ACC lectures

Question 1

steps in interpreting ECG

Answer 1

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

Question 2

how to interpret heart rhythm

Answer 2

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

Question 3

what does cardiac axis measure

Answer 3

direction of electrical spread within the heart

Question 4

what are the 3 types of cardiac axis

Answer 4

normal
Left
Right

Question 5

what is right axis deviation

Answer 5

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

Question 6

what is left axis deviation

Answer 6

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

Question 7

how should p-waves be interpretd

Answer 7

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

Question 8

how long should the P-R interval be?

Answer 8

120-200ms

3-5 small squares

Question 9

what does a prolonged P-R interval suggest

Answer 9

AV block

Question 10

what is first degree heart block

Answer 10

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

Question 11

what is mobitz type 1 (wenkebach)

Answer 11

PR interval slowly increases then drops

Question 12

what is mobitz type 2

Answer 12

PR interval is fixed but there are dropped beats

Question 13

what is third degree heart block

Answer 13

P and QRS unrelated

Question 14

are three factors should be considered when examining QRS complex

Answer 14

Width
height
morphology

Question 15

interpret the width of QRS

Answer 15

narrow = < 0.12s
broad = > 0.12

Question 16

interpret the height of QRS

Answer 16

small

tall = ventricular hypertrophy

Question 17

what is a pathological Q wave

Answer 17

25% size of the R wave

Question 18

what is the ST segment

Answer 18

end of S and start of T wave

Question 19

what is ST elevation

Answer 19

1-2mm increase in more than 1 lead

MI

Question 20

what is ST depression

Answer 20

drop in ST in 2 or more Leads

myocardial ischaemia

Question 21

what are Tall t-waves a sign of

Answer 21

Hyperkalaemia

hyperacute stemi

Question 22

what are inverted T waves a sign of

Answer 22

ichaemia
bundle branch block
PE

Question 23

what are biphasic t waves

Answer 23

ischaemia

hypokalaemia

Question 24

what details to confirm when looking at ECG

Answer 24

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

Question 25

how to assess image quality

Answer 25

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

Question 26

interpretation of A in CxR

Answer 26

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

Question 27

interpretation of B in CxR

Answer 27

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

Question 28

interpretation of C in CxR

Answer 28

check for cardiomegaly--> PA ONLY | assess heart orders ( if not present it suggests consolidation in lungs)

Question 29

interpretation of D in CxR

Answer 29

see if free gas below diagphargm

Question 30

interpretation of E in CxR

Answer 30

``` bone abnormalities soft tissue injuries tubes lines artificial valves pacemaker ```

Question 31

what is the normal range for pH

Answer 31

7.35-7.45

Question 32

what is the normal range for Pa02

Answer 32

11-13

Question 33

what is the normal range for PaC02

Answer 33

4.7-6

Question 34

what is the normal range for HCO3

Answer 34

22-26

Question 35

what is normal base excess

Answer 35

-2 to +2

Question 36

what is always important to consider when interpreting ABG

Answer 36

patient clinical condition | Fi02

Question 37

whats the first step in ABG interpretation

Answer 37

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

Question 38

define stages of hypoxaemia

Answer 38

<10kPa on air = hypoxic | < 8kPa on air = severely hypoxic

Question 39

what are the two types of resp failure

Answer 39

type 1 low oxyge but normal co2 | type 2 = hyoxaemia with hypecapnia

Question 40

whats the second step of interpreting ABG

Answer 40

pH metabolic or respiratory compensation or nah?

Question 41

whats the third step of interpreting ABG

Answer 41

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

Question 42

what is the 4th step in ABG interpretation

Answer 42

HCO3- normal? does it fit with pH

Question 43

what are the causes of respiratory acidosis

Answer 43

``` inadequate alevolar ventilation leading to C02 retention respiratory depression gullian barre asthma COPD ```

Question 44

what are the causes of respiratory alkalosis

Answer 44

``` hyperventilation anxiety hypoxia PE pneumothorax ```

Question 45

what are the causes of metabolic acidosis

Answer 45

DKA lactic acidosis aspirin overdose

Question 46

what are the causes of metabolic alkalosis

Answer 46

vomitting / diarrhoea | loop diuretics / heart failure