Conducting pre-procedural activities Flashcards
A Holter monitor is used to assess what?
Frequency and severity and arrhythmias
When draping a patient for a PPM, the technologist will drapes which area?
drapes the area that has been disinfected for use
Where is the primary source of airborne bacteria?
opening the procedure room door
When handling sterile items it is important to keep the equipment where?
within the sterile field
What influences the shelf life of a sterile package?
number of packaging layers
The patient is presenting for a Bi-V ICD implant has a baseline O2 saturation of 84%, which does not improve with O2 therapy. How should the patient be sedated?
The patient should not be sedated
A patient is taken off Coumadin for one week prior to RF ablation procedure. The INR yields a value of 3. What should the next step be?
Send the patient home and repeat the INR at a later date
What is the acceptable K+ levels for a patient undergoing an EP study?
3.5-5.4
Prior to starting the case, after explaining the procedure to the patient as well as identifying risks and potential complications, permission is given to proceed with the study. This is known as what?
informed consent
The patient is arriving for their pacemaker implant is complaining of itching and feeling warm. The IV ancef was started by the floor nurse approx. 20 mins ago. What immediate action should be taken?
Stop the Ancef drip and notify the physician
What class drug is amiodarone?
Class III
Which medication markedly increases the refractory period?
Amiodarone
Which TVP adjustment would change the unit from the demand mode to asynchronous?
decrease sensitivity
The best description of cardiac thresholds for a single chamber implantable device?
the minimum amount of mA required to elicit a response
What is the unit for resistance?
Ohms
Hysteresis is used for what?
promote intrinsic conduction
What happens to impedance when the lead is fractured?
increases
Class I antiarrhythmic _________________ velocity and _______________ refractory periods.
decrease, increase
If the ICD conductor is fractured by how much will the impedance increase?
250 Ohms or 30%
Where should a patient carry their cellphones when they have a device?
In the contralateral pocket or in their pant pockets
What does low impedance reading mean during a follow up visit post PPM?
possible lead insulation break
The physician orders Ibutilide 1 mg IV. What aspect of patient monitoring should you adjust?
QT interval
During monitoring of a RF ablation procedure, you observe the catheter temperature reach 100 C. What is your next action?
Alert the physician and stop the ablation delivery because of potential coagulum
What are the MOST common catheter positions for performing an initial VT study?
HRA, HIS, RVOT and RVA
In order to help facilitate the induction of AVNRT, is it customary to use which drug via IV?
Isuprel
During open-irrigated ablation, the pump alarm beeps. You should do what action next?
turn off the pump and notify the physician to turn flow off to patient
During RF ablation, a high impedance reading continually shuts off the RF generator. What should your first troubleshooting attempt be?
Check the patient ground is secure
Which blood test is likely to be performed prior to removing an arterial sheath in a heparinized patient?
ACT
What test should be ordered to after a subclavian venous puncture?
chest x-ray
Circulation distal to the femoral artery is best assessed by __________ pulses.
dorsalis-pedis
Post procedure, an arterial line is to be discontinued. The final ACT is 450 seconds. The previous ACT was 320 seconds, with no heparin given since then. The next logical step would be to do what?
repeat the ACT
The following prerequisites describe which type of tachycardia mechanism? Two pathways (A&B) must be connected One pathway must be conduct more slowly The slower pathway must have a shorter effective refractory period
Re entry
During phase 2 of the action potential, there is a slow influx of which ion?
Calcium
Give an example of Class Ia antiarrhythmic
procainamide
Where is the maximum conduction delay?
N-regional cells of the AV node
Repetetive delivery of 8 atrial beats at the same cycle length followed by 9th beat which is delivered with a progressively shorter coupling interval describes which pacing protocol?
Decremental atrial pacing
What is the most common mechanism for tachycardias?
Reentry
What does burst pacing protocol consist of?
sequence of fixed pacing train
What is the most important cause of non-cardiac syncope ?
vagal hypersensitivity syndromes
What is the mA of the stimulator conventionally set at?
2x diastolic threshold
What is the formula for cSNRT?
cSNRT = SNRT-SCL
How is retrograde conduction defined?
Conduction from the ventricle to the atria
In a patient with a resting baseline sinus cycle length (SCL) of 623 msec and a sinus node recovery time (SNRT) of 2122 msec, Calculate the cSNRT.
1499 msec
What is the heart rate in BPM for a patient with a tachycardic rate of 320 msec?
188 BPM
What is the name of the ridge tissue in front of the inferior vena cava?
The Eustasian ridge
What would be necessary for a patient with symptomatic 1st degree AVB with HIS purkinje disease?
PPM
Carotid massage is performed on a patient presenting with syncope. What arrhythmia would you expect?
SVT and VT (could be SVT with aberrancy)
With the exception of a local stimulus of above normal strength, which refractory period describes the time during repolarization in which the longest coupling interval (S1, S2) of input into a tissue fails to produce capture?
Effective
You have induced tachycardia in a patient who did not have an V-A block with adenosine. The tachycardia has a V-A of 180 ms. Suddenly, the patient develops LBBB and the V-A increases to 220ms. What does the patient most likely have?
a left-sided AP
What causes a delta wave?
Antegrade AP conduction pre-exciting the ventricular tissue
What is the equation for corrected QT?
QTc = QT / √R-R interval
Tall peaked T waves on a 12 lead ECG is associated with what?
hyperkalemia
What are the proper high/low pass filter for intracardiac electrograms in Hertz?
30/500
What are the proper high/low pass filter for electrocardiogram in Hertz?
0.5/100
what is the most common site for idiopathic VT?
RVOT
How is the left atrium activated simultaneously with the right atrium?
Bachman’s Bundle
What is a specific complication to PVI?
atrioesophageal fistula
You are assisting with a PPM generator change on a pacemaker dependent patient. The doctor attaches the new generator leads, but no pacing occurs until the generator is placed in the pocket. Why did this happen?
The generator is unipolar
A properly functioning RV apical pacing lead should produce what kind of morphology on the surface ECG?
LBBB morphology
What is the normal range for pacemaker impedance?
300-1200 Ohms
What is the most important consideration when selecting a site for a peripheral IV in a patient undergoing a device implant?
planned side of implant
What is the usual result of moving the ground patch closer to the site of RF energy?
a decrease in impedence
In an effective RF burn, the impedance should follow what pattern?
decrease initially, then increase and stabilize
What safety checks should be performed prior to using a TVP for pacing?
check date of last battery change
Class I recommendations for the extraction of a chronic pacing and defibrillation leads include what risk factor?
An occult (mysterious) infection for which no source can be found and for which the pacing system is suspected
After injecting 15cc of Omnipaque into the CS visualization, the patient’s O2 saturation falls from 98% to 90% on 2L of O2 via nasal cannula and he begins to wheeze. What is the most likely cause?
An allergic to iodine
During a cryoablation for atrial tachycardia near the bundle of HIS, a patient goes into complete heart block. What would the next logical step be?
stop ablation and wait for conduction to return
What are the four structures, outline the triangle of Koch?
Tendon of Todaro, HIS bundle, septal leaflet of tricuspid annulus, coronary sinus os
What nerve drapes itself over the right atrial appendage and affects diaphragmatic motion?
phrenic nerve
What vessel normally supplies blood to the SA and AV node?
RCA
What is the most common site of triggers for a. fib?
pulmonary veins
What best describes the appropriate protocol for testing the pacing capture threshold of a newly implanted lead?
Decreasing the pulse voltage from 5V until the capture is lost
What does magnet application do to the defibrillator Reed switch?
Disables shocking therapies and goes to asynchronous pacing
Which of the following is likely to happen during the lead maturation process?
Encapsulation of the electrode with fibrin tissue
A 12-lead EKG of VT with a positive QRS in Lead I and negative QRS in aVF indicates what axis deviation?
Left axis deviation
