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Cardiopulm > ECG and other stuff > Flashcards

ECG and other stuff Flashcards

1
Q

automaticity

A

are able to discharge/depolarize without stimulation from a nerve, as is typical in other striated muscle cells
They automatically discharge

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2
Q

rhythmicity

A

Depolarization occurs at regular intervals
Cardiac muscle cells can therefore depolarize at regular intervals (rhythm to their firing or depolarization)
Hierarchy of rhythmicity

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3
Q

Primary pacemaker?

A

SA node

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4
Q

SA node

A

Has an inherent discharge rate of 60 and 100 times per minute resulting in a HR of 60-100 BPM;
This rhythmicity creates the sinus rhythm

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5
Q

AV node norm

A

Has an inherent discharge rate of 40 - 60 times per minute i.e. generates HR of 40-60 beats per min

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6
Q

His-Purkinje fibers norm

A

Has an inherent discharge rate of 30 to 40 times per minute i.e. generates HR of 30- 40 beats per min.

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7
Q

fastest to slowest HR rhythm

A

Autonomic
SA
AV
purkinje

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8
Q

conductivity

A

The ability to spread impulses to adjoining cells very quickly without nerve involvement

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9
Q

3 things that cardiac myocytes have

A

automaticity
rhythmicity
conductivity

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10
Q

myocyte depolarization

A

0 - Na+ in
1- K Cl out
2 - Ca in K out
3 - K out
4 k

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11
Q

what is ECG

A

ECG tracings are superficial recordings of electrical events/ionic events occurring within the myocytes.

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12
Q

P wave

A

atrial depolarization

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13
Q

PR interval

A

The electrocardiogram records this as the P-R interval. – time between when P starts and QRS starts

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14
Q

Electric pathway of heart

A

SA - AV - Anterior division
- L bundle branch - posterior division = purkinje fibers
- R bundle branch - purkinje fibers

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15
Q

QRS complex

A

Ventricular depolarization

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16
Q

T wave

A

repolarization of ventricals

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17
Q

strandard 12 ECG consist of

A

6 limb and 6 chest

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18
Q

V1-6 record in what plane

A

horizontal

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19
Q

which lead do we read

A

lead 2

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20
Q

V1 and V2 can look at which artery

A

LAD

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21
Q

V2 and V4 can look at which artery

A

LAD

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22
Q

2 3 and avF can look at which artery

A

PDA (80% RCA 20% LCx)

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23
Q

1 V5 V6 avL look at which artery

A

LCx L circumflex

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24
Q

ECG line graph
5 big squares=
30 big squares =

A

1s
6s

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25
Q

how to calc HR from ECG

A

300/number of boxes between peaks

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26
Q

Single limb monitoring

A

can only accurately assess rate and rhythm

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27
Q

PR interval evaluation

A

Normal duration is 0.12 to 0.20 seconds or 3-5 small boxes)

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28
Q

QRS complex evaluation

A

Do all QRS complexes look alike?)

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29
Q

QRS interval eval

A

Normal duration is 0.06 to 0.10 seconds or 1.5-2.5 small boxes)

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30
Q

P wave evaluation

A

(Is it normal and upright, and is there a P wave before every QRS? Do all the P waves look alike?)

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31
Q

T wave eval

A

(Is it upright and normal in appearance?)

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32
Q

R-R eval

A

is it regular

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33
Q

Norm HR

A

60-100

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34
Q

first degree AV block

A

First-degree AV block occurs when the impulse is initiated in the SA node but is delayed on the way to the AV node

The delay may be initiated in the AV node itself, and the AV conduction time is prolonged
PR prolonged

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35
Q

what do you recognize for first degree AV block

A

“If R is far from P, then you have first degree”

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36
Q

second degree AV block Mobitz 1

A

Transient disturbance that occurs high in the AV junction and prevents conduction of some of the impulses through the AV node

“Longer, longer, drop, then you have Wenckeback”
This progressive lengthening of the P-R interval followed by a dropped QRS complex occurs in a repetitive cycle.

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37
Q

Second degree AV block mobitz 1 other names

A

wenckeback

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38
Q

second degree AV block Mobitz 2

A

“If some p’s don’t get through, then you have Mobitz II”
P waves “march through” at a constant rate
no lengthening of PR interval
QRS drops every once and a while

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39
Q

third degree AV block

A

“If Ps and Qs don’t agree, then you have 3rd degree”
No impulses that are initiated above the ventricles are conducted to the ventricle
Atria fire at their own inherent rate - regular
Ventricles fire at their own inherent rate - regular
P waves are present, regular, and of identical configuration.
The P waves have no relationship to the QRS complex because the atria are firing at their own inherent rate. same thing with QRS

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40
Q

HR for 3rd degree

A

The heart rate depends on the latent ventricular pacemaker and may range from 30 to 50 beats per minute.

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41
Q

tx of these blocks
1st
2nd
3rd

A

1st degree benign and usually not treated

2nd degree
Dependent on the type of 20 block
No treatment necessary or
Pacemaker placement
Result of an MI

3rd degree life threatening
MI, degeneration of the conducting system
Permanent pacemaker placement
Medical emergency

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42
Q

atrial arrhythias - Paroxysmal atrial tachycardia (PAT)/paroxysmal supraventricular tachycardia (PSVT)

A

Paroxysmal = a sudden recurrence or intensification of symptoms
A sudden recurrence of atrial tachycardia

all of the sudden jumping to a super high HR

43
Q

PAT/PSVT

A

P waves may be present but may be merged with the previous T wave.
The P-R intervals may be difficult to determine but are less than 0.20 second.
tachycardic
The QRS complexes are identical unless there is aberration.

44
Q

PAT/PSVT
s/s
treatment

A

If the rapid rate continues for a period of time, other symptoms may include dizziness, weakness, and shortness of breath
determine underlying cause and treat accordingly

45
Q

atrial flutter

A

Defined as a rapid succession of atrial depolarization caused by an ectopic
P waves are uniform and in a “sawtooth” pattern.

46
Q

Afib

A

defined as an erratic quivering or twitching of the atrial muscle caused by multiple!! ectopic foci in the atria that emit electrical impulses constantly

P waves are absent, thus leaving a flat or wavy baseline.

47
Q

Afib considered life threating?

A

not considered life-threatening unless the heart rate is elevated at rest

48
Q

PVC’s

A

occur when an ectopic focus originates an impulse from somewhere in one of the ventricles

the QRS complex is classically described as a wide and bizarre looking QRS without a P wave and followed by a complete compensatory pause

When The Heart Skips a Beat

The PVC is generally followed by a compensatory pause

49
Q

PVC’s considered life threating?

A

Are paired together
Are multifocal in origin
Are more frequent than 6 per minute
Land directly on the T wave
Are present in triplets or more

50
Q

Vtach

A

Defined as a series of three or more PVCs in a row
Torsade de Pointes (twisting of the points)

51
Q

Vtach Rate

A

100-250

52
Q

Vtach cause and treatment

A

ischemia or acute infarction, coronary artery disease, hypertensive heart disease, and reaction to medications
Treatment
Cardioversion –gentile form of defibrillation
Defibrillation
lidocaine, bretylium tosylate [Bretylol], or procainamide [Pronestyl]

53
Q

Vtach is a

A

medical emergency

54
Q

V fib

A

Is a medical emergency
Causes same as those for V-Tach b/c V-fib is usually the sequel to V-tach
Treatment is defibrillation as quickly as possible followed by cardiopulmonary resuscitation, supplemental oxygen, and injection of medications

55
Q

Hypertrophy is determined by

A

looking at voltage in V1 and V5

56
Q

R ventricular Hypertrophy is defined as

A

as a large R wave in V1, which gets progressively smaller in V2, V3, and V4

57
Q

L ventricular hypertrophyy is definedas

A

Left ventricular hypertrophy is defined as a large S wave in V1 and a large R wave in V5 that have a combined voltage of greater than 35 mV

58
Q

Ischemia

A

an inverted T wave
S-T segment depression

59
Q

Ischemia

A

an inverted T wave
S-T segment depression
acute infarct

60
Q

STEMI

A

elevated ST segment
MI

61
Q

stages of cough

A

deep inhalation
glottis closes increased
pressure gradient
glottis opens
forceful movement of air

62
Q

huff cough

A

forced expiration w/ open glottis

63
Q

anterior upper (apical) segment

A

seated up
percussion on upper chest

64
Q

posterior apical segment

A

seated up hunched forward
percussion on posterior upper chest/back

65
Q

anterior segments

A

supine
mid chest percussion

66
Q

right posterior

A

prone right side slightly elevated
R upper back

67
Q

left posterior segment

A

prone but elevated HOB w/ L slightly elevated
L upper back

68
Q

right middle lobe

A

trendelenburg R slightly elevated
mid lower chest percussion

69
Q

left lingular

A

trendelenburg L slightly elevated
lower L lung percussion

70
Q

ant segment lower (basal)

A

slightly increased trendelenburg
percussion middle chest

71
Q

R lateral basal seg

A

inc trendelenburg on L side (R up)
R lower back/side percussion

72
Q

L lateral basal segment

A

inc trendelenburg on R side (L up)
L lower back/side percussion

73
Q

posterior basal segments

A

prone inc trendelenburg pillow under stomach
lower lung percussion

74
Q

superior segments

A

prone pillow under stomach
mid back percussion

75
Q

active cycle of breathing

A

1) Start with relaxed diaphragmatic breathing (20-30 seconds) in sitting
2) Perform 3-4 deep breaths with added thoracic expansion
a) May add inspiratory hold of 1-3 sec
3) Relaxed exhalation
4) May follow with huffs or FET as secretions move into large airways
5) Relaxed, controlled breathing
6) Repeat cycle 2-4 times

76
Q

autogenic drainage

A

Staged breathing at different lung volumes:
1) Start with small tidal breaths from ERV in sitting
a) repeated until secretions are felt gathering in the airways (10 – 20 breaths)
b) the cough is suppressed,
2) A larger tidal volume is taken for another series of 10 - 20 breaths
3) Followed by a series of larger (approaching VC) breaths
4) Followed by several huff or coughs to expectorate sputum

77
Q

incentive spirometer how to use and what

A

Gives visual feedback to encourage the patient to take long, slow, deep inhalations
Very important in post surgical patients or those on prolonged bedrest (atelectasis!)
5-10 breaths per hour when awake

78
Q

the vest used for

A

Great for children along with those in need of more regular airway clearance (CF, COPD exacerbation, etc.)

79
Q

lateral costal expansion

A

hand(s) on posterolateral lower thorax, uni/bilateral;
Instruction: “As you breathe in, expand… against hand(s)”.

80
Q

apical breathing

A

hand(s) on anterior upper ribs (avoid sternum), very light pressure caudal & dorsal.
Instruction: “As you breathe in, push up against hand(s)”.

81
Q

Chest wall excusion places to check motion

A

apical
anterolateral
posterolateral

82
Q

percussion
normal and abdnormal

A

norm - normal resonance
hyper - tympanic - could be pneumothorax
hypo - dull = Atelectasis, Pneumonic consolidation (mucus), Pleural effusion

83
Q

vesicular sounds

A

exhalation last as long as inhalation

84
Q

adventitious sounds
crackles
wheeze
Rhonchi
pleural rub

A

adventitious = abnormal
crackles = fine coarse fluid in small airways
wheeze = continuous heard on exhale, fine high pitched
rhonchi - coarse low pitched
pleural rub = 2 pieces of sandpaper rubbing together

85
Q

elicited sounds
99
whisper 123
eee
what to hear

A

99 = middle upper = clear 99 = abnormal
whisper 123 = lower respiratory = audible = abnormal
eeeee = middle = aaa sound = abnormal

86
Q

FEV/FVC norm

A

.75-8

87
Q

what posture limit vital compacity

A

kyphosis and scoliosis functionally limit

88
Q

pursed lip breathing clinical sign of

A

COPD

89
Q

barrel chest

A

emphazema

90
Q

bronchitis

A

bluebloater

91
Q

emphazema

A

pink puffer

92
Q

eupnea

A

normal rate depth reg rythm

93
Q

bradypnea

A

Slow rate, shallow or normal depth, regular rhythm

94
Q

tachypnea

A

fast rate shallow breathing

95
Q

hyperpnea

A

Normal rate, increased depth, regular rhythm

96
Q

hyperventilation

A

Fast rate, increased depth, regular rhythm; results in decreased arterial carbon dioxide

97
Q

mucus document

A

consistency
color
change over time
sticky?
amount

98
Q

paradoxical breathing

A

chest moves inward instead of outward
trauma to chest wall
phrenic nerve injury
broken rib

99
Q

paradoxical movement

A

Weak diaphragm but strong accessory muscles
The abdomen is drawn inward during inspiration - chest rises abdomen falls

100
Q

atelectasis

A

Complete or partial collapse of a lung or lobe of a lung (alveolar collapse). Trachea moves toward the collapsed side. – part of it is dimpled in

101
Q

PNX - pneumothorax types`

A

closed - lung punctured but air is in plural space
open - rib and pleural space punctured
tension - air in plerual space increased and unable to escape = pushes everything over

102
Q

what has multiple Ectopic foci

A

a fib

103
Q

L vs R lobes

A

L has 2
R has 3

Cardiopulm (5 decks)

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