EKG

Question 1

Sinus Bradycardia

Answer 1

• <60 BPM
• may affect BP
• may be expected due to medical condition
• symptomatic bradycardia: hypotension leading to dizziness
• Tx: atropine 0.5 mg bolus repeat q3-5min max is 3mg – if no response, go to transcutaneous pacing, epi, and dopamine

Question 2

Sinus tachycardia

Answer 2

• >100BPM
• causes: substances (stimulants, caffeine), medical (infection, anemia)
• tx: CCB, BB

Question 3

atrial fibrillation

Answer 3

• no discernible P wave (F waves)
• risk for: clotting, PE, stroke, MI
  
  • prevention: aspirirn, warfarin, clopidogrel
• no atrial kick= dec CO
• goal: vent rate <100
• jacuzzi waves

Question 4

atrial flutter

Answer 4

• sawtooth
• same risk as a flutter
• atrial rate 200-350

Question 5

premature atrial contractions (PAC)

Question 6

ventricular fibrillation (V. FIb)

Answer 6

• LIFE THREATENING, NO PULSE, CODE BLUE
• chaotic irregular wave form
• tx: CPR, dfib, epi

Question 7

ventricular tachycardia (v. tach)

Answer 7

• LIFE THREATENING, CAN BE PULSE OR PULSELESS (CODE BLUE)
• NO pulse= CPR, dfib, epi
• pulse= antidysrrtythmics, cardioversion
• torsades= type of v tach, asses for hypomag and long QT syndrome
• HR >100

Question 8

supraventricular tachycardia (SVT) or paraoxysmal supraventricular tachycardia (PSVT)

Answer 8

• P wave no visible
• 150-220BPM
• assess for underlying cause: e- imbalance
• tx: vagal stim/valsalva maneuver (bear down)= dec HR, adenosine (push rapid, CL preferred), CCB/BB, chemical cardioversion (expect ventricular asystole for a sec), cardiac ablation (destrosy tissue causing electrical activity)

Question 9

preventricular contractions

Answer 9

• wide QRS
• cause: stimulants, pain, e- imbalances
• > 6/min= cal HCP
• prevent/tx: amiodarone
• assess for hyperkalemia

Question 10

asystole

Answer 10

• flat line, code blue, always pulseless
• CPR, dfib, epi

Question 11

ST elevation/T wave inversion

Answer 11

• ST elevation= myocardial tissue injury
• T wave inversion= ischemia to myocardial tissue, a precuror to a STEMI

Question 12

3rd degree heart block

Answer 12

• no not need to know rhythm for exam
• dangerous rhythm may revery to something more fatal
• pacemaker required
  
  • transcutaneous pacing
  • Permanent pacemaker/ICD

Question 13

complete heart block

Answer 13

Question 14

cardioversion

Answer 14

• sync ON
• deliver shock on R wave
• if becomes pulseless turn sync OFF

Question 15

pacemaker and ICD

Answer 15

• Pacing spikes should be followed by their appropriate electrical waveform
  
  • atrial pacing= spike precedes P wave,
  • ventricular pacing = spike precedes QRS complex
• If failure to capture occurs transcutaneous pacing
• no MRI, avoid direct stress (exercise) and trauma to ICD site

Question 16

ACLS algorithm

Answer 16