Advanced EKG 2/4 Flashcards
Test 1
If my pt goes into cardiac arrest while getting anesthesia, what is the first thing I should do?
Stop all anesthetics
-consider reversing NMB
What are EKG signs of hyperkalemia?
P wave: widen/flatten
QRS: widened (may lose fuse w/ T wave & lose ST segment)
T wave: Tall tented
Purkinje fibers are ______ sensitive to hyperkalemia
less
What are EKG signs of hypokalemia?
ST depression
T wave: flattened/negative
U wave: may be present after T wave
What is a symptom of hypokalemia?
muscle cramps
What are EKG signs of mild hypercalcemia?
T waves: broad based tall peaking
What are EKG signs of severe hypercalcemia?
P wave: none
QRS: extremely wide w/ low R wave (low amplitude)
T waves: tall peaking
What types of Sx cause hypercalcemia?
Neck Sx:
Thyroids/parathyroids
What are EKG signs of hypocalcemia?
PR: reduced
QRS: narrowed
QT: Prolonged
ST: prolonged/depressed
T wave: flattened/inverted
U wave: prominent
Where does a J wave appear? What causes it? What leads does it appear in?
J-point: immediately after QRS
Causes: hypothermia & hypercalcemia
precordial & true limb leads
What leads will J waves appear negative in?
AVR & V1
What is a Delta wave? What is it commonly seen in?
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
When a delta wave is present, what medication should we be cautious to give?
Cardizem
What is lead I good at looking at? Why?
Atrial arrhythmias
It goes across the top of the heart
What is the recommended lead for cardioversion?
Lead II
Where is lead III placed?
(-) left shoulder
(+) under left pectoral
Lead III is a better view of the ______ and has _____ waveforms
L ventricle
upright
If I see an arrhythmia in 1 lead, what should I do?
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.
If my pt is having breathing problems that is presenting artifact in my EKG, what should I do?
Im going to need to get another EKG without artifact
What position is my pt supposed to be in for EKG? Why? What is my alt?
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
How many electrodes does a 12 lead EKG use?
10
4 for each limb
6 precordial leads on chest
T/F: I can put my limb leads on my shoulder
F
Where do you place the precordial leads? (V leads)
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
Precordial leads =
V leads
What leads look at inferior wall?
II
III
aVF
What leads look at the septum?
V1
V2
What leads look at the anterior wall?
V3
V4
What leads look at the lateral wall?
V5
V6
What leads look at the high lateral wall?
I
aVL
If I have a R wall infarct, what leads will I see this in?
inferior leads: II, III, aVF
septum leads: V1, V2
By definition, what is a Q wave?
First negative deflection after P wave
What is the R wave?
First positive deflection after the P wave
What is an S wave?
Negative deflection below the baseline after R or Q wave
Where does the J point occur? Why is it important?
Where QRS ends & ST segment begins
Reference point for determining BBB & measuring ST elevation/depression
What will my leads look like with pathological L axis deviation?
Lead I: (+)
Lead II: (-)
Lead III: (-)
What will my leads look like with pathological R axis deviation?
Lead I: (-)
Lead II: (-)
Lead III: (+)
What will my leads look like with pathological extreme R axis deviation?
Lead I: (-)
Lead II: (-)
Lead III: (-)
V1: (+)
What axis deviation is pathologic in all adults?
R axis
What is a common cause of axis deviation?
hypertropy
What medications do I not give if they have a BBB? Why?
Lidocaine
Slows conduction rate with ventricles already not contracting correctly.
BBB put pts at higher risk for what?
Mortality
-heart blocks
What lead to we identify BBB in? How do we identify them?
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
Bifascicular block puts pts at a high risk of _____
Vfib
What does the RCA supply blood to?
R vent
inferior wall
posterior wall
SA/AV node
Posterior LBB
How can we indentify a RCA infarct on EKG?
ST depression in leads V1, V2
How will a RCA infarct present clinically?
Bradycardia
Increased CVP
JVD
Difficulty breathing
What does the LAD (Left anterior descending) supply blood to?
L vent
Septal wall
Anterior wall of L vent
Bundle of His & BB
Why is the LAD called the widow maker?
Since it supplies blood to bother the Bundle of His and BB, it can stop the flow of blood to vents and quickly kill.
What does the circumflex supply blood to?
Lateral wall of L vent
SA/AV node
Posterior wall of L vent
What 2 drugs do I want to give to prevent the clotting from happening?
Aspirin
heparin
Chest pain on exertion means there is ___ of occlusion, at rest it is ______ of occlusion, and unrelieved by nitroglycerin is _____ occluded.
70-85%
90%
100%
If my patient BP is low & is having an AMI, what pain med can I give them instead of morphine?
Fentanyl
What is important to get along with an EKG is I suspect and MI?
Cardiac Enzymes
T/F: You can have a normal EKG and have an MI
T
This is why we need to get cardiac enzymes
How does a necrotic part of the ventricle look on the ultrasound?
Its not squeezing at all –> looks non compliant
What is demand ischemia?
Decreased BP –> Changes on EKG
When BP is corrected the changes on the EKG go away
You will see symmetrical ______ in 2 or more related leads in ischemia
inverted T waves
You will see reciprocal changes for the posterior heart in what leads?
V1 - V4
What causes ST depression?
Reciprocal changes to other ST elevation
-subendocardial injury
-ischemia
-Drug or electrolytes
Which drugs/electrolyes cause ST depression?
Digoxin
Hypokalemia
How can we identify tissue death/necrosis on EKG? What does this tell me?
Pathologic Q waves: > 40ms wide or 1/3 depth of R-wave height
Pt has had a previous infarct
If I see patholgic Q waves with ST elevation what is happening>?
AMI
The inferior leads are ______ and are effected by the _____. I see reciprocal changes in _______
II, III, aVF
RCA
I, aVL
The Spetal leads are ______ and are effected by the _____.
V1, V2
LAD
The Anterior leads are ______ and are effected by the _____. I see reciprocal changes in _______
V3, V4
LAD
II, III, aVF
The Lateral leads are ______ and are effected by the _____. I see reciprocal changes in _______
V5, V6
I, aVL (high lateral)
Circumflex
II, III, avF
The posterior heart are shown by ______ and are effected by the _____.
ST depression in V1-V4
RCA
What is the most lethal MI? Why?
Anterior wall MI
Can suddenly develop complete heart block, vtach, vfib
If my patient has a BBB or hemiblock and has an anterior wall MI, what should i do?
Immediately put pads on my patient to prepare for CPR
L vent hypertropy can imitate an MI but wont have what?
reciprocal changes
What can mimic an MI? What should you do to differentiate?
LBBB
cardiac enzymes
How does pericarditis present on the EKG? How do we differentiate this from an MI?
ST elevation in all leads
When the pt leans forward they will feel better
T/F: Percarditis will have ST depression in reciprocal leads
F
It will be elevation in all leads
What type of patients do we see pericarditis in?
Sepsis
IV drug users
What must we see on the EKG to confirm an MI? Why is this important?
Reciprocal changes
If we dont see reciprocal changes we could misdiagnose an MI with something else
How does an thoracic Aortic Aneurysm present on the EKG?
ST elevation but NO RECIPROCAL CHANGES
Why dont we give nitroglycerin to AAA pts?
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.
