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Assessment > Advanced EKG 2/4 > Flashcards

Advanced EKG 2/4 Flashcards

Test 1

1
Q

If my pt goes into cardiac arrest while getting anesthesia, what is the first thing I should do?

A

Stop all anesthetics
-consider reversing NMB

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2
Q

What are EKG signs of hyperkalemia?

A

P wave: widen/flatten

QRS: widened (may lose fuse w/ T wave & lose ST segment)

T wave: Tall tented

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3
Q

Purkinje fibers are ______ sensitive to hyperkalemia

A

less

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4
Q

What are EKG signs of hypokalemia?

A

ST depression
T wave: flattened/negative
U wave: may be present after T wave

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5
Q

What is a symptom of hypokalemia?

A

muscle cramps

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6
Q

What are EKG signs of mild hypercalcemia?

A

T waves: broad based tall peaking

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7
Q

What are EKG signs of severe hypercalcemia?

A

P wave: none
QRS: extremely wide w/ low R wave (low amplitude)
T waves: tall peaking

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8
Q

What types of Sx cause hypercalcemia?

A

Neck Sx:
Thyroids/parathyroids

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9
Q

What are EKG signs of hypocalcemia?

A

PR: reduced
QRS: narrowed
QT: Prolonged
ST: prolonged/depressed
T wave: flattened/inverted
U wave: prominent

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10
Q

Where does a J wave appear? What causes it? What leads does it appear in?

A

J-point: immediately after QRS

Causes: hypothermia & hypercalcemia

precordial & true limb leads

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11
Q

What leads will J waves appear negative in?

A

AVR & V1

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12
Q

What is a Delta wave? What is it commonly seen in?

A

Slurred upstroke in QRS complex

Causes: WPW (Wolff-Parkinson-White) which is a congenital syndrome what has extra electrical pathways between the atria and vent that can cause arrthmias

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13
Q

When a delta wave is present, what medication should we be cautious to give?

A

Cardizem

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14
Q

What is lead I good at looking at? Why?

A

Atrial arrhythmias

It goes across the top of the heart

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15
Q

What is the recommended lead for cardioversion?

A

Lead II

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16
Q

Where is lead III placed?

A

(-) left shoulder
(+) under left pectoral

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17
Q

Lead III is a better view of the ______ and has _____ waveforms

A

L ventricle

upright

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18
Q

If I see an arrhythmia in 1 lead, what should I do?

A

Switch to another lead and see if I see the same thing.

Dont depend on 1 lead even if its vtach/vfib. switch leads, it could be artifact.

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19
Q

If my pt is having breathing problems that is presenting artifact in my EKG, what should I do?

A

Im going to need to get another EKG without artifact

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20
Q

What position is my pt supposed to be in for EKG? Why? What is my alt?

A

SUPINE.. FLAT

sitting up increases tissue motion which causes disturbances

If my pt cannot tolerate this, sit this, sit them up to the flattest point they can tolerate

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21
Q

How many electrodes does a 12 lead EKG use?

A

10

4 for each limb

6 precordial leads on chest

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22
Q

T/F: I can put my limb leads on my shoulder

A

F

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23
Q

Where do you place the precordial leads? (V leads)

A

V1: 4th ICS R sternum
V2: 4th ICS L sternum
V3: between V2 & V4
V4: 5th ICS L sternum
V5: 5th ICS L sternum
V6: 5th ICS L sternum

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24
Q

Precordial leads =

A

V leads

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25
Q

What leads look at inferior wall?

A

II
III
aVF

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26
Q

What leads look at the septum?

A

V1
V2

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27
Q

What leads look at the anterior wall?

A

V3
V4

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28
Q

What leads look at the lateral wall?

A

V5
V6

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29
Q

What leads look at the high lateral wall?

A

I
aVL

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30
Q

If I have a R wall infarct, what leads will I see this in?

A

inferior leads: II, III, aVF
septum leads: V1, V2

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31
Q

By definition, what is a Q wave?

A

First negative deflection after P wave

32
Q

What is the R wave?

A

First positive deflection after the P wave

33
Q

What is an S wave?

A

Negative deflection below the baseline after R or Q wave

34
Q

Where does the J point occur? Why is it important?

A

Where QRS ends & ST segment begins

Reference point for determining BBB & measuring ST elevation/depression

35
Q

What will my leads look like with pathological L axis deviation?

A

Lead I: (+)
Lead II: (-)
Lead III: (-)

36
Q

What will my leads look like with pathological R axis deviation?

A

Lead I: (-)
Lead II: (-)
Lead III: (+)

37
Q

What will my leads look like with pathological extreme R axis deviation?

A

Lead I: (-)
Lead II: (-)
Lead III: (-)
V1: (+)

38
Q

What axis deviation is pathologic in all adults?

A

R axis

39
Q

What is a common cause of axis deviation?

A

hypertropy

40
Q

What medications do I not give if they have a BBB? Why?

A

Lidocaine

Slows conduction rate with ventricles already not contracting correctly.

41
Q

BBB put pts at higher risk for what?

A

Mortality
-heart blocks

42
Q

What lead to we identify BBB in? How do we identify them?

A

V1

The QRS has to be longer than .120 secs –> find J point –> draw line into complex, then go up or down with the LAST DEFLECTION

(-) LBBB
(+) RBBB

43
Q

Bifascicular block puts pts at a high risk of _____

A

Vfib

44
Q

What does the RCA supply blood to?

A

R vent
inferior wall
posterior wall
SA/AV node
Posterior LBB

45
Q

How can we indentify a RCA infarct on EKG?

A

ST depression in leads V1, V2

46
Q

How will a RCA infarct present clinically?

A

Bradycardia
Increased CVP
JVD
Difficulty breathing

47
Q

What does the LAD (Left anterior descending) supply blood to?

A

L vent
Septal wall
Anterior wall of L vent
Bundle of His & BB

48
Q

Why is the LAD called the widow maker?

A

Since it supplies blood to bother the Bundle of His and BB, it can stop the flow of blood to vents and quickly kill.

49
Q

What does the circumflex supply blood to?

A

Lateral wall of L vent
SA/AV node
Posterior wall of L vent

50
Q

What 2 drugs do I want to give to prevent the clotting from happening?

A

Aspirin
heparin

51
Q

Chest pain on exertion means there is ___ of occlusion, at rest it is ______ of occlusion, and unrelieved by nitroglycerin is _____ occluded.

A

70-85%

90%

100%

52
Q

If my patient BP is low & is having an AMI, what pain med can I give them instead of morphine?

A

Fentanyl

53
Q

What is important to get along with an EKG is I suspect and MI?

A

Cardiac Enzymes

54
Q

T/F: You can have a normal EKG and have an MI

A

T

This is why we need to get cardiac enzymes

55
Q

How does a necrotic part of the ventricle look on the ultrasound?

A

Its not squeezing at all –> looks non compliant

56
Q

What is demand ischemia?

A

Decreased BP –> Changes on EKG

When BP is corrected the changes on the EKG go away

57
Q

You will see symmetrical ______ in 2 or more related leads in ischemia

A

inverted T waves

58
Q

You will see reciprocal changes for the posterior heart in what leads?

A

V1 - V4

59
Q

What causes ST depression?

A

Reciprocal changes to other ST elevation
-subendocardial injury
-ischemia
-Drug or electrolytes

60
Q

Which drugs/electrolyes cause ST depression?

A

Digoxin
Hypokalemia

61
Q

How can we identify tissue death/necrosis on EKG? What does this tell me?

A

Pathologic Q waves: > 40ms wide or 1/3 depth of R-wave height

Pt has had a previous infarct

62
Q

If I see patholgic Q waves with ST elevation what is happening>?

A

AMI

63
Q

The inferior leads are ______ and are effected by the _____. I see reciprocal changes in _______

A

II, III, aVF

RCA

I, aVL

64
Q

The Spetal leads are ______ and are effected by the _____.

A

V1, V2

LAD

65
Q

The Anterior leads are ______ and are effected by the _____. I see reciprocal changes in _______

A

V3, V4

LAD

II, III, aVF

66
Q

The Lateral leads are ______ and are effected by the _____. I see reciprocal changes in _______

A

V5, V6
I, aVL (high lateral)

Circumflex

II, III, avF

67
Q

The posterior heart are shown by ______ and are effected by the _____.

A

ST depression in V1-V4

RCA

68
Q

What is the most lethal MI? Why?

A

Anterior wall MI

Can suddenly develop complete heart block, vtach, vfib

69
Q

If my patient has a BBB or hemiblock and has an anterior wall MI, what should i do?

A

Immediately put pads on my patient to prepare for CPR

70
Q

L vent hypertropy can imitate an MI but wont have what?

A

reciprocal changes

71
Q

What can mimic an MI? What should you do to differentiate?

A

LBBB

cardiac enzymes

72
Q

How does pericarditis present on the EKG? How do we differentiate this from an MI?

A

ST elevation in all leads

When the pt leans forward they will feel better

73
Q

T/F: Percarditis will have ST depression in reciprocal leads

A

F

It will be elevation in all leads

74
Q

What type of patients do we see pericarditis in?

A

Sepsis
IV drug users

75
Q

What must we see on the EKG to confirm an MI? Why is this important?

A

Reciprocal changes

If we dont see reciprocal changes we could misdiagnose an MI with something else

76
Q

How does an thoracic Aortic Aneurysm present on the EKG?

A

ST elevation but NO RECIPROCAL CHANGES

77
Q

Why dont we give nitroglycerin to AAA pts?

A

decreases afterload and will cause the heart to try to compensate by increasing HR and contractility. This would cause undue stress on a weakened aorta area.

Assessment (7 decks)

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