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Advanced Life Support (ALS) > Chapter 8: Rhythm Recognition > Flashcards

Chapter 8: Rhythm Recognition Flashcards

1
Q

What is the typical position for the defibrillator pads?

A
  1. Beneath right clavicle
  2. Left MAL
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2
Q

What alternative position for defibrillator pads can be used and when?

A

Position:
1. Anterior posterior positions

When:
1. Permanent pace maker in right pectoral region
2. Chest wall trauma

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3
Q

What is the normal length of a PR interval?

A
  1. 3-5 small squares
  2. 0.12-0.20s
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4
Q

What is the normal length of a QRS?

A
  1. < 3 small squares
  2. < 0.12 s

If QRS < 0.12s- originates above Bundle of His
If QRS > 0.12s - orginates from ventricles or supraventricular rhythm w/ BBB

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5
Q

What happens to the QRS in a bundle branch block?

A

Widens

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6
Q

How can VF be classified?

A

Fine or Coarse - depending on amplitude of complexes

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7
Q

What is likely the diagnosis if there is a regular rhythm with intermittent irregularity?

A

Ectopic beats

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8
Q

Describe how atrial flutter may be seen?

A
  1. Regular repetitive positive deflection
  2. With a saw tooth appearance
  3. Often around 300 beats/min
  4. Usually in inferior leads - II, III, AVF
  5. Can be 2:1, 3:1 etc.
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9
Q

How may retrograde atrial activation be spotted?

A
  1. Inverted p waves
  2. In II and aVF
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10
Q

What is the immediate treatment for polymorphic VT?

A

Same as for VF:

  1. Shock
  2. Adrenaline every 3-5 mins
  3. Amiodarone after 3rd shock
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11
Q

What is the normal QT interval and how is it measured??

A
  1. Start of Q to end of T
  2. It is corrected to calculate QTc = QT/square root of RR
  3. Should be >0.35s and <0.44s in males, <0.46s in females
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12
Q

What can cause long QT?

A
  1. Hypokalaemia
  2. Hypomagnasaemia
  3. Amiodarone (avoid in pt. with Torsades)
  4. Hypocalcaemia
  5. Hypothermia
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13
Q

What are some reversible causes for PEA?

A
  1. Severe fluid depletion or blood loss
  2. Cardiac tamponade
  3. Massive PE
  4. Tension pneumothorax
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14
Q

What are the main causes for Bradyarrhythmias?

A
  1. Heart block - 1st, 2nd Mobitz I and II, 3rd
  2. Escape rhythm’s - SA node fail
  3. Agonal rhythm’s
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15
Q

When does agonal rhythm occur and what is it?

A
  1. Occur in dying patients
  2. Slow irregular wide ventricular complexes
  3. Doesn’t usually generate pulse
  4. Often progress to asystole
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16
Q

How can tachyarrhythmia’s be split up?

A
  1. Narrow complex - SVT / atrial flutter / AF
  2. Broad complex - VF/VT (can be SVT + AV block but less common)
17
Q

6 stage system to analyse rhythm:

A
  1. Is there electrical activity?
  2. What is the rate?
  3. What is the rhythm - regular or irregular?
  4. Is the QRS complex narrow or broad?
  5. Is atrial activity present?
  6. Is atrial activity related to ventricular activity?
18
Q

What to check if no eletrical activity?

A
  1. Check gain control
  2. Check electrode connections
  3. Check pulse
19
Q

What does a completely flat line on ECG usually mean?

A
  1. Lead not connected
20
Q

What is an ECG with atrial activity but NO QRS complexes?

A
  1. Ventricular standstill
21
Q

Mx of ventricular standstill?

22
Q

ECG appears to be VF but pt. conscious - what could be cause?

A
  1. Likely artefact
23
Q

How is VF classified?

A
  1. Classified according to amplitude of complexes
  2. Coarse vs Fine
24
Q

How to calculate rate?

A
  1. Count number of R-Rs
  2. In 30 large squares (6s)
  3. Multiply by 10

In 15 large squares (3s)
Multiply by 20

25
Q

How to classify irregular rhythms?

A
  1. Totally irregular
  2. Basic regular rhythm w/ intermittent irregularity
  3. Recurring cyclic variability
26
Q

If R-R intervals are totally irregular and QRS complex of constant morphology - what is the most likely rhythm?

27
Q

If the QRS complex is narrow (<0.12s) the beat is likely to come from?

A
  1. Above the ventricular myocardium

From Atrial mm. or AV node

28
Q

Broad complex ectopic beats may originate from where?

A
  1. Ventricular origin
  2. Supraventricular ectopic beats w/ BBB
29
Q

What is an escape beat?

A
  1. Beat originating in AV node or ventricular myocardium
  2. After a long pause

AV node or ventricle is acting as back up pacemaker

30
Q

Best leads to see AF?

A
  1. Lead II
  2. V1

Advanced Life Support (ALS) (13 decks)

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