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CPR2 Exam 1 > ECG Tutorial Part 1 - Dr. Johnston > Flashcards

ECG Tutorial Part 1 - Dr. Johnston Flashcards

1
Q

Treat sinus tachy

A

Find the cause and tx THAT

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2
Q

21yo otherwise healthy with 120bpm tachy most likely EKG finding

A

Supraventricular tachycardia

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3
Q

Normal sinus arrhythmia

A

Some beats are a little closer then others since you increase HR a little in inhalation and decrease a little in exhalation

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4
Q

Causes of sinus tachy 8

A
  1. Emotions (anxiety, fear)
  2. fever
  3. Preg
  4. Drugs
  5. Hyperthyroidism
  6. Anemia
  7. CHF
  8. Hypovolemia
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5
Q

Bradycardia causes 8

A
  1. Normal healthy people
  2. Athletes, yoga
  3. Sleep
  4. Fright
  5. Carotid sinus massage , carotid hypersensitivity = avoid tight collars
  6. Obstructive jaundice
  7. Sliding hiatal hernia
  8. Valsalva maneuver
    9**. DRUGS : B-blocker, or hyperkalemia, HTN drugs
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6
Q

Biological conditions that can cause bradycardia

A
  1. acute Inferiror MI : you have more Vagal tone leading to N/V also
  2. Low pO2
  3. Low pH
  4. High BP
  5. High pCO2
  6. Sick Sinus Syndrome = going fast then going slow HR
  7. Ischemia
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7
Q

Tx bradycardia

A

** think of cause first** then ATROPINE
1. Atropine ——> repeat as needed, 2mg IV to 2mg IV
= can cause IOP (precipitate narrow angle) in glaucoma
= side effects : ABD distention, urinary retention

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8
Q

Automaticity

A

Cardiac cell that can spontaneously depolarize on its own during phase 4 of action potential ——> impulse

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9
Q

Premature Atrial Contraction causes

A

= normal heart pts

  1. Coffee
  2. Alcohol
  3. Stress
  4. Smoking
  5. COPD, CAD
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10
Q

Premature Atrial Contraction is what

A

Spontaneous fire in the SA node causing a smaller or different looking P wave and and the entire P, QRS,T complex to come sooner then expected, the next one takes longer then expected to come

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11
Q

Non-conductive Premature Atrial Contraction

A

P wave right after the T wave that is earlier then expected in the bpm, only with NO QRS following it , the next beat is farther then expected

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12
Q

Aberrant Premature Atrial Contraction

A

Premature p wave that causes the entire P,QRS,T to look different then normal

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13
Q

Premature Atrial Contraction TX

A

Nothing (reverse cause) unless symptomatic :

1. Small does B-blocker = Metoprolol

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14
Q

Paroxysmal Atrial Tachycardia (PAT)

A

= sudden unset HR greater then 100

  1. Rate 150- 250bpm
  2. From irritable foci someplace ——> P’ wave
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15
Q

Paroxysmal Atrial Tachycardia (PAT) causes

A
  1. Ischemia or hypoxia in atrium
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16
Q

Paroxysmal Atrial Tachycardia (PAT) looks like on ECG

A

Normal HR then premature P wave comes

  1. Then all beats after are that rhythm
  2. Only premature P wave is in place of the T normal wave and that happens every time in every beat
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17
Q

2:1 P’:QRS and you cant see T wave is what

A

2 spiked p waves for every QRS
= Paroxysmal Atrial Tachycardia (PAT) (you cant really see the T wave) + AV BLOCK
= suspect digitalis excess or toxicity

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18
Q

Multifocal Atrial Tachycardia (MAT)

A
  1. 3 or more P waves (meaning at least 3 p waves that look different)
  2. Irregular V rhythm
  3. Beats over 100bpm
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19
Q

Multifocal Atrial Tachycardia (MAT) associated with

A
  1. COPD ** = LUNG
  2. Pneumonia ** = LUNG
  3. Ventilator theophylline ** = LUNG
  4. B agonist
  5. Low K or low Mg
  6. digitalis toxicity ** which is drug for CHF or arrhythmia
  7. Sepsis
20
Q

Multifocal Atrial Tachycardia (MAT) TX

A
  1. Ca Channel Blocker : CCB, be careful can make worse
  2. MgSO2 + Amiodarone / Adenosine
  3. Diliazem
  4. Verapamil
21
Q

Multifocal Atrial Tachycardia (MAT) dont give

A
  1. B -Blocker

2. Digitalis

22
Q

Atrial Fibrillation wha happens

A
  1. 350bpm - 600bpm, quivering P waves = undulation of baseline cant see what some P waves are
  2. Irregularly Irregular ** ventricular rhythm = QRS is not regular
  3. Causes blood to pool ——> clots form ——> travel to brain, kidney, foot other places
23
Q

Atrial Flutter looks like what and seen in what leads

A
  1. “ Saw tooth appearance”

2. Leads 2,3,AVF, V

24
Q

Atrial Flutter bpm

A

250-350bpm

25
Q

Atrial Flutter with 2:1 AV Block

A

2 atrial saw tooth looking waves for each QRS

26
Q

Proximal Junctional Tachycardia looks like

A
  1. Inverted P wave since ectopic impulse firing up is from junction above AV node
  2. Upright QRS wave
  3. P wave can come before QRS, after QRS, or after T wave
27
Q

Proximal Junctional Tachycardia what happens no bpm

A
  1. Sudden ,Narrow QRS
  2. Cant see P wave is probably is buried ——> supraventricular tachycardia contraction (PSVT)
    = 150-250bpm
28
Q

Supraventricular tachycardia contraction (PSVT)

A

A type of Proximal Junctional tachy + proximal atrial tachy

= you cant see P wave or really know for sure you see T wave

29
Q

Premature Ventricular Contraction (PVC, VPC) causes

A
  1. Normal heart
  2. CAD, MI, HF, myocardial ischemia, hypoxia
  3. Cardiomyopathy
  4. Acid base problem, electrolyte problem
  5. Hyperthyroidism
  6. Drugs
30
Q

Things to order for abnormal EKG

A
  1. Toxicity panel
  2. CBC : ischemia or bleeding, hypoxia can be seen in vitals
  3. Electrolytes CMP
  4. ABG acid base
  5. Thyroid hormones hyperthyroidism
31
Q

Premature Ventricular Contraction (PVC, VPC) looks like what on EKG

A
  1. Premature not normal looking QRS
  2. No P wave or small inverse P wave in ST segment
  3. ST-T wave opposite of QRS
32
Q

More then 3 Premature Ventricular contractions

A

For longer then 30 sec = V tach with hemodynamics significance

33
Q

Multifocal Premature Ventricular Contraction

A

More then 2 foci = more then 2 different looking QRS waves from different places in V
= they are hemodynamicaly unstable

34
Q

Ventricular Premature contraction with R on T phenomenon

A

Means premature beat happens during repolarization of normal beat
= notch in the bottom part of QRS ( S wave)

35
Q

Accelerated idioventricular rhythm

A

Looks like very bad V tach = huge upward wide R and narrow S
= you dont see P or T
= this is GOOD
= after thrombolysis is done ( clot buster is working)

36
Q

Premature Ventricular Contraction (PVC, VPC) TX

A
  1. Stable = nothing
  2. Symptomatic or acute coronary syndrome = give B-blocker small dose ( Metoprolol)
  3. Unstable : Amiodarone, Lidocaine , Procainamide
37
Q

Monomorphic Ventricular tachycardia

A

All the same looking V Tach

38
Q

Sustained V Tach

A

Goes on and on until something is done

39
Q

Torsades de Pointes what is it

A

“ twisting of the points”

  1. QRS goes from + to - direction
  2. Looks like a party streamer like a twisting flat streamer
40
Q

Causes of Torsades de Pointes

A
  1. Anti-psychotic , anti- arrhythmia
  2. Alcohol
  3. TCA
  4. Inherited prolonged QT
  5. Electrolytes imbalanced
41
Q

Torsades de Pointes TX

A
  1. Pacemaker put in
  2. MgSO4 IV
  3. Isoproterenol
  4. Remove the drug and reverse it if they were taking something
42
Q

When will you most likely be asked to do CPR

A

Ventricular Fibrillation

43
Q

Ventricular Fibrillation is what

A

No pumping, quivering
Disorganized depolarization of V
= usually no pulse and not conscious

44
Q

Ventricular Fibrillation causes

A
  1. AMI
  2. HF
  3. IHD (ischemic heart disease)
  4. K+ low or high
45
Q

Asystole

A

No rhythm , goes away downward line

CPR2 Exam 1 (19 decks)

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