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emt 230 Flashcards

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1
Q

The coronary arteries deliver _____ml of blood to the myocardium each minute?

A

200-250 ml

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2
Q

The L main coronary artery supplies what part of the heart?

A

The L ventricle, the interventricular septum, and part of the R ventricle

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3
Q

The R coronary artery supplies what part of the heart?

A

The R atrium and ventricle, part of the L vent, and the conduction system

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4
Q

Avg stroke volume is ___ml for an adult

A

70 ml

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5
Q

Preload? End-diastolic volume?…definitions

A

Preload - the volume of blood returning to the heart

End diastolic - the volume returning to each ventricle

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6
Q

Cardiac output is?

A

the amount of blood pumped by the ventricles in 1 min

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7
Q

Afterload (definition)…..a result of?

A

the pressure within the aorta before ventricular contractions. A result of peripheral vascular resistance

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8
Q

How is afterload reduced?

A

lowering bp and vasodilators

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9
Q

Parasympathetic control of the heart is through the ____ nerve?

A

Vagus nerve - reduces HR and to a lesser extent contractility

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10
Q

Sympathetic nerve fibers originate in _____ region of the spinal cord

A

Thoracic region

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11
Q

The resting membrane potential inside a cell is appx ____ to ____ mV

A

-70 to -90 mV.

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12
Q

What electrolyte/ion is most responsible for cardiac contraction?

A

Calcium

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13
Q

Give 2 examples of calcium channel blockers

A

Verapmil and ditiazem

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14
Q

What happens is phase 0 of the cardiac action potential?

A

Rapid depolarization - rapid entry of sodium into the cell, this causes the inside of the cell to become more positively charged than the outside….leading to muscular contraction

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15
Q

What are the 2 ways basic ways ectopic impulses are generated?

A

Enhanced automaticity and reentry

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16
Q

Phase 1 of cardiac action potential?

A

the early rapid repolarization. Returns the cell membrane to it’s resting permeability state

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17
Q

Phase 2 of the cardiac AP?

A

The “plateau phase”. Prolonged phase of repolarization of the AP

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18
Q

Phase 3 of the cardiac AP?

A

The terminal phase. It results in the inside of the cell becoming negatively charged. Repolarization is completed by the end of this phase

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19
Q

Phase 4 of the cardiac AP?

A

the period between action potentials

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20
Q

EKG paper: each sm square is equal to ____ seconds?

A

.04 seconds

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21
Q

EKG paper: each small square (height/amplitude) is equal to _____ mV?

A

0.1 mV

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22
Q

PR segment…begins and ends where?…

A

starts at the end of the P wave and ends at the onset of the QRS complex

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23
Q

PR interval…begins and ends where?

A

starts at the beginning of the P wave and ends at the onset of the QRS complex

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24
Q

The duration and amplitude of the P wave is normally?

A

duration: 0.1 seconds or less
amplitude: 0.5 - 2.5 mm

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25
Q

Normal P-R interval duration?

A

0.12 - 0.20 sec

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26
Q

Normal QRS complex duration?

A

0.08 - 0.10 sec

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27
Q

The triplicate method can be used when?

A

the rhythm is regular and the HR is above 50

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28
Q

R-R method is used when?

A

The rhythm is regular and it can also be used for HR’s under 50

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29
Q

6 second count method used for?

A

appx rate in regular and IRREGULAR rhythms

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30
Q

If the distance between the R to R waves are equal or vary by less than ____ sec, they are considered regular.

A

0.16 second

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31
Q

Any duration greater than ____ is considered a prolonged P-R interval and indicates an AV block

A

0.2 second

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32
Q

Most SVT’s are likely caused by what?

A

A reentry mechanism that involves abnormal pathways in the AV node

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33
Q

SVT’s are rare in pt’s with _____?

A

myocardial infarction

34
Q

SVT typical rate?

A

150 - 250 beats/min

35
Q

Treatment (in order) for symptomatic narrow complex SVT?

A

vagal maneuvers and adenosine, calcium channel/beta blockers (stable pt’s only), then synchronized cardioversion beginning at 50 J

36
Q

NEVER administer diltiazem or verapamil to a pt with what rhythm?

A

V-tach

37
Q

Signs and symptoms of CHF with impaired cardiac function?

A

jvd, dyspnea, tachycardia, chest pain, or decreased LOC

38
Q

Atrial flutter is almost always a result of ?

A

rapid atrial reentry focus

39
Q

What drugs are used to treat pt’s with rapid a-fib?

A

Diltiazem, beta blockers, calcium channel blockers. Possibly amniodarone or digoxin if used within 48 hrs of a-fib onset.

40
Q

The pt is at an increased risk of _____ when a-fib or a-flutter has been present for more than 48hrs.

A

Emboli Formation. “throwing a clot” …this usually occurs when a-fib is converted suddenly to a sinus rhythm.

41
Q

What drugs should never be given to a pt with WPW?

A

adenosine, diltiazem, verapamil, digoxin, and in most cases beta blockers. These drugs may cause a dangerous increase in HR

42
Q

The initial shock to convert A-fib should be set at ___?

A

synchronized shock

100-120 J biphasic (200 J monophasic)

43
Q

What are the 3 main P-wave characteristics in a junctional dysrhythmia?

A

1) inverted P wave in lead II with a short P-R interval
2) absent P wave
3) P wave after the QRS complex

44
Q

3 ECG features found in VENTRICULAR dysrhythmias?

A

1) QRS complexes are wide and bizarre in appearance
2) P waves may be hidden in the QRS complex
3) ST segments usually deviate from the baseline

45
Q

Ventricular Escape Complex/Rhythm is also known as ___?

A

Idioventricular Rhythm

46
Q

Ventricular Escape dysrhythmias happen when ___?

A

impulses from higher pacemakers fail to fire or reach the ventricles or when the rate of discharge of a higher pacemaker falls below the rate of the ventricles.

47
Q

What dysrhythmia is often the first seen after defibrillation?

A

Ventricular escape rhythm

48
Q

R on T phenomenon definition?

A

The occurrence of ventricular depolarization during the refractory period

49
Q

V-tach is defined as?

A

3 or more consecutive ventricular complexes that occur at a rate of 100+ beats/min

50
Q

Torsades de pointes definition

A

a type of polymorphic ventricular tachycardia

51
Q

Any wide complex tachycardia that occurs with serious signs and symptoms requires what?

A

immediate cardioversion

52
Q

When is a precordial thump appropriate?

A

when unstable v-tach is witnessed and cardioversion is not immediately available

53
Q

What is the most common initial rhythm disturbance in sudden cardiac arrest?

A

v-fib

54
Q

4 possible causes of pacemaker malfunction

A

1) battery failure 2) runaway pacemaker

3) failure of the sensing device 4) failure to capture

55
Q

ECG abnormality for a 1st degree AV block

A

a prolonged, constant P-R interval is often the only alteration on the ECG

56
Q

ECG abnormality for a 2nd degree AV block - type I

aka Wenckbach or Morbitz I

A

A cyclical pattern where the P-R intervals get progressively longer until a P wave is not followed by a QRS complex. ( a missed beat)

57
Q

Where are 2nd degree AV blocks - type II usually located?

A

below the bundle of His

58
Q

2 ECG criteria for recognizing a bundle branch block?

A

1) a QRS complex equal or greater than .12 sec (wide complex “rabbit ears)
2) QRS complexes produced by supraventricular activity.

59
Q

When viewing a 12-lead, which leads are best for viewing ventricular conduction disturbances?

A

V1 and V6

60
Q

What class of drug is Lasix (Furosemide)?

A

loop diuretic

61
Q

What action should you take for a pt with an unstable, bradycardic rhythm?

A

Pace the pt

62
Q

What position should a pt with chest pain be in?

A

semi-fowlers

63
Q

Depolarization of the heart is dependent on what?

A

Sodium/Potassium pump

64
Q

A heart failure pt should be positioned at what angle?

A

45 degrees

65
Q

When the heart can’t meet the metabolic needs of the body…..this is referred to as?

A

Cardiogenic shock

66
Q

Never pace a pt with PEA

A

Never pace a pt with PEA

67
Q

What part of the EKG show atrial depolarization?

A

P wave

68
Q

What type of nerve fibers go through the heart

A

sympathetic

69
Q

Sinus tachycardia is commonly caused by ____?

A

an increase in sympathetic tone

70
Q

What may be a lethal treatment for a pt with a ventricular escape rhythm?

A

Lidocaine

71
Q

Leads I, II, and III are referred to as ______ or _______ leads

A

bipolar or limb leads

72
Q

What type of valves prevent the backflow of blood into the ventricles?

A

semilunar valves

73
Q

Starling’s Law

A

Myocardial fibers contract more forcefully when they are stretched

74
Q

Automaticity in cells?

A

cardiac fibers have specialized cells that can generate their own electrical impulses spontaneously

75
Q

Bipolar leads have what type of electrode charge?

A

Each of the bipolar leads has one positive electrode and one negative electrode

76
Q

What are the 3 augmented leads? Bipolar or Unipolar?

A

Unipolar leads. aVR, aVL, and aVF

77
Q

In augmented leads, the current flows from the heart ______ to the extremities

A

outward

78
Q

V1 - V6 are _____ leads

A

unipolar. aka precordial leads

79
Q

What part of the EKG represents ventricle relaxation and repolarization?

A

T wave

80
Q

Collateral circulation allows for what?

_____ makes collateral circulation possible

A

Collateral circulations allows for an alternate path of blood flow in the event of a vascular occlusion.
ANASTOMOSES (comm between two or more vessels) make coll circ possible

81
Q

Blood vessels and arterial walls have 3 layers, what’s the middle layer called?

A

Middle is the tunica media

82
Q

Main differences between a 2nd degree type I and II AV block

A

The P-R interval progressively lengthens in Type I whereas it’s usually constant for Type II.
Type II will have more frequent missed QRS complexes.
Type II generally has a wider QRS complex compared to Type II is usually associated with an MI
Type I is usually transient and reversible

emt 230 (1 decks)

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