Cardiac Rhythm Interpretation

Question 1

Placement of Five lead EKG

Answer 1

White- RA
Black- LA
Red- LL
Green RL
Brown close to heart- 4th intercoastal space

Question 2

P wave

Answer 2

upright
firing of SA node
Atrial depolarization and contraction

Question 3

PR interval

Answer 3

normal interval is 0.12-0.20

Question 4

QRS

Answer 4

ventricular depolarization and contraction
normal interval 0.06-0.12
commonly viewed in lead 2

Question 5

RT on T phenomonon

Answer 5

abnormal impulse of sufficient electrical strength that trigger prematurely or late
can result in life threatening dysrhythmia’s ( vtach, Vfib, torsade’s)

Question 6

if t wave is flattened it can mean

Answer 6

hypokalemia, ischemia

Question 7

if T wave is inverted

Answer 7

ischemia

Question 8

if T wave is peaked/tall

Answer 8

hyperkalemia

Question 9

ST segment elevation or depression means

Answer 9

MI or ischemia

Question 10

normal QT interval

Answer 10

< 0.40 seconds

Question 11

NSR

Answer 11

Regular rhythm
rate 60-100
p precedes each QRS
PR interval 0.12-.0.20
QRS duration 0.06-0.12

Question 12

common causes of dysrhytmia’s

Answer 12

FE imbalances
MI/ ischemia
hypoxia
failure of conduction system
drugs/ toxins
hypo/ hyperthermia
toxins
cardiac Tamponade
tension pneumothorax

Question 13

sinus tachycardia

Answer 13

Atrial and ventricular rates >100
regular rhythm
normal PR and QRS duration

Question 14

tachycardias

Answer 14

narrow complex with wide QRS > 0.12 seconds
VTACH incompatible with life

Question 15

common causes of tachycardia

Answer 15

dehydration
blood loss
hypoxia
PE
Panic attack/ Anxiety
Pain
Fever
Cocaine/ Heroin/ Meth
Hyperthyroidism
Acute MI
Acute HF
Shock

Question 16

sinus bradycardia

Answer 16

rate <60 bpm
everything else is normal

Question 17

when do you treat bradycardia?

Answer 17

only when symptomatic
symptoms include hypotension, dizziness, syncope, SOB, CP, Altered mental status, decreased LOC

Question 18

how do you treat symptomatic bradycardia

Answer 18

determine cause
increase CO
IV atropine
IV dopamine or epinephrine
if meds don’t work transcutaneous pacemaker
emergent transvenous pacemaker

Question 19

adverse effects of atropine

Answer 19

widened QRS
large dilated pupils, urinary retention
SVT/VTACH
dry mouth, blurry vision, vasodilation, flushing

Question 20

sinus arrythmia

Answer 20

irregular rhythm
everything else is normal