EKG

Question 1

AUTOMATICITY

Answer 1

creation of impulse

Question 2

EXCITABILITY

Answer 2

response to impulse

Question 3

CONDUCTIVITY

Answer 3

passing of impulse

Question 4

CONTRACTILITY

Answer 4

contraction + work of heart

Question 5

CONDUCTION PATHWAY

Answer 5

SA (sinoatrial) NODE > INTERNODAL TRACT > RT/LT ATRIA > AV (atrioventricular) NODE > BUNDLE OF HIS > BUNDLE BRANCHES > PURKINJE FIBERS > VENTRICLE

Question 6

how many BPM if SA node is controlling it?

Answer 6

60-100 BPM; normal sinus rhythm

Question 7

how many BPM if AV node is controlling it?

Answer 7

40-60 BMP

Question 8

how many BPM if BOH is controlling it?

Answer 8

20-40 BMP

Question 9

what is the P WAVE responsible for?

Answer 9

atrial contraction/depolarization ; the electrical impulse into atria

Question 10

what is the PR INTERVAL?

Answer 10

time from atrial depolarization to ventricular contraction (goes from start of P to start of R)

Question 11

what is the QRS complex?

Answer 11

ventricular contraction/depolarization

Question 12

what is the ST segment?

Answer 12

beginning of ventricular depolarization (from end of S to beginning of T)

Question 13

what is the T WAVE?

Answer 13

ventricular repolarization (ending wave); heart is in diastole > rest

Question 14

what is the QT INTERVAL?

Answer 14

entire depolarization and repolarization of the ventricles

Question 15

EKG measurements: PR INTERVAL

Answer 15

0.12-.20 seconds - normal

Question 16

EKG measurements: QRS COMPLEX

Answer 16

0.04-0.12 seconds - normal

Question 17

EKG measurements: ST SEGMENT

Answer 17

0.12 seconds - normal (ensure there isn’t a 1mm+ height = MI)

Question 18

EKG measurements: QT INTERVAL

Answer 18

0.34-0.43 seconds - normal

Question 19

how many seconds is obtained to read an EKG?

Answer 19

SIX SECONDS; 6 SECONDS

Question 20

how many small squares is a 6 second interval?

Answer 20

150 small squares = 6 seconds

Question 21

how many large squares is a 6 second interval?

Answer 21

30 large squares = 6 seconds

Question 22

how many small squares is equal to ONE MINUTE on EKG?

Answer 22

1500 small squares = 1 minute

Question 23

how many large squares is equal to ONE MINUTE on EKG?

Answer 23

300 large squares = 1 minute

Question 24

how do you figure out the heartrate on the EKG strip?

Answer 24

#1: obtain 6 second sample: 30 large squares OR 150 small squares
#2: count the R intervals (intervals between QRS complex)
#3: multiply this number by 10 (7 R intervals x10 = 70 BPM)

Question 25

what is the size of one of the squares; in height?

Answer 25

1 small square = 1 mm

Question 26

what is the time length of one small square vs large square?

Answer 26

1 small square = 0.04 seconds

1 large square = 0.20 seconds

Question 27

how many small blocks vs big blocks = 1 minute

Answer 27

1 minute = 1500 small blocks
and
1 minute = 300 large blocks

Question 28

what is the most accurate way to determine the HR in normal sinus rhythm?

Answer 28

count the small blocks between each R wave; divide that number into 1500 small blocks (number in 1 minute) = accurate heartrate!

***this cannot necessarily be used to determine the HR on an irregular rate

Question 29

SYSTEMATIC APPROACH TO RHYTHM ASSESSMENT:

Answer 29

1) Determine the rate
2) What is the atrial activity
3) What is the ventricular activity

Question 30

systematic approach to rhythm assessment - DETERMINE THE RATE

Answer 30

-is the rhythm regular or irregular?
» measure the distance between two R WAVES (R to R intervals)
**how many R intervals x10 = BPM

Question 31

systematic approach to rhythm assessment - WHAT IS THE ATRIAL ACTIVITY

Answer 31

• is there a P WAVE, and do all P WAVES all look the same
• is there a P WAVE for every single QRS COMPLEX?
• is atrial activity rapid, irregular, or difficult to identify?
• what is the PR INTERVAL; is it normal or prolonged? **NORMAL = 0.12-0.20

Question 32

systematic approach to rhythm assessment - WHAT IS THE VENTRICULAR ACTIVITY?

Answer 32

• what is the QRS INTERVAL; is it normal or prolonged?
• what is the QRS duration?
• what is the ST SEGMENT; is it normal or prolonged? is it elevated, or depressed?
• is the T WAVE upright or inverted?
• what is the QT INTERVAL; is it normal or prolonged?

Question 33

what is NORMAL SINUS RHYTHM?

Answer 33

NSR = 60-100 BPM

• P>Ps are normal + consistent
• there is a P wave for every QRS complex
• R>Rs normal + consistent
• PR interval = 0.16 seconds
• QR complex = 0.04 seconds
• QT interval = 0.40 seconds

Question 34

what is SINUS BRADYCARDIA?

Answer 34

**less than 60 BPM; normal rhythm LESS than 60 BPM; all other aspects of the EKG would be normal except for the lower HR

Question 35

What interventions are needed for SINUS BRADYCARDIA?

Answer 35

• administer oxygen
• administer atropine and/or epinephrine
• external pacing

Question 36

what is a common cause of this? (movie theatre example)

Answer 36

too much digoxin leads to hypokalemia;

too much potassium leads to increased digoxin levels

Question 37

what is SINUS TACHYCARDIA?

Answer 37

***BPM GREATER THAN 100; heart is working harder, pushing blood faster

-this can be normal if exercising, or other high demands on body

Question 38

what to do with tachycardia?

Answer 38

TREAT THE UNDERLYING CAUSE/ISSUE:
-decreased B/P; treat HYPOtension
-decreased oxygen sat; administer oxygen
etc.