ECG Flashcards
Pacemaker cells possess
AUTOMATICITY (the ability to initiate an impulse)
Bundle Branches & Purkinje Fibers: - bmp (slowest ones)
20-40 bpm
pulseless electrical activity (vents don’t have pulses, of course)
looks like a normal EKG but ventricles don’t contract so there’s no cardiac output or BP
with AV blocks, is something wrong with the SA nodes?
there’s nothing wrong with SA nodes (because they come before AV)
supraventricular tachycardia - rate (the suprer hero goes 100 mph)
above ventricles but something else is causing rapid firings - rates higher than 100 bmp
SA nodes
Sinoatrial node (SA) is the pacemaker that:
Sets the rate (60-100)
Generates nerve impulses to contract both atria
P wave on ECG
Atrioventricular (AV)
SA to AV bundle transmission
Atrioventricular bundle is a - which segment on the ECG? (Ava purrs)
bundle of nerve fibers in the septum that:
Carries impulses doen the septum to the RBB
PR segment on the ECG
Allows atrial contraction
ask yourself this with every ECG (in this order) (RRP RPR QRS ST T - rip ripper)
Is the rhythm regular?
what is the rate?
are there P waves? Are they consistent? (atrial)
are there R waves? (ventricular)
waht is the P-R interval?
are the QRS complexes normal shape and duration?
is the S-T segment isoelectric? (waves go down not up - icicles go down)
Do the T waves have normal configuration? (can detect eschemia and K+ problems) don’t need to figure out rate***
P wave
P wave: Atrial depolarization
QRS Complex
QRS Complex: Ventricular depolarization (atrial repolarization is hidden)
T wave
T wave: Ventricular repolarization
measurements in seconds - PR interval: (Prrr cats age is 12 - 20)
PR interval: .12 - .2 sec
ECG paper - each square is how many seconds?
Standard paper speed= 25mm/sec
mm= .04 sec (60 sec/1500=.04 sec)
5mm= .2 sec (.04 x 5) = .2 sec (60 sec/ .2 = 300/min
heart rate determination - how to count on ecg (heart rate needs some R and R for 300 days)
Count the number of large boxes between R-R interval and divide into 300
Example: 300/4=75 bpm
rhthym can be normal, but doesn’t mean that
the pt is perfusing
Arrhythmias are no big deal UNTIL they affect…
cardiac output
VT
Vfib
Heart Blocks
Multiple PVC’s (premature ventricular contractions)
Atrial fibrillation/flutter
Junctional rhythms
how to diagnose arrthymias
ECG
3 lead, 5 lead, 12 lead, Transcutaneous paddles
EPS
Echocardiography
Tilt table testing
Genetic testing
Labs
CXR (chest x-ray)
Coronary angiography
premature atrial contraction
rhythm - irregular - it comes early and prob faster.
AFib - rate and rhythm - Gab is bigger than 150
Rhythm: Irregular
Rate: >150 (depends on AV conduction)
AV node is the bouncer at a bar and lets a few in at a time.
AFib causes (gab door)
CAD, HTN, mitral or tricuspid valve disease, PE
Afib treatments (gab gets the RAT treatment)
1 GOAL is to Control rate
Rhythm conversion
Prevent thrombus formation
Surgical ablation
AFib - assessments (assess gab bc she’s an SOB and she passes out when she beats on her chest pain)
Assess patient for SOB, decreased energy, fatigue, “feeling beats”, chest pain, light headedness, syncope, decreased ability to exert
atrial flutter rhythm (butterflies can have regular or irregular shapes)
rhythm: Regular or regularly irregular
atrial flutter Causes (butterfly causes are the PIT ishmail)
PE, thyrotoxicosis (too much thyroid hormone), ischemic heart disease
atrial flutter treatment (same as aFib)
Control rate
Rhythm conversion
Prevent thrombus formation
Surgical ablation successful in 80-90% cases
premature ventricular contraction - what about perfusion?
not good perfusion.
premature ventricular contraction - causes (jimmy was always irritated)
electrolyte imbalances, irritability of the heart, stress response. more than 6 is bad.
isolectric - what is it and when does it happen? (Jimmy Icicles)
wave goes down not up - happens with PVC
ventricular tachycardia - how does the ECG look? (Tachy Tombstones)
rapid rate, can’t decipher P waves.
VFib rate and rhythm (Velma is chaotic with no rate)
Rhythm Chaotic
Rate - None, non discernable
can defibrillate the pt.
VFib causes - how does the ECG look? (Velma’s ecg is gone)
No P, P-R interval, atrial rate or QRS duration
VFib treatment
CPR, precordial thump (strike person’s sternum), defibrillation (do it fast), medications - epinephrine, ABC, check pulses, call code right away
Vfib nursing implications
Nursing Implications
Assess patient NO palpable pulses
ABC
Call code/ask for AED (automated external defibrillator)
biphasic defibrillator
delivers shock going in both directions - sandwich the paddles between the heart. goes through posterior and anterior then back the other way. uses less electricity and causes less damage to the pt.
QRS interval in seconds (can’t stand QVC for 12 seconds)
QRS interval: < .12 sec
QT interval in seconds (QTs are 36 - 44)
QT interval: .36 - .44 sec
heart rate - how to count rapid HR? (rapidly die in 1500 bc)
Rapid heart rate, count number of small boxes between R and R and divide into 1500
Example: 1500/19 = 79 bpm