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Acute Care Module 3 > EKG > Flashcards

EKG Flashcards

1
Q

what are the three cogs in the gas exchange diagram

A

muscle, heart, and lungs

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2
Q

what three things are most vital to PT EKG interpretation

A

rate, rhythm, and ischemia

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3
Q

what is standard resting myocardium resting membrane potential

A

-90 mV

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4
Q

describe a positive wave

A

depolarization from the endocardium to the epicardium

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5
Q

why use a 12 lead

A

standardized, 3D view of the heart

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6
Q

what is telemetry and why use it?

A

4 chest leads and little box on the patient’s hip useful for remote monitoring and mobilization

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7
Q

what is a holter monitor

A

long term EKG that can be employed if a patient feels their own dysrhythmia

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8
Q

Describe limb leads

A

4 electrodes producing 6 views of the heart

I, II, III and aVR, aVL, and aVF

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9
Q

describe chest leads

A

6 electrodes for 6 views of the heart

V1-6

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10
Q

what is the normal conduction pathway (8 steps)

A
  1. SA node (pacemaker)
  2. intranodal branches and Bachman’s Bundle
  3. Atrium
  4. AV node
  5. Bundle of His
  6. R and L Bundle Branches
  7. Purkinje fibers
  8. Ventricles
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11
Q

what allows the electrical wave of depolarization to go from the pacemaker cells through the myocardium?

A

gap junctions

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12
Q

If the R arm is the “cold” lead and the L arm is the “hot” lead…

  1. which way will the EKG deflect during a depolarization to the L arm
  2. which way will the EKG deflect during a depolarization to the R arm
  3. which way will the EKG deflect during a repolarization to the R arm
A
  1. positive to positive = upward deflection
  2. positive to negative = downward deflection
  3. negative to negative = upward deflection
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13
Q

what is going on here

A

atrial depolarization

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14
Q

what is going on here

A

AV node delay - charge returns to isoelectric line b/c no electrical activity currently

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15
Q

what is going on here

A

septal depolarization: L bundle branch moves faster than R bundle branch

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16
Q

what is going on here

A

ventricular depolarization

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17
Q

what is going on here

A

the downspike begins as the vetricles complete their depolarization and the EKG returns to the isoelectric line

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18
Q

what is going on here

A

the ventricles have completed depolarization and the EKG has returned to the isoelectric line - no electrical activity of the heart

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19
Q

what is going on here

A

ventricular repolarization

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20
Q

where is atrial repolarization on an EKG

A

trick question, it’s masked by the QRS complex

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21
Q

what will an EKG look like if the “hot” lead is on the right? (as in aVR?)

A

everything will be the same, but inverted

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22
Q

what is happening in NSR

A
  1. HR = 60-100
  2. SA Node is in control
  3. rhythm is regular
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23
Q

what is a normal PR interval? how does 1st degree AV block differ?

A

< 0.2s or 1 large box; prolonged or delayed p wave

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24
Q

what does this EKG indicate?

A

ST segment depression of 1mm = myocardial ischemia

the greater the ischemia, the greater the depression

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25
Q

what does this EKG indicate?

A

STEMI - acute myocardial infarction

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26
Q

how much time elapses between these marks?

A

3 seconds

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27
Q

what is the heart rate?

A

80 bpm

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28
Q

what is the heart rate using the rule of 300s?

A

75 bpm

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29
Q

when can you use the rule of 300s

A

only on rhymical EKGs

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30
Q

the rule of 300s can also be used on an EKG ruler, but what is primary difference when using the EKG ruler

A

you need to look 3 cycles from the reference arrow

31
Q

what qualifies as bradycardia and tachycardia? in what populations do you see these rhythms as “normal”

A
  • bradycardia - <60 bpm - normal in athletes
  • tachycardia - >100 bpm - normal in babies
32
Q

what is the HR? name the EKG

A

40 bpm - sinus bradycardia

33
Q

what is the HR? name the EKG

A

140 - sinus tachycardia

34
Q

what is the HR? name this rhythm

A

120 bpm - sinus tachycardia

35
Q

what’s the inherent rate of…

  • the SA node
  • atria
  • AV node
  • ventricles
A
  • 100 bpm
  • 75 bpm
  • 60 bpm
  • 30-40 bpm
36
Q

with dysrhythmia, how would you measure the heart rate MOST reliably

very important

A

auscultation

37
Q

name this rhythm abnormality

A

L atrium PAC

(LA b/c T wave is inverted)

38
Q

name this rhythm abnormality

A

RA PAC

39
Q

what is this rhythm abnormality and how can you tell

A

PNC aka early AV node contraction

“no P wave with a normal QRST”

40
Q

what is this rhythm abnormality and how can you tell

A

PVC b/c wide, wild, and bizzarre

41
Q

what is a compensatory pause?

A

a pause after a premature contraction in order to correct for the inadequate filling. The pulse after the premature contraction will feel weaker, but the second pulse will feel stronger

42
Q

how many premature contractions per minute do we contact the doctor?

A

6 per minute

43
Q

what is the difference between unifocal and bifocal/multifocal PVCs?

A

unifocal PVCs all look the same, bifocal two look the same, multifocal - PVCs look different - mutlifocal PVCs are usually worse

44
Q

what is the HR and how would you name it?

A

50 bpm

normal sinus bradycardia with 2 unifocal PVCs

45
Q

what do you call this and would you exercise this patient?

A

bigeminy

46
Q

what is this rhythm

A

trigeminy (2 normal and 1 abnormal)

47
Q

what is this rhythm?

A

quadrigeminy (3 normal and 1 abnormal)

48
Q

what’s the HR and what would you name this

A

80 bpm

quadrigeminy PVC

49
Q

name this

A

couplet

50
Q

what do you call this and why

A

v-tach because more than 3 PVCs in a row

51
Q

T/F: all patients who are in v-tach feel it

A

false, some patients can be unaware that they are in v tach

52
Q

what is this? where is the ectopic site?

A

paroxysmal atrial tachycardia (PAT) - the ectopic site is in the RA because of the upward P wave

53
Q

what is the difference between PAT and Normal Sinus Tach

A

PAT jumps up to a higher heart rate immediately whereas normal sinus tach gradually builds up

54
Q

what is this and how can you tell

A

supraventricular tachycardia (SVT) - cant distinguish p vs t waves but the QRS is normal

55
Q

what is the HR for people in vtach?

A

150-250 bpm with >3 PVCs in a row

56
Q

what is this?

A

v tach

57
Q

what is this

A

atrial flutter - multiple p waves for every qrst

58
Q

what is this

A

A-fib - wiggly line with irregularly spaced spikes

59
Q

what is the HR? How would you name it? where is the ectopic site?

A

90 bpm

A-Fib with PVC couplet

ectopic sites all over the atrium and one in the ventricle

60
Q

what is this and what is the usual HR for these patients? what would you do?

A

ventricular flutter - 250-350 bpm

most of the time these patients are unconscious and you wont feel a pulse

61
Q

what is this

A

V Flutter

62
Q

what is this? what would you do?

A

V-Fib

activate EAP and begin compressions

63
Q

what is this?

A

V Fib

64
Q

name this rhythm

A

quadrigeminy STEMI with PVC landing on t wave

65
Q

what are the three escape beats

A

atrial, nodal, and ventricular

66
Q

name this

A

Atrial Escape Beat

67
Q

name this… why?

A

nodal escape beat - b/c no p wave and QRST looks normal

68
Q

name this and why

A

ventricular escape beat - flat line followed by PVC

69
Q

how do you determine a 1st degree AV block?

A

PR interval greater than one large block (> 0.2s )

70
Q

name this

A

1st degree AV block with ST depression

71
Q

what is this, how can you tell

A

second degree heart block

multiple (2-3) P waves to cause a QRS

72
Q

what is this and how can you tell

A

3rd degree AV block b/c p waves dont match QRS

73
Q

where does an NSTEMI occur? STEMI?

A

NSTEMI = sub-endocardial

STEMI = transmural

Acute Care Module 3 (11 decks)

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