EKG Basics Flashcards
When __________ is high, cells may not be able to start depolarizing appropriately.
Potassium
__________ stabilizes hyperkalemia, and it works by ___________
Calcium
Stabilizing the cell membrane
What electrolyte imbalance leads to ectopy?
Hypomagnesemia
This electrical conductance issue causes SVT
aberrant pathway - pissed off atrial nodal cell
________ and ________ makes someone unstable with SVT.
Low BP and poor mentation
What is the normal junctional rhythm?
40-60bpm
The AV node slows conduction by _______ seconds.
What is the purpose of this?
0.1s, allows the atria to contract before the ventricles
What is the purkinje fibers autonomic rate?
20-40bpm
The P wave will be positive in what leads?
I, II, aVF,V4-V6
_______, ________, _________, _________, ___________, are all rhythms where you may not see a P wave.
Idioventricular, A-fib, SVT, V-tach, V-fib
What is the only thing present in primary cardiac standstill?
What does this represent?
Causes:
P waves
The atria are working, ventricle are not doing anything
Blockade preventing impulse to move to ventricles - infarct @ AV node
What does it mean if you have ST elevation in all leads?
Pericarditis
_______ can cause big peaked QRS complexes, and _______ can cause smaller QRS complexes.
Low body tissue amount
Obesity/high tissue amounts
In what leads will the T wave be positive?
I, II, V3-V6
What is the difference b/w ST elevation & peaked T waves?
With ST elevation - they never return to the isometric line
5 steps to rhythm interpretation
- Figure out the HR
- Look @ the P waves
- Is the PR interval fixed or long?
- Look @ the QRS
- Assess T wave morphology
Potential causes of PSVT:
Medications (we stressed the pt), an intervention (medication for the SVT), Aberrant pathway
At above _____ bpm, is when it is considered SVT.
150
______________ usually follows PACs, PVCs, and PJCs.
A compensatory pause
__________ & _________ can be causes of PACs.
Hypoxia, caffeine
What medications clue you into someone having A-fib?
Aspirin, Eliquis, Plavix
_______ and _______ can actually treat/convert A-fib acutely.
_______ is a long-term treatment for A-fib.
Cardioversion & Amiodarone
Digoxin
Rate control meds for A-fib
BB, CCB (cardizem), Esmolol
What are the 3 common causes of A-flutter?
- Drug/medication induced
- Caffeine
- Cocaine intoxication
Why are we more concerned about PVCs over PACs?
PACs - lose 25% CO
PVCs - lose 75% CO
*can lead to V-tach
________, _______, ________, & ______ are common causes of PVCs
Hypoxia (most common)
Electrolyte abnormalities
Ischemia
Electrical injuries
Unstable bradycardia treatment
Pacing
_______ is the 1st line medication for bradycardia.
_______ is the 2nd line medication for bradycardia.
What other meds can we give for bradycardia? (2)
Atropine
Isoproterenol
Epi & Dopamine @ alpha dosing
___________ has a PR interval that gets longer, longer, longer, then drops a QRS.
___________ has a fixed PR interval, with a dropped QRS.
2nd degree type 1 (Wenckebach)
2nd degree type 2
Hints for a 3rd degree block
- Fixed P-P interval
- Fixed R-R interval
*they are not communicating w/ each other
Causes of 3rd degree heart block
- Lenegre Disease (fibrotic degeneration of distal conduction)
- Ischemia
- Metabolic/electrolyte abnormalities
- Infection near conduction system
- Reperfusion injury
- Stunned myocardium after cardiac surgery
How do you treat stable Vtach?
Cardioversion or amiodarone
How do you treat unstable V-tach?
Cardioversion (prob. Not synchronized) - harder for computer to sync
Benefit of synchronized cardioversion
Can use less energy, less chance of R on T & V-fib
Energy amount for defibrillation w/ V-fib
Max recommendation from manufacturers
Monophasic: 360J
Biphasic: 120-200J
What end-tidal CO2 is associated w/ ROSC?
what does it indicate?
> 10mmHg or 50% increase in continuous monitoring
-perfusion happening & cellular byproduct being blown off
Amiodarone dosing
1st: 300mg
2nd: 150mg
Supplied: 150mg/5mL
Lidocaine Dosing (anti-arrhythmic)
1-1.5mg/kg - max 3mg/kg
______ is the most common cause of cardiac arrest and _______ is the 2nd most common cause.
Hypoxia, Hypovolemia
This electrolyte abnormality is a common cause of V-fib/pulseless V-tach
Who is it seen in?
Hyperkalemia
Rhabdo, burns, crush injuries, renal failure
Hs:
Hypovolemia, hypoxia, hypothermia, hydrogen ion (acidosis), hypo/hyperkalemia
Hypo/hyperglycemia
Ts
Tension pneumothorax, cardiac tamponade, toxins, thrombosis (PE, coronary)
REVERSAL AGENTS
________ for Diltiazem.
________ for BB
________ for Digoxin
________ for Opioids
________ for TCAs
Calcium
Glucagon
Digibind
Narcan
Na Bicarbonate
Differences w/ kids hearts compared to adults
- Vagal influence stronger
- Fixed ventricular volume - cannot alter their contractility
-compensate by changing HR
Why is IV bupivacaine worse r/t arrhythmias?
More cardiac toxic & longer acting
_________ can cause hyperkalemia, and ________ can cause hypokalemia
Hypoventilation, Hyperventilation
What can we do to prevent bradycardia in abdominal surgeries?
Give something that blocks vagal stimuli
-Atropine, Ephedrine, Anticholinergics (Glycopyrrolate)
_________, __________, & __________ are common causes of post-op dysrhythmias.
Hypoxemia
Cardiac Ischemia
Catecholamine Excess (cocaine, ketamine, stress, surgical stimulation, inadequate analgesia/anesthesia)
Lidocaine 2nd dose
0.5-0.75mg/kg
______ is the energy for the 1st defibrillation in pediatric cardiac arrest.
______ is the energy for the 2nd defibrillation in pediatric cardiac arrest.
______ is the energy for subsequent defibrillation in pediatric cardiac arrest.
______ is the max energy.
2J/kg
4J/kg
> or equal to 4J/kg
Max: 10J/kg or the adult dose
Pediatric Epi dose
0.01mg/kg - 0.1mL of the 0.1mg/mL concentration
Max dose 1mg
Pediatric Atropine Dose
0.02mg/kg
Common causes of V-fib/V-tach in kids
Electrocution, drowning
Pediatric Amiodarone dose
5mg/kg bolus in cardiac arrest
*can repeat up to 3x in refractory v-fib/v-tach
Pediatric lidocaine dose
1mg/kg loading dose
Adenosine doses
6mg, 12mg
Procainamide Doses IV (adult tachycardia)
20-50mg/min until arrhythmias suppressed or if there is hypotension, or if QRS duration > by 50%
*max dose: 17mg/kg
Maintenance infusion: 1-4mg/min
When do we avoid Procainamide?
Prolonged QT or CHF
Amiodarone dose for adult tachycardia
150mg over 10min - repeat if V-tach recurs
Maintenance: 1mg/min for 1st 6hrs
Sotalol IV dose for adult tachycardia
100mg (1.5mg/kg) over 5min
*avoid in prolonged QT
Synchronized Cardioversion energy
50J, 100J, 200J
Depends on rhythm & device
Pediatric synchronized cardioversion energy
0.5 - 1J/kg
Increase to 2J/kg
Pediatric Adenosine Dose
0.1m/kg max 6mg
0.2mg/kg max 12mg
Potential causes for maternal cardiac arrest
Anesthetic complications, bleeding, cardiovascular, drugs, embolic, fever, general non-OB causes (Hs & Ts), HTN
