ECG/Treatment

Question 1

Normal PR interval

Answer 1

0.1 - 0.2

Question 2

Normal QRS interval

Answer 2

0.08 - 0.12

Question 3

Normal QT interval

Answer 3

0.34 - 0.43

Question 4

Sinus means…

Answer 4

Present, upright P Wave

Question 5

Sinus Bradycardia tx

Answer 5

1. Assess
2. Identify and treat cause (O2, maintain airway, monitor, IV access, 12 lead)
3. If symptomatic –> ATROPINE 0.5 mg q 3-5 min max of 3 mg
4. Dopamine (2-10 mg/kg/min), Epi (2-10 mg/min)

Question 6

Sinus Tachycardia tx

Answer 6

1. Assess
2. Treat underlying cause (O2, maintain airway, monitor)
3. If symptomatic with normal QRS –> cardioversion
4. Not symptomatic –> BBs and CCBs

Question 7

Sinus Arrhythmia

Answer 7

Irregular rhythm

Question 8

Sinus Arrhythmia treatment

Answer 8

No treatment required, ABCD assessment

Question 9

Sinus Rhythm with Premature Atrial Complexes (PAC)

Answer 9

• Impulse from high in the atria before the next sinus beat
• P waves are there but often hiding in preceding T wave
• Irregular rhythm

Question 10

Sinus with PAC tx

Answer 10

No treatment required, ABCD assessment

Question 11

Junctional Rhythm/Premature Junctional Contraction (PJC)

Answer 11

• Impulse in AV junction –> SA causes retrograde atrial depolarization –> INVERTED P wave
• Narrow QRS

Question 12

Atrio-Ventricular Nodal Rhythm

Answer 12

• Impulse in AV junction –> SA causes retrograde atrial depolarization –> MISSING P wave
• Narrow QRS

Question 13

Junctional Rhythm rate

Answer 13

40 - 60 bpm

Question 14

Accelerated Junctional rate

Answer 14

60 - 100 bpm

Question 15

Junctional tachycardia

Answer 15

> 100 bpm

Question 16

Paroxysmal Supraventricular Tachycardia (PSVT)

Answer 16

• P waves are present but hidden
• HR > 150
• Normal QRS

Question 17

PSVT tx

Answer 17

1. Assess
2. Treat underlying cause (O2, maintain airway, IV, 12 lead)
3. ADENOSINE (first dose 6 mg, 2nd dose, 12 mg)
4. Cardioversion

Question 18

How do you give Adenosine?

Answer 18

• Rapidly over 2 seconds through the closest IV port

- Lift arm after administration to expedite via gravity

Question 19

Atrial Flutter

Answer 19

• Saw tooth P Wave
• Atrial 250-350
• Regular rhythm, regular QRS

Question 20

A Fib

Answer 20

• Irregularly irregular

- Atrial 300-600

Question 21

Stable A Fib tx

Answer 21

• ABCD
• Treat reversible causes
• Digoxin, amiodarone

Question 22

Unstable A Fib tx

Answer 22

Find out how long the A fib has been going for

• if less than 2 days (48 hrs) get TEE
• if no thrombus –> cardiovert
• if there is a thrombus –> Coumadin

Question 23

Torsades de Pointes

Answer 23

Polymorphic Ventricular tachy

- width of QRS varies

Question 24

Torsades de pointes tx

Answer 24

Mag Sulfate

Question 25

PVC

Answer 25

Wide QRS followed by compensatory pulse (pause)

Question 26

PVC treatment

Answer 26

- treat if there are > 6 in one min, couplets, bigeminy (alternation of normal, PVC), multifocal, or short run V tach - Amiodarone

Question 27

V Tach

Answer 27

- HR 150-250 - Can't see the P - WIDE QRS - can lead to V Fib

Question 28

V tach with a pulse tx

Answer 28

- ABCD --> cardioversion + amiodarone

Question 29

V tac without a pulse tx & V fib tx

Answer 29

- CPR --> defibrilate --> --> Epi 1 mg q 3-5 min --> SHOCK --> CPR --> Amio 300 mg bolus

Question 30

Asystole, PEA, Idioventricular Rhythm tx

Answer 30

CPR --> intubate --> IV Epi 1 mg q 3-5 min --> CPR - do NOT shock

Question 31

First Degree Heart Block

Answer 31

constant prolonged PR

Question 32

1 st degree tx

Answer 32

Atropine if symptomatic

Question 33

2nd degree heart block type 1

Answer 33

Progressive prolongation followed by a dropped beat

Question 34

What if the 2nd degree heart block is in the lower bundle of His

Answer 34

NO ATROPINE | - only give Atropine to high heart block

Question 35

2nd degree heart block type 2

Answer 35

Constant prolonged PR followed by dropped beat

Question 36

2nd degree type 2 tx

Answer 36

Atropine 0.5 mg q 3-5 min for max of 3 mg --> epi --> dopamine

Question 37

3rd degree heart block

Answer 37

P and QRS are independent

Question 38

3rd degree heart block tx

Answer 38

atropine, epi, dopamine

Question 39

Low heart block creates what kind of QRS

Answer 39

Wide

Question 40

High heart block creates what kind of QRS

Answer 40

Narrow