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Acute - EKG strips (Exam 2) > Acute - EKG strips > Flashcards

Acute - EKG strips Flashcards

1
Q

QRS complex represents which period of time

A

ventricular depolarizaion

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2
Q

EKG - ischemia

A
  • lack of oxygenation
  • „ ST segment depression or T wave inversion
  • REVERSIBLE
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3
Q

EKG - injury

A

-„ prolonged ischemia
„- ST segment elevation
- REVERSIBLE

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4
Q

EKG - infarction

A
  • death of tissue IRREVERSIBLE
    Earliest stage: T wave (tall & narrow); symmetrical T wave inversion

Next stage: ST segment elevation; ST segment depression

Last stage: may or may not show a Q wave

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5
Q

depolarization

A

spread of electrical impulse

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6
Q

repolarization

A

returning to resting

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7
Q

length of PR interval

A

0.12 - 0.20 sec (3 -5 boxes)

atrial depolarization and spread of impulse to AV node, Bundle of His, RBB and LBB, and Purkinje fibers

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8
Q

QRS complex

A

< 0.12 sec (3 squares)

ventricular depolarization

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9
Q

ST segment

A

end of ventricular depolarization
beginning of ventricular repolarization
normally - flat line

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10
Q

ST segment - elevated

A

> 1-2 mm elevation

–> myocardial infarction

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11
Q

ST segment - depressed

A

> 0.5 mm depression

  • -> mycardial ischemia
  • -> if a “dip” – digoxin toxicity
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12
Q

T wave

A

ventricular repolarization

- normal is slightly asymmetrical

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13
Q

abnormal T wave - inverted

A

myocardial ischemia

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14
Q

abnormal T wave - peaked

A

hyperkalemia

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15
Q

U wave

A
  • sometimes follow T wave

- prominent U waves (> 2 mm) = hypokalemia

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16
Q

sinus tachycardia (100-160) - causes

A
  1. increased sympathetic stimulation
    - stress, anxiety, fever, exercise, pain, sepsis, hyperthyroidism, drugs
  2. drugs that increase sympathetic tone:
    - epinephrine, atropine, caffeine, alcohol, nicotine, cocaine, aminophylline, thyroid meds
  3. low cardiac output states - cardiac arrest, shock, hypovolemia
  4. low oxygen states - COPD, asthma, PE, MI
  5. drugs that decrease parasympathetic tone - see #2
17
Q

sinus bradycardia (40-60 bpm) - causes

A
  1. decreased sympathetic tone
  2. increased parasympathetic tone
  3. drugs - beta adrenergic agents, CCB, digitalis
  4. other causes - Lyme disease, hypothyroidism

⇡↓

18
Q

sinus brady - treatment

A 
only treat if symptomatic (↓ BP, ⇡ cap refill, 
↓ LOC)
1. atropine
2. pacemaker (transcutaneous/transvenous = temporary)
3. D/C meds that cause rhythm
4. Dopamine (if hypotensive)
5. O2
6. Chronic = permanent pacemaker
19
Q

premature atrial contraction - causes

A
  • excess stimulation (caffeine, nicotine, alcohol)
  • electrolyte imbalance
  • heart disease (MI, atrial stretch)
  • sypathomimetic drugs (epinephrine, amphetamines, digitalis)
  • others (stress, fatigue, anxiety, inflammation, infection)
20
Q

PACs - treatment

A

no treatment - eliminate or treat cause
monitor pt - 3 or more consecutive = atrial tach
can be a precursor to A. Fib, A. Flutter of PSVT (aka atrial tachycardia)

21
Q

paroxysmal atrial tachycardia

A

rate: 150-250 bpm
starts and/or ends abruptly

treatment: adenosine (Initial dose: 6 mg given as a rapid intravenous bolus (administered over a 1-2 second period).

Repeat administration: If the first dose does not result in elimination of the supraventricular tachycardia within 1-2 minutes, 12 mg should be given as a rapid intravenous bolus

22
Q

atrial tachycardia - treatment

A

STABLE:

  1. vagal maneuvers - will stim baroreceptors to stim parasym system (carotid massage, bear down (Caution - can cause “rebound” tachycardia or severe bradycardia)
  2. adenosine IV
  3. CCB, BB, digtalis (but don’t combine)
  4. cardioversion
  5. antiarrhythmics

UNSTABLE:
- require immediate synchonized cardioversion

23
Q

atrial flutter

A 
sawtooth
rhythm: reg or irreg
rate: 250-400
can be in 2:1, 3:1, 4:1 ratio
PR interval - not measurable

Risk for: stasis of blood –> mural thrombi (formed in atria)

24
Q

adenosine

A
  • antiarrhythmic
  • given for PSVT when vagal maneuvers don’t work
  • administered over a 1-2 second period, followed by saline flush
25
atrial flutter -- treatment
1. Control the ventricular rate - (if ventr rate is <100 = controlled) CCB (diltiazem), BB, Digitalis 2. If A. flutter < 48 hrs = cardioversion 3. if A. flutter > 48 hrs = chance of thrombi formed, so TEE first to check, then cardioversion - anticoags 4. If hemodynamically unstable = (if ventr. rate >100) = cardioversion
26
atrial fibrillation
rhythm: irregular/chaotic rate: > 400 (atria quivers); ventri rate varies ventricular rate: < 100 = controlled > 100 = uncontrolled A. fib or A. fib w/rapid ventricular response
27
A. fib treatment
SAME TREATMENT AS A. FLUTTER W/EXCEPTION OF AMIODARONE 1. Control rate = Digoxin, CCB (diltiazem), BB 2. Amiodarone = if < 48 hour onset 3. A. fib < 48 hours = cardioversion 4. A. fib > 48 hours = TEE to r/o mural thrombi, then cardioversion 5. if hemodynamically unstable = cardioversion Chronic A. fib = control ventricular rate; anticoags
28
amiodarone (Cordarone)
antiarrhythmic | treatment for ventricular arrhythmias
29
premature ventricular tachycardia
QRS = wide, distorted, bizarre, notched Can be: 1. single 2. bigeminal - every other 3. trigeminal - every 3rd 4. quadrigeminal - every 4th 5. pairs - 2 in a row 6. runs - many in a row = > 3 = ventri. tachycardia 7. unifocal - comes from one area/same pattern 8. multifocal - different look/comes from different area of ventricle
30
causes of ventricular dysrhythmias
1. age = ⇡ 2. sympathetic stimulation = infection, surgery, stress, nicotine, caffeine, alcohol 3. certain drugs = anesthesia, sympathomimetic agents 4. heart disease = chronic HF, COPD 5. anemia, hypokalemia, hypomagnesemia
31
PVC treatment
asymptomatic - no treatment symptomatic - treat underlying cause = electrolyte imbalance/acid-base/O2 Treat if any/several are present: - more than 5-6 PVC/min - multifocal PVCs - paired PVCs (couplet) - R on T phenom - short bursts of V. Tach (run of 3
32
V. Tach
lethal dysrhythmia | QRS = wide, bizarre
33
V. Tach treatment
No pulse = DEFIBRILLATE Stable and pulse = 1. Codarone (amiodarone) 2. Lidocaine 3. Procainamide 4. Cardioversion = to get back good rhythm Unstable w/a pulse (⇡ RR, ↓ PO2, chest pain, seizures, cool/clammy skin, hyperventilation, change in LOC = shock symptoms) 1. Cardioversion (sedate if possible) 2. Lidocaine or Cordarone (to prevent recurrence)
34
V. fibrillation
Lethal dysrhythmia / #1 cause of cardiac arrest w/acute MI
35
V. fibrillation treatment
1st = check another lead/check pulse No pulse/unconscious 1. V. fib = defib 2. CPR, IV line, intubate 3. Medications = epinephrine, vasopressin, cordarone, lidocaine, procainimide, Magnesium
36
ventricular standstill (asystole) treatment
Always: CHECK PULSE DO NOT defibrillation - there's no electrical activity ``` CPR IV intubate Transcutaneous pacing epinephrine atropine ```
37
cardioversion - when?
SYNCHRONIZED: delivers shock during ventricular DEpolarization (on R wave) When: 1. supraventricular tachy 2. A. fib 3. A. flutter 4. unstable V. tach w/a pulse
38
defibrillation - when?
1. pulseless V. tach 2. V. fib 3. sustained Torsades de Pointes (unstable V. tach w/ a pulse)
39
defibrillation - patient safety issues
1. correct ID dysrhythmia 2. remove transdermal med patches - can cause burns 3. don't use too much gel - burns 4. paddles cleaned after each use

Acute - EKG strips (Exam 2) (1 decks)

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