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Paramedic > Cardio section 1 PP Pt 2 > Flashcards

Cardio section 1 PP Pt 2 Flashcards

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1
Q

Reading the Electrocardiogram: What should your main focus be?

A

Treat your patient, not the monitor

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2
Q

Reading the Electrocardiogram: What are the first five steps of reading the electrocardiogram?

A
  1. Rate
  2. Rhythm (including the presence of ectopic beats)
  3. Presence and shape of the P wave, and its relationship to the QRS
  4. PR interval
  5. QRS complex
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3
Q

Reading the Electrocardiogram: What are the next five steps in reading the electrocardiogram?

A
  1. Fast or Slow
  2. Wide or Narrow
  3. Regular or Irregular
  4. Sick or Not Sick
  5. Does it have “P” waves
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4
Q

Reading the Electrocardiogram: What are two things to consider while assessing the rate?

A
  • Most modern ECG monitors will give you a fairly accurate reading regarding the heart rate
  • However, not every beat that shows up on the ECG is actually perfusing
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5
Q

Reading the Electrocardiogram: What should you do to assure the rate from the EKG is accurate?

A

You must learn to check your patient’s pulse rate and then compare that to the ECG rate from the tracing

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6
Q

Reading the Electrocardiogram: How do you calculate the rate while looking at the EKG?

A

Multiply the number of QRS complexes or P waves by 10

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7
Q

Reading the Electrocardiogram: What are you assessing, dealing with the rhythm?

A

How regular or irregular the cardiac cycles are occurring

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8
Q

Reading the Electrocardiogram: What are your choices for rhythm assessment?

A
  • Regular
  • Essentially regular
  • Regularly irregular
  • Irregularly irregular
  • Look for consistent patterns while assessing*
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9
Q

Reading the Electrocardiogram: What is a dangerous assumption regarding the P wave?

A

Do not assume every small bump you see on the ECG is a P wave

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10
Q

Reading the Electrocardiogram: What is the ratio between the Ps and QRSs?

A

There should be a one-to-one relationship between the Ps and QRSs

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11
Q

Reading the Electrocardiogram: What is the range for a normal PR interval?

A

Normally between 0.12 and 0.20 seconds

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12
Q

Reading the Electrocardiogram: What is revealed if the PR interval is more than .20 seconds?

A

If this interval is prolonged beyond 0.20 seconds, a block within the AV node or junction exists

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13
Q

Reading the Electrocardiogram: What are the four things you should be looking at while assessing the QRS?

A
  • The duration (width) of the complex
  • Amplitude (height) of the complex
  • The presence of Q waves and their length and size
  • The general configuration of the complex, noting any notching or slurring of the waves and how the QRS flows into the T wave
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14
Q

Dr. Henry Marriott’s Principles: What are the 8 principles?

A
  1. Use a lead containing maximum information
  2. Learn all you can about what causes each dysrhythmia
  3. Milk the QRS
  4. Cherchez le P (look for the P)
  5. Mind your Ps
  6. Dig the break
  7. Who’s married to whom?
  8. Pinpoint the primary rhythm
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15
Q

Rhythms Originating Within the Sinus Node: What are the diagnostic criteria for normal sinus rhythm (NSR)?

A 
Rate: 60-100
Rhythm: regular w/o any ectopy
P waves: Present and precedes each QRS relationship
PRI: .12-.20 seconds
QRS: < .12 seconds, uniform in shape
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16
Q

Rhythms Originating Within the Sinus Node: Where does NSR arise? Where does it travel after that?

A

Normal sinus rhythm arises from the SA node

-Each impulse travels down through the conduction system in a normal manner

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17
Q

Rhythms Originating Within the Sinus Node: What are the diagnostic criteria for Sinus Arrhythmia?

A

Rate: 60-100
Rhythm: regularly irregular with respiration and without any ectopy
P waves: present and precedes each QRS with a 1:1 relationship
PRI: .12-.20 seconds
QRS: < .12 seconds, uniform in shape

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18
Q

Rhythms Originating Within the Sinus Node: What is the outlier for Sinus Arrhythmia?

A

Rhythm is regularly irregular with respirations

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19
Q

Rhythms Originating Within the Sinus Node: What are the diagnostic criteria for Sinus Tachycardia?

A 
Rate: 100-160
Rhythm: regular w/o any ectopy
P waves: Present and precedes each QRS 1:1 relationship
PRI: .12-.20 seconds
QRS: < .12 seconds, uniform in shape
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20
Q

Rhythms Originating Within the Sinus Node: What is the outlier for Sinus Tachycardia?

A

Rate is faster than 100 beats per minute

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21
Q

Rhythms Originating Within the Sinus Node: What are the diagnostic criteria for Sinus Bradycardia?

A

Rate: <60
Rhythm: regular to essentially regular w/o any ectopy
P waves: Present and precedes each QRS 1:1 relationship
PRI: .12-.20 seconds
QRS: < .12 seconds, uniform in shape

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22
Q

Rhythms Originating Within the Sinus Node: What is the outlier for Sinus Bradycardia?

A

Rate is less than 60 beats per minute

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23
Q

Rhythms Originating Within the Sinus Node: What are the diagnostic criteria for Sinus Arrest?

A

Rate: depends upon the frequency of the arrest
Rhythm: regular to essentially regular with obviously dropped beats; ectopic beats may be present if the AV node or purkinji fibers tried to pace the heart during the sinus arrest beat
P waves: Present and precedes each QRS relationship
PRI: .12-.20 seconds
QRS: < .12 seconds, uniform in shape

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24
Q

Rhythms Originating Within the Sinus Node: What is the outlier for Sinus Arrest?

A

Rate: depends upon the frequency of the arrest
Rhythm: regular to essentially regular with obviously dropped beats; ectopic beats may be present if the AV node or purkinji fibers tried to pace the heart during the sinus arrest beat

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25
Q

Rhythms Originating Within the Sinus Node: When does sinus arrest occur?

A

Sinus arrest occurs when the SA node fails to initiate an impulse

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26
Q

Rhythms Originating Within the Sinus Node: What are the diagnostic criteria for wandering atrial pacemaker (WAP)?

A

Rate: 60-100, but frequently < 60
Rhythm: regular to essentially regular, usually no additional ectopic beats other than the wondering pacer site
P waves: Vary in morphology but a 1:1 relationship generally exists
PRI: varied
QRS: < .12 seconds, uniform in shape

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27
Q

Rhythms Originating Within the Sinus Node: What is the outlier for WAP?

A

Rate: 60-100, but frequently < 60
Rhythm: regular to essentially regular, usually no additional ectopic beats other than the wondering pacer site
P waves: Vary in morphology but a 1:1 relationship generally exists
PRI: varied

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28
Q

Rhythms Originating Within the Sinus Node: How does WAP arise?

A

Wandering atrial pacemaker arises from different sites in the atria

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29
Q

Rhythms Originating Within the Sinus Node: How does sinus bradycardia arise? How does the conduction follow?

A

Sinus bradycardia arises from the SA node. Each impulse travels down through the conduction system in a normal manner

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30
Q

Dysrhythmias Originating Within the Atria: What are the diagnostic criteria for Premature atrial complexes (PAC)?

A

Rate: Matches that of the underlying rhythm
Rhythm: Slightly irregular due to extra complex
P waves: Present and precedes each QRS in a 1:1 relationship, slightly different morphology
PRI: .12-.20 seconds (less on premature complex)
QRS: < .12 seconds, uniform in shape

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31
Q

Dysrhythmias Originating Within the Atria: What is the outlier for PAC?

A

Rate: Matches that of the underlying rhythm
Rhythm: Slightly irregular due to extra complex
P waves: Present and precedes each QRS in a 1:1 relationship, slightly different morphology. (may be upright or inverted, will appear different from those of the underlying rhythm)
PRI: .12-.20 seconds (less on premature complex). (can be normal, shortened or prolonged)

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32
Q

Dysrhythmias Originating Within the Atria: Where does PAC arise from?

A

Arises from somewhere in the atrium

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33
Q

Dysrhythmias Originating Within the Atria: What is a street secret you should know about?

A

When the heart is beating too fast, there is not enough time to allow for adequate ventricular filling, which eventually leads to a significant drop in cardiac output and a drop in blood pressure. Symptomatic tachycardias need aggressive intervention with either drugs or electrical therapy.

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34
Q

Dysrhythmias Originating Within the Atria: What are the diagnostic criteria for Atrial Tachycardia?

A 
Rate: 160-240
Rhythm: regular unless MAT
P waves: Present and precedes each QRS, 1:1 relationship
PRI: .12-.20 seconds, may be prolonged
QRS:
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35
Q

Dysrhythmias Originating Within the Atria: What is the outlier for Atrial Tachycardia?

A
  • Rate: 160-240
  • Rhythm: regular unless MAT
  • PRI: .12-.20 seconds, may be prolonged
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36
Q

Dysrhythmias Originating Within the Atria: Where does Atrial Tachycardia arise from?

A

Atrial Tachycardia arises from a single focus in the atria

*reentry circuit

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37
Q

Dysrhythmias Originating Within the Atria: What are the diagnostic criteria for Atrial Flutter?

A

Rate: atrial 250-350. ventricular varies dependant upon AV conduction
Rhythm: Regular, may be irregular
P waves: replaced by F waves
PRI: replaced by FR intervals, and the PRI is not reliable or determinable
QRS:

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38
Q

Dysrhythmias Originating Within the Atria: What is the outlier for Atrial Flutter?

A

-Rate: atrial 250-350. ventricular varies dependant upon AV conduction (Ventricular rate may be slow, normal, or fast; atrial rate is between 250-350 beats per minute)
-Rhythm: Regular, may be irregular
-P waves: replaced by F waves. (P waves absent, instead there are sawtooth flutter waves)
PRI: replaced by FR intervals, and the PRI is not reliable or determinable

39
Q

Dysrhythmias Originating Within the Atria: Where does Atrial Flutter arise from?

A

Atrial flutter arises from rapid depolarization of a single focus in the atria

40
Q

Dysrhythmias Originating Within the Atria: What are the diagnostic criteria for Atrial Fibrillation?

A 
Rate: variable in ventricles
Rhythm: irregularly irregular 
P Waves: undetectable 
PRI: none
QRS:
41
Q

Dysrhythmias Originating Within the Atria: What is the outlier for Atrial Fibrillation?

A 
Rate: variable in ventricles
Rhythm: irregularly irregular 
P Waves: undetectable 
PRI: none
QRS:
42
Q

Dysrhythmias Originating Within the Atria: Where does Atrial Fibrillation arise from?

A

Atrial fibrillation arises from many different sites in the atria

43
Q

Dysrhythmias Originating from the Junction: What are the diagnostic criteria for Premature Junctional Complex (PJC)?

A 
Rate: Dependent upon underlying rhythm
Rhythm: Occasionally irregular
P waves: Inverted, prior, during or after QRS
PRI: usually < .12 seconds (if visable)
QRS: < .12 seconds, uniform in shape
44
Q

Dysrhythmias Originating from the Junction: What is the outlier for Premature Junctional Complex?

A
  • Rhythm is irregular due to premature beat
  • P wave of PJC is inverted; may appear before, during, or after the QRS complex
  • If present, the PRI of the PJC will be shorter than normal
45
Q

Dysrhythmias Originating from the Junction: Where does Premature junctional complex arise from?

A

PJC arises from somewhere in the AV junction

46
Q

Dysrhythmias Originating from the Junction: What are the diagnostic criteria for Junctional Escape?

A 
Rate: 40-60
Rhythm: regular
P waves: prior, during or after QRS complex
PRI: < .12 seconds
QRS: < .12 seconds, uniform in shape
47
Q

Dysrhythmias Originating from the Junction: What is the outlier for Junctional Escape?

A
  • Rate is 40-60 beats per minute
  • P waves are inverted; may appear before, during, or after the QRS complex
  • If present, the PRI will be shorter than normal
48
Q

Dysrhythmias Originating from the Junction: Where does Junctional Escape arise from?

A

Junctional escape rhythm arises from a single site in the AV junction

49
Q

Dysrhythmias Originating from the Junction: What are the diagnostic criteria for Accelerated Junctional?

A 
Rate: 60-100
Rhythm: regular
P waves: prior, during or after the QRS
PRI: < .12 seconds if visable
QRS: < .12 seconds, uniform in shape
50
Q

Dysrhythmias Originating from the Junction: What is the outlier for Accelerated Junctional?

A
  • Rate is 60-100 bpm
  • P waves are inverted; may appear before, during, or after the QRS complex
  • If present, the PRI will be shorter than normal
51
Q

Dysrhythmias Originating from the Junction: Where does Accelerated Junctional arise from?

A

Accelerated junctional rhythm arises from a single site in the AV junction

52
Q

Dysrhythmias Originating from the Junction: What are the diagnostic criteria for Junctional Tachycardia?

A

Rate: > 100 (100-180)
Rhythm: regular
P waves: prior, during of after the QRS
PRI:

53
Q

Dysrhythmias Originating from the Junction: What is the outlier for Junctional Tachycardia?

A
  • Rate is 100-180 bpm
  • P waves are inverted; may appear before, during or after the QRS complex
  • If present, the PRI will be shorter than normal
54
Q

Dysrhythmias Originating from the Junction: Where does Junctional Tachycardia arise from?

A

Junctional tachycardia arises from a single focus in the AV junction

55
Q

Atrioventricular Blocks: What are the diagnostic criteria for First-Degree Block?

A 
Rate: That of the underlying rhythm
Rhythm: regular
P waves: present and precede each QRS
PRI: > .20 seconds
QRS: < .12 seconds, uniform in shape
56
Q

Atrioventricular Blocks: What is the outlier for First-Degree Block?

A

-PRI is longer than .20 seconds and is constant

57
Q

Atrioventricular Blocks: Where does First-Degree Block arise from?

A

In 1st degree AV heart block, impulses arise from the SA node but their passage through the AV node is delayed

58
Q

Atrioventricular Blocks: What are the diagnostic criteria for Second-Degree Type 1 Block?

A

Rate: that of the underlying atrial rhythm
Rhythm: regularly irregular
P Waves: present and precedes QRS when it occurs because of the unconducted beat, there are more Ps than QRSs
PRI: gradually lengthens
QRS: < .12 seconds, uniform in shape

59
Q

Atrioventricular Blocks: What is the outlier for Second-Degree Type 1 Block?

A
  • Ventricular rate may be slow, normal, or fast; atrial rate is normal
  • Patterned irregularly
  • P waves are present and normal; not all are followed by a QRS complex
  • PRI is progressively longer until a QRS complex is dropped, then cycle begins again
60
Q

Atrioventricular Blocks: Where does Second-Degree Type 1 Block arise from?

A

In 2nd-degree AV heart block type 1, impulses arise from the SA node but their passage through the AV node is progressively delayed until the impulse is blocked

61
Q

Atrioventricular Blocks: What is another name for a Second-Degree Type 1 Block?

A

Wenckebach

62
Q

Atrioventricular Blocks: What are the diagnostic criteria for Second-Degree Type 2 Block?

A

Rate: Atrial rate due to underlying rhythm, ventricular rate is lower
Rhythm: irregular
P waves: regular and precede conducted QRS
PRI: consistent until QRS is dropped
QRS: typically > .12 seconds

63
Q

Atrioventricular Blocks: What is the outlier for Second-Degree Type 2 Block?

A
  • Ventricular rate may be slow, normal, or fast; atrial rate is often within normal range
  • May be regular or irregular (depends on whether conduction ratio remains the same)
  • P waves are present and normal; not all the P waves are followed by a QRS complex
  • PRI is constant for all conducted beats (may be normal or prolonged)
64
Q

Atrioventricular Blocks: Where does Second-Degree Type 2 Block arise from?

A

In 2nd-degree AV heart block type 2, impulses arise from the SA node but some are blocked in the AV node

65
Q

Atrioventricular Blocks: What are the diagnostic criteria for Third-Degree Block?

A

Rate: Atrial rate that of underlying rhythm. Ventricular rate typically 20-60
Rhythm: regular
P Wave: not associated with QRS
PRI: vary widely
QRS: narrow or wide, dependant upon location of block and origin of the QRS

66
Q

Atrioventricular Blocks: What is the outlier for Third-Degree Block?

A
  • Ventricular rate may be slow, normal, or fast; atrial rate is within normal range
  • Atrial rhythm and ventricular rhythms are regular but not related to one another
  • P waves are present and normal, not related to the QRS complexes, appear to march through the QRS complexes
  • PR interval is not measurable
  • QRS complexes are normal if escape focus is junctional and widened if escape focus is ventricular
67
Q

Atrioventricular Blocks: Where does Third-Degree Block arise from?

A

In 3rd-degree AV heart block, there is a complete block at the AV node resulting in the atria being depolarized by an impulse that arises from the SA node and the ventricles being depolarized by an escape pacemaker that arises somewhere below the AV node

68
Q

Ventricular Dysrhythmias: What are the diagnostic criteria for Premature Ventricular Complexes (PVCs)?

A 
Rate: That of the underlying rhythm
Rhythm: Irregular when PVC is present 
P waves: may or may not be associated with PVC
PRI: none associated with PVC
QRS: > .12 and premature
69
Q

Ventricular Dysrhythmias: What is the outlier for Premature Ventricular Complexes (PVCs)?

A
  • Rhythm is irregular due to premature beat
  • P waves are not visible with PVCs as they are hidden in QRS complexes
  • PR interval is absent
  • QRS complexes seen with PVCs are wide and bizarre in appearance, have T waves in opposite direction of R wave
70
Q

Ventricular Dysrhythmias: Where does Premature Ventricular Complexes (PVCs) arise from?

A

PVCs arise from somewhere in the ventricles

71
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for Ventricular Fibrillation (V-Fib)?

A 
Rate: None
Rhythm: None
P waves: None
PRI: None
QRS: None; isoelectric line is chaotic
72
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for Asystole?

A 
Rate: None
Rhythm: None
P waves: None
PRI: None
QRS: None; isoelectric line is flat and "silent"
73
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for PEA?

A 
Rate: depends upon rhythm
Rhythm: depends
P waves: depends
PRI: depends
QRS: Present and depends upon rhythm. The problem is there is no pulse to accompany the rhythm, which means there is electrical activity but no mechanical response or perfusion
74
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for Ventricular Tachycardia (V-Tach)?

A 
Rate: 100-250
Rhythm: depends, usually regular 
P waves: none
PRI: none
QRS: wider than .12 seconds. often the QRS wave is deflected the opposite direction from the T wave
75
Q

Life-Threatening Dysrhythmias: What is the outlier for Ventricular Tachycardia (V-Tach)?

A
  • Rate is 100 to 250 bpm
  • P waves are not visable as they are hidden in the QRS complexes
  • QRS complexes are wide and bizarre in appearance. Have t waves in the opposite direction of the R wave
  • PRI are absent
76
Q

Life-Threatening Dysrhythmias: Where does Ventricular Tachycardia (V-Tach) arise from?

A

V-Tach arises from a single site in the ventricles

77
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for Torsades De Pointes?

A

Rate: 100-250
Rhythm: regular
P Waves: not associated with ectopic complex if any as seen
PRI: If P waves are seen they are dissociated with the complex
QRS: > .12 seconds, wide and bizarre appearance

78
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for Idioventricular Rhythm?

A 
Rate: 20-40 (or slower)
Rhythm: regular
P waves: none 
PRI: none
QRS: > .12 bizarre appearance
79
Q

Life-Threatening Dysrhythmias: What is the outlier for Idioventricular Rhythm?

A

-rate is 20-40 bpm

80
Q

Life-Threatening Dysrhythmias: What are the diagnostic criteria for AIVR?

A 
Rate: 60-110
Rhythm: regular
P waves: none
PRI: none
QRS: > .12 seconds, bizarre shape, uniform
81
Q

Life-Threatening Dysrhythmias: What is the outlier for AIVR?

A
  • P waves are not visable as they are hidden in the QRS complexes
  • PRI are absent
82
Q

Bundle Branch and Fascicular Blocks: What are they associated with?

A

May appear in normal hearts, but they are usually associated with heart disease

83
Q

Bundle Branch and Fascicular Blocks: What are the causes?

A
  • ischemia
  • degeneration of the conduction system
  • cardiomyopathy
  • left ventricular hypertrophy
84
Q

Bundle Branch and Fascicular Blocks: What can bundle branch blocks produce? What are they similar to?

A

Bundle branch blocks can produce ST elevation similar to that of an acute myocardial infarction

85
Q

Bundle Branch and Fascicular Blocks: What are the best leads to identify a bundle branch block?

A

V1 and V2 are the best leads to identify a bundle branch block and distinguish between the origins of the various sites

86
Q

Bundle Branch and Fascicular Blocks: What does hemiblocks have to be associated with to be problematic?

A

Hemiblocks are seldom problematic unless in the presence of a RBBB or acute myocardial infarction

87
Q

Bundle Branch and Fascicular Blocks: What does a Right Bundle Branch Block look like in V1, V2?

A

Different M-shaped configurations that may be seen

88
Q

Bundle Branch and Fascicular Blocks: What does a Right Bundle Branch Block look like in V5, V6, I, and aVL?

A

Late broad S waves

89
Q

Bundle Branch and Fascicular Blocks: What does a Left Bundle Branch Block look like in V1, V2?

A

QS and Deep S

90
Q

Bundle Branch and Fascicular Blocks: What does a Left Bundle Branch Block look like in V5, V6?

A

Look at slide 197

91
Q

Bundle Branch and Fascicular Blocks: What does a Left Anterior Hemiblock (left axis deviation) look like in lead I?

A

Small Q

Tall R

92
Q

Bundle Branch and Fascicular Blocks: What does a Left Anterior Hemiblock (left axis deviation) look like in lead III?

A

Small R

Deep S

93
Q

Bundle Branch and Fascicular Blocks: What does a Left Anterior Hemiblock (right axis deviation) look like in lead I?

A

Small R

Deep S

94
Q

Bundle Branch and Fascicular Blocks: What does a Left Anterior Hemiblock (right axis deviation) look like in lead III?

A

Tall R

Small Q

Paramedic (34 decks)

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