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ACC lectures Flashcards

1
Q

steps in interpreting ECG

A
  1. HR
  2. Heart rhythm
  3. Cardiac axis
  4. P waves
  5. P-R interval
  6. QRS complex
  7. Q-waves
  8. ST segment
  9. T waves
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2
Q

how to interpret heart rhythm

A

mark out R-R intervals and check that they are the same

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3
Q

what does cardiac axis measure

A

direction of electrical spread within the heart

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4
Q

what are the 3 types of cardiac axis

A

normal
Left
Right

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5
Q

what is right axis deviation

A

biphasic lead I
lead II + III are positive
right ventricular hypertrophy

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6
Q

what is left axis deviation

A

Lead I positive
lead II + III negative
waves are LLLeaving each other
seen in heart conduction defects

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7
Q

how should p-waves be interpretd

A

are they present?
p wave followed by QRS
do p waves look normal
saw tooth ?

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8
Q

how long should the P-R interval be?

A

120-200ms

3-5 small squares

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9
Q

what does a prolonged P-R interval suggest

A

AV block

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10
Q

what is first degree heart block

A

P-R interval > 200ms ( 5 small squares)

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11
Q

what is mobitz type 1 (wenkebach)

A

PR interval slowly increases then drops

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12
Q

what is mobitz type 2

A

PR interval is fixed but there are dropped beats

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13
Q

what is third degree heart block

A

P and QRS unrelated

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14
Q

are three factors should be considered when examining QRS complex

A

Width
height
morphology

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15
Q

interpret the width of QRS

A 
narrow = < 0.12s
broad = > 0.12
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16
Q

interpret the height of QRS

A

small

tall = ventricular hypertrophy

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17
Q

what is a pathological Q wave

A

25% size of the R wave

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18
Q

what is the ST segment

A

end of S and start of T wave

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19
Q

what is ST elevation

A

1-2mm increase in more than 1 lead

MI

20
Q

what is ST depression

A

drop in ST in 2 or more Leads

myocardial ischaemia

21
Q

what are Tall t-waves a sign of

A

Hyperkalaemia

hyperacute stemi

22
Q

what are inverted T waves a sign of

A

ichaemia
bundle branch block
PE

23
Q

what are biphasic t waves

A

ischaemia

hypokalaemia

24
Q

what details to confirm when looking at ECG

A

name / DOB
date and time film was taken
any previous imaging

25
Q

how to assess image quality

A

RIPE
rotation - clavicle equidistant from spinous processes
inspiration - 5-6 anterior ribs / lung apcies / both costophrenic angles / lateral rib edges
projection - AP vs PA
exposure - left hemidiagpharm visible / vertebrae visible behind heart

26
Q

interpretation of A in CxR

A

tracheal deviation?
masses in trachea
pushing of trachea = large pleural effusion / Tension Pneumo
pulling of tracha = consolidation with lobar collapse

check carina visibility
left + right bronchus

27
Q

interpretation of B in CxR

A 
inspect lungs into 3 zones
check for asymmetry 
increase airspace shadowing may suggest pathology 
absent lung markings = pneumothorax 
check pleura
28
Q

interpretation of C in CxR

A

check for cardiomegaly–> PA ONLY

assess heart orders ( if not present it suggests consolidation in lungs)

29
Q

interpretation of D in CxR

A

see if free gas below diagphargm

30
Q

interpretation of E in CxR

A 
bone abnormalities 
soft tissue injuries
tubes
lines
artificial valves
pacemaker
31
Q

what is the normal range for pH

32
Q

what is the normal range for Pa02

33
Q

what is the normal range for PaC02

34
Q

what is the normal range for HCO3

35
Q

what is normal base excess

36
Q

what is always important to consider when interpreting ABG

A

patient clinical condition

Fi02

37
Q

whats the first step in ABG interpretation

A

Oxygenation
is pateint hypoxic
if patient on oxygen then Pa02 should be 10 less than concentration

38
Q

define stages of hypoxaemia

A

<10kPa on air = hypoxic

< 8kPa on air = severely hypoxic

39
Q

what are the two types of resp failure

A

type 1 low oxyge but normal co2

type 2 = hyoxaemia with hypecapnia

40
Q

whats the second step of interpreting ABG

A

pH
metabolic or respiratory
compensation or nah?

41
Q

whats the third step of interpreting ABG

A

PaC02
is it normal or abnormal?
is it affecting the pH

42
Q

what is the 4th step in ABG interpretation

A

HCO3-
normal?
does it fit with pH

43
Q

what are the causes of respiratory acidosis

A 
inadequate alevolar ventilation leading to C02 retention 
respiratory depression
gullian barre
asthma 
COPD
44
Q

what are the causes of respiratory alkalosis

A 
hyperventilation 
anxiety
hypoxia 
PE
pneumothorax
45
Q

what are the causes of metabolic acidosis

A

DKA
lactic acidosis
aspirin overdose

46
Q

what are the causes of metabolic alkalosis

A

vomitting / diarrhoea

loop diuretics / heart failure

ACC (5 decks)

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