diagnostic - acute coronary
Ischemia - st depress, t wave inversion
STEMI
282
How does blood get to the lungs
right atrium through the tricuspid to the right ventricle pumps oxygen poor blood through the pulmonary valve to pulmonary arteries (away to lungs)
283
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)
284
Precordial leads look at the heart from a _________ plane
horizontal
285
What is the 12 lead acronym: I SEE ALL LEADS
I - Inferior
See - Septal
All - Anterior
Leads - Lateral
286
Define Therapeutic reasons
care in the hospital
287
Normal range for WBCs
4,500 - 10,000
288
Right Axis comes with __________ hemiblock
posterior
289
What is the drug dose for Dopamine
when do you give
drip
5-20mcg/kg/min
Brady
290
Left circumflex artery feeds the (3 things):
-sinus node (40-50% of patients)
-lateral left ventricular wall
-posterior left ventricular wall
291
What is the dose of Atropine for Bradycardia
Atropine 1mg every (q) 3-5mins max of 3mg
292
How do you calculate LVH?
"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
Define PVC
- Premature ventricular complex
- Has compensatory pause
- If all match = unifocal; if they don’t match = multifocal
294
The left main splits into both the
left anterior descending and the left circumflex
295
Leads II, III, and aVf look at the _______ _______
Inferior wall
296
Which leads are NOT anatomically contiguous?
I and II
avr and avf
v1 and v4
297
When do you give EPI during a working code
AFTER 2nd shock
1mg EPI (0.1mg/ml) IVP
298
What is it called when the R/L sides of the heart have flipped
Dextrocardia
299
What are 2 NON Shockable Rhythms
PEA, ASYSTOLE
300
T wave represents
repolarization of ventricles
301
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
302
Define Einthoven's triangle
what type of limb lead view is it
Bi-Polar limb leads
I, II, III
303
Morphine
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
What does a biphasic T Wave in Lead III indicate
hyperkalemia
305
Presence of low hemoglobin and low hematocrit indicates _________ until proven otherwise
Bleeding
306
Normal sodium (Na)
135-145 mEq/L
307
Define each part
Q
R
S
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
What lead is the positive lead in aVf?
left leg +
309
Whats the difference between Physiological Q wave and Pathological Q wave
Physio is NORMAL variant (less that .04)
PATHOLOGICAL is wider (greater than .04)
or depth is 1/3 x
310
what should you say instead of "shock"
synchronized cardiovert - at 100 j
transcutaneous Pace - at 80bpm
defibrillate - at 200 j
311
Right coronary artery turns into the
Posterior descending artery
312
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
313
What lead groups look at the:
Lateral side of Left Ventricle
V5, V6, 1, avL
314
Q wave is the negative deflection ______________ the R wave
preceding
315
Venlafaxine
Trade: Effexor XR
Class: SNRI
Use: Depression
316
What lead groups look at the:
Inferior Wall of the heart
II, III, avF. (limb leads)
inferior wall of the left ventricle
+ electrode is left leg, posterior view
317
To get the accurate rate you would count small squares between R-R and divide by
1500
318
What is the most common cause of high hematocrit?
dehydration
319
What additional leads do you use if you interpret ST depression in V1-V4? What would you be looking at with these additional leads?
V8 - just below the scapula
V9- just below spine
You are looking at the posterior wall of the heart
320
What makes a Q wave pathologic? (2 things)
> or = to .04 seconds (greater than or equal to 1 small box)
If Q wave depth is > 1/3 height of R wave
321
Is Depolarization the same as contraction
No, Depolarization is an ELECTRICAL phenomenon,
contraction is MECHANICAL and is expected to follow depolarization
322
My patient has no pulse. I am 1 ectopic focus in the right ventricle that is sending signals regularly at 140bpm.
Pulseless V-Tach
323
What is the drug dose of Adenosine
when do you give
6mg
12mg
Tachy
324
Aspirin
324mg
platelet inhibitor
for CP, STEMI
contra - GI Bleed
325
What is the atrial rate in a-flutter
250-350 bpm
326
If you find a Bi-Fascicular Block what should you be prepared for?
To Pace and or Defibrillate (put on the PADS)
327
Dose for adenosine
When do you give it?
6mg (1st dose)
12mg (2nd dose)
SVT
328
A-fib with 2 unifocal PVCs
329
Ranitidine
Trade: Zantac
Class: H2 Antihistamine
Use: GERD, Stomach ulcers
330
Does a TYPE II second degree block have the same P waves for every QRS
no there will be more P waves
331
Sinus with Atrial Pacing
332
What are the symptoms of Inferior/RV AMI
Weakness and nausea - angianal equivalents
urge to defecate
JVD
Hypotension
CP
333
Name one local IV site reaction or complication.
Infiltration
334
What is bifascicular heart block?
a blockage of 2/3 pathways to contract the ventricles in an organized fashion
335
SVT with wide QRS
160-250 bpm
p wave might look like steps
336
What are the 2 shockable rhythms to DEFRIBRILLATE
V- Fib (squiggly worms)
Pulseless V-Tach (no pulse) (tombstones)
337
How do you confirm LBBB after turnsignal in V1
(with qrs over 120 & supra rhythm)
look at I and/or v6 for:
FAT/BROAD R Waves
338
I have NO discernible P waves or QRS waves and look erratic. Cardiac output plummeted when I switched to this rhythm.
V-Fib
339
What is the most common AMI
Inferior Wall MI is 80%
340
When treating Tachy
what questions should you ask
is the patient
stable or unstable
qrs wide or narrow
is the rhythm reg or irreg
341
What part of the ECG signifies the relative refractory period
the downslope of the T wave
342
SVT with a wide QRS
343
What is the treatment for Inferior/Posterior AMI
Oxygen
Aspiring asap
Nitro (0.4) sL
Fentanyl - 1meq/kg
344
The normal duration for the PR interval is _____ seconds.
0.11 - 0.20
345
How does a PT with pericarditis present?
sharp pain, changes with movement. Often relieves when leaning forward and worsens when lying down.
346
If unstable TACHY what should you do immediately
Synchronized cardiovert (class I)
before IV or meds
347
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
348
What is the drug dose of Lidocaine
and when do you give?
0.5-0.75mg/kg
Tachy
349
What does ST elevation indicate?
STEMI (injury)
350
Sinus Brady with 1 PVC
351
What is happening during a
Pwave
Atrial Depolarization
352
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
353
Depression in aVr indicates
Pericarditis
354
When should you avoid Atropine
When there is a high degree block
(2nd type II, 3rd Degree)
go right to pacing
355
Define ST segment
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
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
What is the hr of brady
less than 50 (for treatment)
358
Norgestimate
Trade: Ortho tri-cyclen
Class: Hormone
Use: Contraceptive
359
Idioventricular
- Rate 20-40
- QRS wide
