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RCES self assessment > Conducting pre-procedural activities > Flashcards

Conducting pre-procedural activities Flashcards

1
Q

A Holter monitor is used to assess what?

A

Frequency and severity and arrhythmias

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2
Q

When draping a patient for a PPM, the technologist will drapes which area?

A

drapes the area that has been disinfected for use

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3
Q

Where is the primary source of airborne bacteria?

A

opening the procedure room door

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4
Q

When handling sterile items it is important to keep the equipment where?

A

within the sterile field

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5
Q

What influences the shelf life of a sterile package?

A

number of packaging layers

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6
Q

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?

A

The patient should not be sedated

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7
Q

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?

A

Send the patient home and repeat the INR at a later date

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8
Q

What is the acceptable K+ levels for a patient undergoing an EP study?

A

3.5-5.4

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9
Q

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?

A

informed consent

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10
Q

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?

A

Stop the Ancef drip and notify the physician

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11
Q

What class drug is amiodarone?

A

Class III

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12
Q

Which medication markedly increases the refractory period?

A

Amiodarone

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13
Q

Which TVP adjustment would change the unit from the demand mode to asynchronous?

A

decrease sensitivity

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14
Q

The best description of cardiac thresholds for a single chamber implantable device?

A

the minimum amount of mA required to elicit a response

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15
Q

What is the unit for resistance?

A

Ohms

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16
Q

Hysteresis is used for what?

A

promote intrinsic conduction

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17
Q

What happens to impedance when the lead is fractured?

A

increases

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18
Q

Class I antiarrhythmic _________________ velocity and _______________ refractory periods.

A

decrease, increase

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19
Q

If the ICD conductor is fractured by how much will the impedance increase?

A

250 Ohms or 30%

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20
Q

Where should a patient carry their cellphones when they have a device?

A

In the contralateral pocket or in their pant pockets

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21
Q

What does low impedance reading mean during a follow up visit post PPM?

A

possible lead insulation break

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22
Q

The physician orders Ibutilide 1 mg IV. What aspect of patient monitoring should you adjust?

A

QT interval

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23
Q

During monitoring of a RF ablation procedure, you observe the catheter temperature reach 100 C. What is your next action?

A

Alert the physician and stop the ablation delivery because of potential coagulum

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24
Q

What are the MOST common catheter positions for performing an initial VT study?

A

HRA, HIS, RVOT and RVA

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25
Q

In order to help facilitate the induction of AVNRT, is it customary to use which drug via IV?

A

Isuprel

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26
Q

During open-irrigated ablation, the pump alarm beeps. You should do what action next?

A

turn off the pump and notify the physician to turn flow off to patient

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27
Q

During RF ablation, a high impedance reading continually shuts off the RF generator. What should your first troubleshooting attempt be?

A

Check the patient ground is secure

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28
Q

Which blood test is likely to be performed prior to removing an arterial sheath in a heparinized patient?

A

ACT

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29
Q

What test should be ordered to after a subclavian venous puncture?

A

chest x-ray

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30
Q

Circulation distal to the femoral artery is best assessed by __________ pulses.

A

dorsalis-pedis

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31
Q

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?

A

repeat the ACT

32
Q 
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
A

Re entry

33
Q

During phase 2 of the action potential, there is a slow influx of which ion?

A

Calcium

34
Q

Give an example of Class Ia antiarrhythmic

A

procainamide

35
Q

Where is the maximum conduction delay?

A

N-regional cells of the AV node

36
Q

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?

A

Decremental atrial pacing

37
Q

What is the most common mechanism for tachycardias?

A

Reentry

38
Q

What does burst pacing protocol consist of?

A

sequence of fixed pacing train

39
Q

What is the most important cause of non-cardiac syncope ?

A

vagal hypersensitivity syndromes

40
Q

What is the mA of the stimulator conventionally set at?

A

2x diastolic threshold

41
Q

What is the formula for cSNRT?

A

cSNRT = SNRT-SCL

42
Q

How is retrograde conduction defined?

A

Conduction from the ventricle to the atria

43
Q

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.

A

1499 msec

44
Q

What is the heart rate in BPM for a patient with a tachycardic rate of 320 msec?

A

188 BPM

45
Q

What is the name of the ridge tissue in front of the inferior vena cava?

A

The Eustasian ridge

46
Q

What would be necessary for a patient with symptomatic 1st degree AVB with HIS purkinje disease?

A

PPM

47
Q

Carotid massage is performed on a patient presenting with syncope. What arrhythmia would you expect?

A

SVT and VT (could be SVT with aberrancy)

48
Q

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?

A

Effective

49
Q

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

a left-sided AP

50
Q

What causes a delta wave?

A

Antegrade AP conduction pre-exciting the ventricular tissue

51
Q

What is the equation for corrected QT?

A

QTc = QT / √R-R interval

52
Q

Tall peaked T waves on a 12 lead ECG is associated with what?

A

hyperkalemia

53
Q

What are the proper high/low pass filter for intracardiac electrograms in Hertz?

A

30/500

54
Q

What are the proper high/low pass filter for electrocardiogram in Hertz?

A

0.5/100

55
Q

what is the most common site for idiopathic VT?

A

RVOT

56
Q

How is the left atrium activated simultaneously with the right atrium?

A

Bachman’s Bundle

57
Q

What is a specific complication to PVI?

A

atrioesophageal fistula

58
Q

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?

A

The generator is unipolar

59
Q

A properly functioning RV apical pacing lead should produce what kind of morphology on the surface ECG?

A

LBBB morphology

60
Q

What is the normal range for pacemaker impedance?

A

300-1200 Ohms

61
Q

What is the most important consideration when selecting a site for a peripheral IV in a patient undergoing a device implant?

A

planned side of implant

62
Q

What is the usual result of moving the ground patch closer to the site of RF energy?

A

a decrease in impedence

63
Q

In an effective RF burn, the impedance should follow what pattern?

A

decrease initially, then increase and stabilize

64
Q

What safety checks should be performed prior to using a TVP for pacing?

A

check date of last battery change

65
Q

Class I recommendations for the extraction of a chronic pacing and defibrillation leads include what risk factor?

A

An occult (mysterious) infection for which no source can be found and for which the pacing system is suspected

66
Q

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?

A

An allergic to iodine

67
Q

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?

A

stop ablation and wait for conduction to return

68
Q

What are the four structures, outline the triangle of Koch?

A

Tendon of Todaro, HIS bundle, septal leaflet of tricuspid annulus, coronary sinus os

69
Q

What nerve drapes itself over the right atrial appendage and affects diaphragmatic motion?

A

phrenic nerve

70
Q

What vessel normally supplies blood to the SA and AV node?

A

RCA

71
Q

What is the most common site of triggers for a. fib?

A

pulmonary veins

72
Q

What best describes the appropriate protocol for testing the pacing capture threshold of a newly implanted lead?

A

Decreasing the pulse voltage from 5V until the capture is lost

73
Q

What does magnet application do to the defibrillator Reed switch?

A

Disables shocking therapies and goes to asynchronous pacing

74
Q

Which of the following is likely to happen during the lead maturation process?

A

Encapsulation of the electrode with fibrin tissue

75
Q

A 12-lead EKG of VT with a positive QRS in Lead I and negative QRS in aVF indicates what axis deviation?

A

Left axis deviation

RCES self assessment (11 decks)

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