EKG Monitoring

Question 1

Consists of 3 sections:

• P wave
• QRS complex
• T wave

Answer 1

Normal rhythm signwave

Question 2

A method of calculating bpm from EKG output readings

Atrial rate: # of boxes between the PP interval
Ventricular rate: # of boxes between the RR interval

Divide 1,500 by # for bpm
ex. if # is 15 then: 1,500/15 = 100 bpm

Good 4 precise measurements and best applied 2 fast rhythms

Answer 2

1500 method

Question 3

A method of calculating bpm from EKG output readings

Must remember the pattern: 300-150-100-75-60-50
(300 comes from 300 boxes in 1 min of output signwave)

Estimates bpm based on # of mm boxes between QRS complexes
(only an estimate of bpm-not accurate)

1) find R wave and assign 300 to nearest 5 mm grid line (then 150 to next 5 mm grid line on right, then 100…)
2) the assigned # closest 2 the next R wave represents ventricular rate

Answer 3

The sequence method

Question 4

A method of calculating bpm from EKG output readings

Works in any situation and is considered the Gold standard 4 estimating bpm of irregular rhythms

1) count # of QRS complexes in two 3 second intervals(hash marks on top of output paper represent 3 second intervals)
2) # x 10 = bpm

Answer 4

The 6 second rule

Question 5

Structures that can appear in the EKG recording that r not natural

Can b caused by a variety of reasons: (from text book)

• muscle: movement of patient
• wandering baseline: loose electrodes, dried out electrolyte, moisture on skin and excessive movement of the chest during respiration.
• 60 cycle: electrical interference from other machines or improper grounding of EKG
• interrupted baseline: broken hardware

Answer 5

Artifacts

Question 6

A type of artifact

Appears when:

• electrodes r improperly placed on torso
• movement of leads during reading
• patient movement(text classifies as muscle artifact)
• loose or dry electrodes
• patient’s labored breathing
• moisture on skin from lotions, oils….

2 eliminate this artifact:

• move the limb leads from the torso 2 the wrists and ankles or 2 an area of low tremor
• tell patient 2 relax and breath more slowly
• clean skin where electrodes r 2 b placed

Answer 6

Wandering baseline

Question 7

A type of artifact

Movement caused by seizures, shivering or an anxious patient.

2 eliminate artifact:

• seizure must b controlled b4 testing
• reassure patient 2 calm them
• provide blankets
• move electrodes 2 an area w/minimal movement

Answer 7

Seizure and trembling artifacts

Question 8

A type of artifact

When the electrodes or gel wont adhere well 2 the skin causing not enough skin contact 2 ensure a strong signal
-or-
When there is too much moisture on the skin (diaphoretic)

2 eliminate artifact use a tincture of benzoin on the skin b4 placing electrodes and must completely dry b4 electrodes r placed on skin

Answer 8

Dry or wet skin

Question 9

Specially designed 2 interface w/skin

Senses low energy levels and requires full surface area 2 make contact

do not use if dried out

Answer 9

Dry gel artifact

Question 10

Electrical interference from other machines

Cell phone: may appear as flutter or P waves w/an output signwave of 300/min

2 eliminate artifact:

• ensure that all unnecessary devices r turned off or moved away
• first consider non-medical devices as cause of artifact

Answer 10

Interference artifact