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Adult assessment tools > Cardiac monitoring and rhythm recognition > Flashcards

Cardiac monitoring and rhythm recognition Flashcards

1
Q

What is an ECG?

A

Recording of electrical activity within heart.
Normal ECG will demonstrate electrical activity through normal conduction pathways.

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2
Q

What is a myocardial fibre contraction?

A

Contraction of heart
Occurs simultaneously with electrical activity.

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3
Q

State the movement of electrical activity in a heart beat

A
  1. Sinoatrial node
  2. Atrioventricular node
  3. Atrioventricular bundle (bundle of his)
  4. Right and left bundle branches
  5. Purkinje fibres
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4
Q

What is a lead in reference to ECG?

A

Refer to electrical activity between two points. (ECG normally three leads used)
Standard lead II used for monitoring as allows for positive deflection of the heart.

  • Right just below the clavicle (red)
  • Left side below clavicle (yellow)
  • Left side on leg (green)
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5
Q

Where should the red lead go in an ECG?

A

Right just below the clavicle

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6
Q

Where should the yellow lead go in an ECG?

A

Left side below clavicle

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7
Q

Where should the green lead go in an ECG?

A

Left side on leg

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8
Q

What are some potential problems in recording an ECG?

A
  1. Poor contact eg. Sweating
  2. AC interference (eg. Other machines nearby)
  3. Patient movement (shivering)
  4. Gain set inappropriately
  5. Paper speed set incorrectly/ not checked
  6. Leads attached incorrectly
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9
Q

On ECg paper what does one small square indicate?

A

0.04seconds

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10
Q

On ECG paper what does 1 large square signify?

A

0.2 seconds

5 small squares

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11
Q

On ECG paper what does 5 large squares signify?

A

1 second

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12
Q

What does the P wave signify on an ECG reading?

A

SA node firing
Atrial depolarisation

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13
Q

What is the P-R interval?

What is the normal size for this?

A

Time it takes for the AV node contraction

Normal = 3-5 small squares (0.6-1second)

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14
Q

What can it signify if a P-R interval is longer than 5 small squares?

A

Arythmia
eg.
1st degree heart blood
Prolonged P-R interval

Normal - 3-5 small squares

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15
Q

What is the QRS interval and how big is a normal QRS interval?

A

Signifies right and left ventricular depolarisation
Should be thin and quick
Normally less than 3 small squares

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16
Q

What can it signify if the QRS interval is longer than normal?

A

If wider than 3 small squares
There is a delay in conduction in ventricular conduction
Can signify a bundle branch block

17
Q

What is the T wave?

A

Ventricle Depolarisation

18
Q

What is the PR interval?

A

Time between atrial and ventricular depolarisation
AV node conduction

19
Q

What is the structured approach for accessing the rhythm of an ECG?

A
  1. Is there electrical activity (has it been done correctly)
  2. Is it regular
  3. What is the rate
  4. Are there P waves/ atrial activity
  5. What is the PR interval
  6. What shape is the QRS complex
20
Q

How can you assess the rate of a heart beat using ECG?

A

Check that ECG paper speed is set at 25mm/sec

300 large squares is one minute
Number of large squares between R waves and divide by 300

Eg. 300/4 = 75bpm (normal sinus rhythm)

CHECK THAT THE R WAVES ARE REGULAR

21
Q

What questions should we be asking to assess the P wave and atrial activity?

A
  • Are there identifiable P waves?
  • Do the P waves have normal morphology (shape)?
  • Are there P waves before every QRS complex?
  • Is every P wave followed by QRS complex?
22
Q

How would you assess the PR interval?

A
  • Measure from beginning of P wave to first deflection of QRS complex
  • Normal duraction 0.12-0.20 seconds (3-5 small squares)
  • PR interval greater than 0.2 seconds indicated block at AV node
  • Short PR interval indicated abnormally fast conduction
23
Q

How would you assess a QRS complex?

A
  • Normal duration is 0.12 seconds (less than 3 small squares)
  • Ford QRS complex follow every P wave?
  • Is the complex wide or narrow?
  • Is the morphology (shape) normal?
24
Q

What would a wide QRS indicate?

A

Abnormal electrical activity through abnormal pathways

Slow conduction

Associated with ineffective myocardial contraction and reduced cardiac output

25
Q

State three cardiac arrest rhythms

A
  • asystole
  • ventricular fibrillation
  • ventricular tachycardia
26
Q

Explain teh characteristics of asystole?

A
  • Cardiac arrest
  • Wandering baseline (not actually flat)
  • No identifiable atrial or ventricular activity
  • No cardiac output
27
Q

State the characteristics of ventricular fibrillation

A

• Chaotic ventricular activity
• No cardiac output – cardiac arrest
• Cardiac arrest rhythm
- No blood being pumped from the heart (no QRS wave)

28
Q

Explain the characteristics of atrial fibrillation

A

• Irregularly irregular
• Ventricular rate variable
• No identifiable P wave
• Fibrillation wave – very common
• Blood clots form – this can move through body and cause stroke
• Chaotic atrial activity with intermittent atrioventricular conduction
- QRS complex narrow

29
Q

State the characteristics of ventricular tachycardia

A

• Regularly irregular rhythm
• Wide – from ventricles
• No P waves
• Tachycardia
• Can cause cardiac arrest but not always
• Rate 100-300bpm

30
Q

Define bradycardia

A

P-T wave spread out (less than 60) – whole wave

31
Q

Define tachycardia

A

P-T wave close together (more than 90) – whole wave

32
Q

State the two types of cardiac arrest

A

STEMi

Non-STEMI

33
Q

Whats the difference between teh two types of cardiac arrest?

A

STEMI - ST segment elevation - ST segment moved up - this caused by acute myocardial infarction

Non-STEMI - no ST segment elevation - so ST segment depression

Adult assessment tools (12 decks)

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