ECG Bootcamp Flashcards
What is plan A?
SA node
What is plan B?
AV node
What is Plan C?
AV bundle
What is plan D?
Purkinje Fibers
SA node inherent rate
60-100bpm
AV node inherent rate
40-60 bpm
Bundle of HIS inherent rate
20-40 bpm
Cardiac Monitoring where leads go
“White over Right”
“Clouds over grass”
“Smoke over Fire”
“Chocolate close to the heart”
Small box seconds
0.04 seconds
Large box seconds
0.2 seconds
Large box=___small boxes
5
PR interval length
0.12-0.20 seconds
QRS complex length
0.06-0.12 seconds
ST segment length
0.08-0.12 seconds
Q length
< 0.04 seconds
Normal Sinus rhythm rate
60-100 bpm
P-wave in NSR
Normal
Sinus Tachycardia rate
100-150 bpm
Causes of sinus tachycardia (9)
- hyperthyroidism
- hypovolemia
- HF
- anemia
- exercise
- use of stimulants
- fever
- pain
- anxiety
What to assess for in sinus tachycardia?
Low cardiac output
Treatment for sinus tachycardia (4)
Treat cause—> pain med, antipyretics, hydration, etc
Sinus Bradycardia rate
Bpm less than 60
Causes of sinus bradycardia (7)
- vagal response
- drugs
- ischemia
- disease of the nodes
- ICP
- hypoxemia
- athletes
Difference between asymptomatic and symptomatic sinus Brady
Symptomatic —> decreased CO
What to do for symptomatic Brady
Assess and tx cause
Interventions for sinus brady
- atropine
- transcutaneous pacing
- dopamine or epinephrine infusion
When to not use atropine to tx sinus bradycardia
When the bradycardia is associated with hypothermia
What is sinus arrhythmia?
Sinus rhythm but the rate varies with inspirations
Rate changes with sinus arrhythmias
Inspire=increase in rate
Expire=decrease in rate
Does sinus arrythmia affect hemodynamics status?
Very rarely
What happens in sinus arrest/pause?
SA node fails to fire —> no PQRST complex
Causes of sinus arrest (5)
- MI
- hyperkalemia
- digoxin
- OD
- physiological response to increased vagal tone
For atrial dysrhythmias, where is it seen on the EKG?
Changes in the p wave
Premature Atrial Contraction —> what is seen in the EKG?
Early p wave..may be seen in the t wave
Rate of Supraventricular tachycardia or paroxysmal SVT
150-250 bpm and regular
Rate of atrial tachycardia
150-250 bpm
Main difference between SVT and AT
1:1 conduction for AT —> ventricle responds to every atrial impulse……SVT —> abrupt onset and cessation
Pattern of atrial flutter
Sawtooth pattern
Causes of atrial flutter (6) and intervention
- lung disease
- ischemic heart disease
- Hyperthyroidism
- hypoxemia
- HF
- alcoholism
Intervention —> address cause
A fib characteristics (3)
- no discernible p wave
- irregular ventricular rate
- results in loss of atrial kick
What is someone with a fib at risk for
Pulmonary or systemic emboli
What are junctional rhythms?
When the AV node takes over as the conduction system “gate keeper”
What is the junctional escape rate
40-60 bpm
Accelerated junctional rate
60-100 bpm
Junctional bradycardia rate
Less than 40 bpm
Since the location of the AV node is in the center of the heart, what happens to the impulses that are generated from it?
They may be conducted forward, backward, or both
What happens to the EKG in the junctional escape rhythm?
P-wave changes —> may be inverted, absent, or may follow QRS
Rate and rhythm of junctional escape rhythm
Regular (not from SA node) usually 40-60 bpm
Accelerated junctional rate
60-100bpm
Patient response to accelerated junctional
Decrease in CO and hemodynamic instability, depending on the rate
Causes of accelerated junctional- 6
- SA node disease
- ischemic heart disease
- electrolyte imbalances
- dig. Toxicity
- acute MI
- hypoxemia
Treatment of accelerated junctional
-treat tachycardia if hemodynamically unstable and alert the provider to change the rhythm
What happens to EKG in ventricular dysrhythmias?
Wide and bizarre QRS
Characteristics of premature ventricular contractions-3
- wide irregular QRS
- QRS complex greater than 0.12 sec
- absent p waves
Types of PVCs-5-and what they are
- pairs (couplets): 2 sequential pvc
- runs or bursts: 3 or more sequential PVCs (aka vtach)
- bigeminy PVC: every other beat is a PVC
- trigeminy PVC: every third beat is a PVC
- Quadrigeminy PVC: every 4th beat is a PVC
WHen are PVCs dangerous?-4
- frequent, multi focal
- two or more in a row
- PVC falls into the vulnerable period of the T wave
- may lead to Vtach (pulse less VT) or ventricular fib.
What is Vtach?-5
- 3 or more PVCs in a row
- greater than 100 bpm (may go up to 300)
- wide QRS complexes
- pulse and pulse less VT
- treatment pulse less same as v fib
Causes of VT-10
- hypoxemia
- acid-base imbalances
- exacerbation of HF
- ischemic heart disease
- cardiomyopathy
- hypokalemia
- hypomagnesemia
- valvular heart disease
- genetic abnormalities
- QT prolongation
Torsades de Pointes aka…
“Twisting about the point”
Torsades de pointes is a type of ____ and what needs to be done
- type of VT
- lethal and treated as pulseless VT—> CPR!!!!!!
Cause of torsades de pointes
Magnesium deficiency
V fib characteristics-4
- chaotic pattern
- no discernible P, Q, R, S or T
- coarse or fine
- no CO
What to do first for V fib
Check pt-make sure not a loose lead
What needs to be done after the patient is checked for a loose lead with v fib (if its not a loose lead)?
IMMEDIATE CPR AND DEFIBRILLATION
What is an idioventricular rhythm?
Escape ventricular rhythm from purkinje fibers
Rate for idioventricular rhythm
15-40 bpm, regular rhythm
Characteristics of idioventricular rhythm
- wide QRS
- no p waves
Pulseless electrical activity —> what is it?
Looks like a normal rhythm, but no pulse
Pulseless electrical activity —> what to assess
- apical and carotid pulses
- quick cardio assessment
PEA causes 5 H’s
- hypoxia
- hypovolemia
- hypothermia
- H+ ions (acidosis)
- Hypo or hyperkalemia
PEA causes 5 T’s
- Tablets (OD)
- tamponade (cardiac)
- tension pneumothorax
- thrombosis (coronary)
- Thrombosis (pulmonary
