Cardiac - Unit 2 - EKG Interpretation Flashcards
What conditions might predispose someone to have dysrhythmia’s?
Respiratory problems, recent MI, etc.
What are the main areas of impulse for the heart?
SA Node, AV Node, Bundle of HIS
What is the main pacemaker of the heart?
The SA Node
Where is the SA Node located? What’s some info about it?
Right atrium near the superior vena cava - it is the pacemaker of the heart. It beats about 60-100 BPM and is innervated by the autonomic nervous system.
The SA Node causes atrial ____.
Depolarization.
If the SA Node fails, then the __ node picks up the pace.
AV Node.
Where is the AV node located? Basic info about it?
Located in the back of right atrium near the septal leaflet of the tricuspid valve. It beats at about 40-60 BPM.
What does the AV node do for impulses?
It delays them for a brief moment - allows for atrial contraction to precede ventricular contraction.
Transplanted hearts have a SA node - T/F?
FALSE - they do not. So it’s all chemical for them.
If a patient has a transplanted heart, will atropine work for them?
NO!
Where is the bundle of HIS? What does it do (___ depolarization).
It runs down the right side of the interventricular septum - it causes ventricular depolarization.
Where are electrodes placed on the heart? Think of a little pneumonic…
Clouds over grass (Right side, white over green).
Smoke over fire (Black over Red, Left Side)
Shit in the middle (brown).
What does the P wave indicate?
The atria are contracting and pumping blood into the ventricles.
What does the QRS complex show?
Ventricular Depolarization and contraction.
What does the PR interval show?
The transit time for the electrical signal to travel from the sinus node to the ventricles.
What does the T wave show?
Ventricular Repolarization
ECG - One small square = __ seconds.
One big square = __ seconds.
5 Big square = __ sec
15 big squares = __ sec.
ECG - One small square = .04 seconds.
One big square = .2 seconds.
5 Big square = 1 sec
15 big squares = 3 sec.
Electrodes - if the electricity flows TOWARD the positive electrode, the patterns will always be ____.
Upright.
If the electricity flows toward the negative electrode, the patterns will be ___.
Inverted.
What does a flipped T wave mean?
Possible MI.
What are the six steps to EKG interpretation?
- Regularity
- Calculate the HR
- The P Wave
- The PR interval
- The QRS
- The ST Segment
(What is the rhythm?)
What are ectopic beats? What’s the name for early and late beats?
Ectopic are extra beats.
Early = premature. Late = escape.
Calculate HR by strip - what’s the 10 times method?
Count the number of r waves in a 6 second strip and multiply by 10.
Calculate HR - what’s the big block method?
Divided the number of big boxes between two consecutive R waves into 300.
OR - divide the number of small boxes between two consecutive R waves into 1500.
Calculate HR - what’s the Memory Method?
Memorize 300,150,100,75,60,50,43
How long should the PR interval be?
0.12-.20 seconds.
What’s the normal time of the QRS?
0.04-0.10 seconds (one small box to 2.5 small boxes)
ST Segment - what type of line is it?
Isoelectric
What is NSR?
Normal Sinus Rhythm, typically 60-100 BPM.
What is Sinus Tachycardia?
It’s NSR that is high.
Is perfusion decreased with Sinus Tach?
Yea
How do we treat Sinus Tach?
Tread underlying causes, cardioversion, vagal maneuvers like a carotid massage
What is Sinus Brady?
NSR that is slow -
Should we watch for clots in sinus brady?
Yes - the atria’s aren’t really working that fast so clots can form.
How do we treat sinus brady?
TREAT ONLY IF SYMPTOMATIC.
If symptomatic, treat the cause, oxygen, atropine, pacemaker, etc.
What is atrial fibrillation?
Multiple rapid impulses from many foci depolarize in the atrial in a disorganized manner. The atria aren’t contracting. It’s all happening SUPER fast but the AV stops some of the fast beats.
What is some treatment for A-Fib?
O2, Anticoagulants, Cardioversion for new onset, medications to control the ventricular rate like digoxin, calcium channel bockers, beta blockers, etc.
What’s Atrial Flutter?
More than one P-Wave - A rate of about 200-350 BPM - looks like a saw tooth.
How do we treat A-Flutter?
Cardioversion for unstable patients, O2, anticoagulants, medications to slow ventricular response.
What’s the drug of choice for symptomatic bradycardia?
Atropine
What are PVC’s?
Early ventricular complexes resulting from increased irritability of the ventricles.
(PVC Types) Uni-focal - Multi-focal - Bigeminy - Trigeminy - Couplet - Three or more =
(PVC Types) Uni-focal - one foci Multi-focal - many foci Bigeminy - every other Trigeminy - every third Couplet - two in a row Three or more = V TACH
What are the treatments for PVC’s?
Notify DR if there are 6-10 pvc’s in a minute, client has pain, increased PVC frequency, multifocal or in runs..also give O2, treat the cause (hypokalemia?), amiodorone, pronestyl, lidocaine, etc.
Which are worse - multi-focal or unifocal PVC’s?
Multi-Focal
What is V. Tach?
rapid beats that originate in the ventricles.
How do we treat stable V. Tach with a pulse?
O2, Amiodarone, Procainamide, Lidocaine, Correct electrolyte disturbances.
How do we treat unstable V. Tach without a pulse?
Cardioversion/O2
How do we treat V. Tach that has no pulse?
Treated like V FIb (Defibrillate!!!)
What is V Fib?
Impulses from many irritable foci firing in a totally disorganized manner. The ventricles are fibrillating.
How do we treat V Fib?
You get those paddles…
CPR, Epi/Vasopressin, O2, Anti-dysrhythmic Drugs.
THIS IS SERIOUS. IT IS A CODE.
What is asystole?
No electrical activity - again, THIS IS A CODE.
How do we treat asystole?
CPR, Check in two leads, epi/atropine, pacemaker, consider the possible causes.
What is PEA?
Pulse-less electrical activity. They have a rhythm but no pulse.
How do we treat PEA?
CPR/EPI - 6 H’s (hypovolemia, hypoxia, hypothermia, hyperkalemia, hypoglycemia, hydrogen ion acidosis), 5 T’s (toxins, tamponade, tension pneumothorax, thrombosis, trauma) (known causes)
