ECG 2 Flashcards
Most accurate way to take HR
taking a pulse
P waves tel only about:
depolarization
NOT contraction
Leads 1, 2, and 3 P waves should be
upright
time it takes to leave the SA node, travel through and depolarize both atria, get to the junction and be held
P wave
QRS complex just tells about depolarization
Do what to confirm contraction?
Take a pulse
ST segment depression - tells about an old injury- electricity is taking a different pathway
depression =
hypokalemia
myocardial ischemia
digitalis toxicity
Prioritizing between elevated ST segment and depressed ST segment?
Elevated = acute myocardial injury
If patient has no pulse, but has EKG activity, what do you do?
CPR
False high and false low alarms - Make sure you :
Do not just trust the machine
count HR/ take pulse
Most high-voltage artifacts are related to:
Muscle movement from the patient moving in bed, or moving the extremities
Seizures and gastric pacemakers can also cause this
False low alarms may be caused by:
any disturbance in the transmission of the electrical signal from the skin electrode to the monitoring system.
Usually caused by ineffective contact between the skin and the electrode-lead wire
Solution for low alarm
Turn up amplitude (gain ) knob on monitor or change lead positions
Sinus Rhythms and Arrhytmias
Sinus- Identifies where rhythm originates (____)
SA node
Normal Sinus Rhythm
Rhythm: Regular Rate: 60 – 100 P waves: 1 P wave before each QRS Normal in appearance PR: .12 - .20 seconds QRS: < .12 seconds
How do we know it is sinus?
Look at P waves -
one per
smooth, round, upright
regular
Normal Sinus rhythm -
There is only one NORMAL sinus rhythm
Tachycardia and bradycardia are Sinus tachycardia and Sinus bradycardia
- not normal sinus tachycardia…
First thing you do when reading a strip:
Look to make sure it is a 6 second strip. 2 hash marks
Sinus Tachycardia
Rhythm: Regular Rate: 100 - 160 P waves: 1 P wave before each QRS Normal in appearance PR: .12 seconds - .20 seconds QRS: < .12 seconds
Sinus Tachycardia
Normal response to an increased demand for _____
blood flow.
Main Causes for sinus tachycardia
Pain
Pump problem/perfusion
Volume deficit & overload
Other causes of sinus tachycardia
Exercise
Stimulants- caffeine, nicotine, amphetamine
Drug withdrawal
Increase in catecholamine release resulting from anxiety, excitement, pain or stress
Increased metabolic conditions (hyperthermia, hyperthyroidism)
Anemia
Hypoxia, hypovolemia, hypotension or shock, heart failure
Myocardial ischemia or acute MI
Pulmonary embolism
Drugs that increase sympathetic tone (epinephrine, dopamine, isoproterenol, nitroprusside) or drugs that decrease parasympathetic tone (atropine)
Treatment for Sinus tachycardia
Treat underlying cause
- Pain, anxiety, fever, hypoxia, volume replacement
Sinus Bradycardia
Rhythm: Regular Rate: 40 - 60 P waves: 1 P wave before each QRS Normal in appearance PR: .12 seconds - .20 seconds QRS: < .10 seconds
Sinus Bradycardia
Normal response to ____ and ____
heart relaxation and sleep.
Sinus bradycardia causes include:
Sleep Well conditioned-athletes Sleep apnea Hypoxia Hypothermia/hypothyroidism - decreased metabolic conditions Hyperkalemia Pain Hypoglycemia Vagal stimulation from pain, vomitting, gagging, bearing down
In acute inferior wall MI involving the right coronary artery which supplies the SA node
As a reperfusion rhythm after coronary angioplasty or after treatment with thrombolytics
drugs such as digitalis, beta blockers, or calcium channel blockers
Sudden movement from sitting to standing
Treatment for bradycardia
Treat the cause
Atropine - drug that increases heart rate
Pacemaker if atropine dose not work
Sinus Arrhythmia
Rhythm: Irregular Rate: 60 - 100 P waves: 1 P wave for each QRS Normal in appearance PR: .12 seconds - .20 seconds QRS: < .10 seconds
Sinus Arrhythmia
Normal in:
Normal in children and young adults.
Heart Rate slows down with expiration and speeds up with inspiration (respiratory variance)
