Exam 4 Flashcards
where is precordial stethoscope placed
4th intercostal space and LEFT sternal border
is Vt based on IDEAL body weight
yes (6-8ml/kg)
low BLOOD O2
hypoxEMIA
low TISSUE oxygen
hypoxia
oxygen consumption
VO2
oxygen delivery
DO2
(DO2 tissue is MORE important than DO2 lung)
Low inspired oxygen (FiO2)
Hypoventilation
V/Q mismatch leading to shunt
Diffusion limitations
HYPOXEMIC hypoxia
Not enough Hgb hypoxia
ANEMIC hypoxia
Decreased release of O2
AFFINITY hypoxia
Not enough cardiac output
CIRCULATORY hypoxia
Cell won’t accept the delivery of the O2
HISTIOCYSTIC/O2 utilization hypoxia
when are you more likely to illustrate cyanosis
with HIGH hgb
does an increase in CO2 cause decrease in O2
YES
If SpO2 is near 100% then increasing FiO2 will have ________ effect on DO2
little effect
what are the wavelengths for pulse ox
660nm
940nm
what cause false LOW pulse ox readings
Excessive motion
Blue nail polish
Anemia (low Hgb concentration)
SpO2 < 60%
Improper fitting probe
MetHgb similar to Hgb; if SaO2 (actual oxygen saturation) GREATER than > 85% then SpO2 will show low
what causes dramatically LOW pulse ox
IV methylene blue dye
what causes falsely HIGH pulse ox
Ambient fluorescent light
Carbon monoxide poisoning
MetHgb similar to Hgb; if SaO2 (actual oxygen saturation) LESS than < 85% then SpO2 will show high
what is most accurate spo2 location
cheek
decreased CO2
Hyperventilation: too much elimination
Hypotension
Decreased CO
R to L pulmonary shunt
Hypothyroidism
Hypothermia
Paralysis, motionless
examples of obstructive issues
COPD, bronchospasm, asthma, cystic fibrosis
looks like a “sharks fin”
what is the issue with capnography for non-intubated patients
no plateau phase, not accurate
what is the measurement for STATIC lung compliance
plateau pressure (end inhalation prior to exhalation)
ALWAYS lower than peak pressure
MORE accurate than dynamic compliance
STATIC lung compliance:
Indicates compliance ___________ resistance
Indicates compliance WITHOUT resistance
Measures lung compliance + airway resistance
DYNAMIC lung compliance
what is the measurement for DYNAMIC lung compliance
peak pressure
Pip – plateau pressure =
resistance
increased PiP withOUT plateau pressure increase?
issues with the tube, secretions, foreign body
increased inspiratory gas flow rate
Effort INdependent
Most objective measurement of airway resistance for medium airways
Most sensitive indicator of obstructive disease
Normal: 4-5L/sec
Forced Expiratory Flow (FEF) between 25% and 75% of exhaled breath
Spirometry measures lung _________, __________, and _______
lung volumes, capacities, and flows
o Helps identify airway resistance
o Normal: at least 80% of vital capacity
Forced Expiratory Volume over one second (FEV1)
o Declines with age
o Normal: at least 80%
Forced Expiratory Volume/Forced Vital Capacity (FVC)
Forced expiratory volume 40%
obstructive
forced expiratory volume 90%
restrictive
forced expiratory volume 80%
normal
difficulty getting air OUT of the lungs
obstructive
difficulty getting air INTO the lungs
restrictive
Enlarged TLC, RV, FRC
Reduced ERV
obstructive
FEV1/FVC ratio preserved
Reduced TLC, FRC, RV, FVC & FEV1
restrictive
loop looks like upside down ice cream cone*
NORMAL (FLOW volume loop)
smaller, normal FLOW volume loop shape
restrictive
- Shape is caved in which indicates expiratory obstruction
- Lung volumes are larger
- Flows are reduced
- FLATTER, LESS ROUND shape as air flow is impeded
obstructive
Analyzing shapes and steepness
Indicator of lung compliance (distensibility)
Yields info regarding leaks, lung over-inflation and obstruction
PRESSURE volume loops
pressure volume loop:
during mechanical/positive pressure ventilation
COUNTER-clockwise
pressure volume loop:
during spontaneous ventilation
CLOCKWISE
pressure volume loop:
Higher pressure moves loop farther ______
RIGHT
pressure volume loop:
Flatter slope = ______________ compliance
DECREASED compliance
pressure volume loop:
Steeper slope = _____________ compliance
INCREASED compliance
flow volume loop:
moves in ______________ direction
clockwise
2 examples of fixed obstruction
tumor, tracheal stenosis
Expiration and inspiration constant
fixed obstruction
inspiration: airway narrows
expiration: opens
(milkshake!)
EXTRAthoracic
inspiration: opens airway
expiration: narrows
INTRAthoracic
example of restrictive disease
pulmonary fibrosis
electrolytes:
hyperreflexia
hypotension after induction
ataxia
seizures
HYPERnatremia
electrolytes:
decreased reflexes
seizures
lethargy
HYPOnatremia
electrolytes:
too rapid a correction leads to demyelination of pontine neurons*
associated with 3% hypertonic saline
central pontine myelinolysis
electrolytes:
prolonged PR interval
peaked T wave
HYPERkalemia
electrolytes:
Avoid HYPOventilation (acidosis)
for every 10-mmHg change in EtCO2 the ___+ changes 0.5 mEq
potassium
hyperkalemia dont hypoventilate!
electrolytes:
high U waves
flattened or inverted T waves
low ST segment
digoxin toxicity
HYPOkalemia
electrolytes:
avoid HYPERventilation (alkalosis) with ________________
HYPOkalemia
electrolytes:
DECREASED reflexes
lethargy
confusion
(breast cancer + hyperparathyroidism)
HYPERcalcemia
electrolytes:
INCREASED reflexes
tetany, twitching, tingling lips and fingers
laryngospasm
HYPOcalcemia
electrolytes:
associated with alkalosis, hypoparathyroid
HYPOcalcemia
(avoid hyperventilation)
electrolytes:
relaxes muscles
HYPERmagnesia + HYPOmagnesia
use nerve stimulator always!
electrolytes:
lethargy
(preeclampsia)
HYPERmagnesium
electrolytes:
Poor GI absorption, dialysis, ETOH
HYPOmagnesium
drugs that cause HYPOkalemia
-beta adrenergic agonists
-catecholamines (epi, norepi)
-insulin
-loop diuretics
-thiazide diuretics
-aminoglycosides
-mineralcorticoids (aldosterone)
-AT II
drugs that cause HYPERkalemia
-NSAIDS
-Sch
-digoxin
-ACE inhibitors
-beta blockers
-potassium sparing diuretics
-AT II blockers
SV / (divided by) end diastolic volume
EF
(normal is 55% or greater)
normal SVO2
70-80%
calcium = ___________ potential
threshold
potassium = _____________ potential
resting
what impacts SVO2 (4)
o Oxygen consumption (VO2)
o Hemoglobin level (Hgb)
o Cardiac Output (CO)
o Arterial oxygen saturation (starting) (SaO2)
SVO2 varies ___________ with VO2 (oxygen consumption)
inversely!
as VO2 increases, SVO2 decreases
(all the others are directly related)
decreased SvO2
- Increased VO2 (fever, hyperthermia)
- Decreased Hgb (anemia, hemolysis)
- Decreased SaO2
- Decreased CO (ex: MI, CHF, hypovolemic states)
increased SvO2
- Decreased VO2 (cyanide toxicity, carbon monoxide poisoning, hypothermia, sepsis)
- Increased Hgb (volume depleted)
- Increased SaO2
- Increased CO (burns, inotropic drugs)
CBF = ____–____ ml/100 gm/min = ISOELECTRIC EEG (internal cell)
15-20 ml/100 gm/min
CBF < ____ ml/100 gm/min = ↓ cell integrity =
<10 = irreversible injury
CBF < ____ ml/100 gm/min = __________ of EEG
< 25 = slowing
Cerebral perfusion pressure < ___ torr
<50 CPP= changes in EEG
cerebral perfusion pressure < ___ torr
<25 CPP = irreversible damage
torr =
pressure (associated with CPP)
anesthesia= _______________ changes
anesthesia= symmetrical
ischemia= ________ and ______________ changes
focal and Asymmetric
Fast activity, alert, eyes open, concentrating, anxious or busy thinking
beta
Normal, resting, relaxed, awake adults
alpha
Slow activity, considered abnormal in awake adults; subcortical lesions and encephalopathy
Normal in young children
theta
slowest, subcortical lesions and encephalopathy, hydrocephalus
Normal in babies
delta
SLOWEST frequency and highest amplitude
delta
FASTEST frequency and lowest amplitude
beta
accentuate frequency, then decrease it
Barbiturates and Benzodiazepines
slow frequency, increase amplitude (delta)
opioids
both frequency and amplitude are attenuated (slowed)
inhalation anesthetics
flat line EEG associated with anesthesia
indicative of decreased metabolic oxygen demands and neuroprotective qualities
(good thing!)
isoelectric state
Conscious recall or remembering exact events of previous experiences
explicit memory
Movement and ability to respond to commands without specific conscious recall of events (“awareness without recall”)
implicit (unconscious) memory
Also known as “recall”
consciousness (explicit memory) under general anesthesia with subsequent RECALL of the experienced events
awareness
Paralysis of un-anesthetized patients occurring when patients are given NMBs prior to anesthesia (out of sequence, mislabeling)
awake paralysis
surgeries with the highest risk of recall?
trauma»_space;> cardiac surgery»_space; c-section
to be a part of anesthesia awareness registry, you must experience _________ recall during general anesthesia
explicit
true or false
NO signs are reliable indicators of “light” anesthesia
true
what are the drugs that can mask signs of awareness during surgery
- 1st: NMBs
- Blockage of physiological responses
o Amphetamines
o Beta blockers
o Calcium channel blockers - High levels of vitamin C
to have NO awareness during surgery:
volatile anesthetic at > ____ MAC
> .7
(.5-.7)
5 questions used to assess awareness event:
What was the last thing you remember before you went to sleep?
What is the first thing you remember after your operation?
Can you remember anything in between?
Can you remember if you had any dreams during your procedure?
What was the worst thing about your procedure?
Burst suppression: EEG _______ to random burst of electrical activity
EEG SLOWS to random burst of electrical activity
4 benefits of BIS monitoring
Reduction of PONV
Utilization of less drug to achieve a hypnotic state (save money)
Rapid emergence and recovery from general anesthesia (more efficient)
Improved quality of recovery, reduced PACU length of stay
when is BIS required*
TIVA (use of propofol)
when is BIS indicated
Hemodynamically sensitive patients (trauma, elderly, etc.)
ECT (monitoring of sub-clinical seizure activity)
TIVA (use of propofol)
BIS**
recall
> 70
BIS**
general anesthesia
40-60
BIS**
burst suppression
20
BIS**
flat line EEG (good neuro protection + reduced demand for oxygen)
0
true or false
Do NOT rely on just a single monitor to test awareness
true
what can alter BIS value (7)
Hypothermia
shivering
warming blankets
head trauma
patient positioning
unipolar cautery
ketamine + nitrous (can INCREASE BIS value)
what does a Signal Quality Indicator (SQI) of 100 indicate
optimal, “perfect” signal, believe the BIS number
Electrical signals produced in response to various stimuli by the CNS
Neuronal pathway dysfunction can be identified
evoked potentials
Analysis of raw EEG data to derive a formula-driven numerical value indicative of LOC
BIS
Evoked potentials:
An INCREASE in latency: occurs _____ often (more time between spikes)
increase in latency = occurs LESS often
evoked potentials
described by (3)
latency
amplitude
site of stimulus
evoked potentials
Somatosensory (SSEP)
Afferent signaling = dorsal
Brainstem Auditory: clicking sounds send auditory nerve signal (CN #8)
evoked potentials
Motor (MEP)
Generally inaccurate, less utilized
Giving so much anesthetic to keep patient from moving without NMBs
Efferent signaling = ventral (corticospinal tracts)
evoked potentials
true or false
You CANNOT use NMBs with MEPs
true
it interferes with signal
four types of evoked potentials
Somatosensory
motor
auditory
visual
evoked potentials
IV anesthetics affect SSEP ______ than < inhaled anesthetics
IV anesthetics affect SSEP LESSSSSSS than inhaled
inhaled»_space; bigger impact than IV
Volatile anesthetics produce an _________ in SSEP latency and ___________ in amplitude (slow spikes, less tall)
increase in latency
decrease in amplitude
Etomidate and Ketamine __________ SSEP amplitude
increase amplitude
Nitrous ____________ SSEP amplitude
decreases amplitude
Reductions in blood flow ____________ SSEP
decrease
Opioids have ____ ________ on SSEP amplitude
no effect
cerebral oximetry looks at ____ __________, _________ blood flow
NON-pulsatile
venous blood flow
when should you attach a patient to cerebral oximetry
BEFORE giving oxygen (so you have a baseline)
cerebral oximetry
Regional sat < ____% or changes > ____% of baseline indicate possible reduction in cerebral oxygen
regional < 40%
>25% baseline
If cerebral oximetry goes down, increase the ETCO2 to >_____ mmHg by hypoventilating the patient**
> 40
hypoventilation (acidosis)
causes cerebral vasodilation
Guedel’s Stages of Anesthesia
analyzes ____, ________, and __________ used for respiration
rate, rhythm, and muscles used
Guedel’s Stages of Anesthesia:
Analgesia and Disorientation (in pre-op holding)
stage 1
Guedel’s Stages of Anesthesia*
“Ether eye signs”: gaze becomes disconjugate
stage 2
Guedel’s Stages of Anesthesia*
Laryngospasm, HYPERreflexia,
delirium, agitation, excitement, irregular breathing, apnea, thrashing
stage 2
Guedel’s Stages of Anesthesia
Occurs during both induction + emergence (worst during EMERGENCE)
stage 2
Guedel’s Stages of Anesthesia:
EYELID reflex eliminated
Regular respirations + normal muscle tone
Plane 1, stage 3
Guedel’s Stages of Anesthesia:
LARYNGEAL reflex eliminated (no gag, intubate)
Volume reduced + rate increased
plane 2, stage 3 (ideal stage)
Guedel’s Stages of Anesthesia:
CARINAL reflex eliminated
onset of intercostal muscle paralysis
plane 3, stage 3 (ideal stage)
Guedel’s Stages of Anesthesia:
INTERCOSTAL paralysis complete (respirations eliminated)
plane 4, stage 3
Guedel’s Stages of Anesthesia:
Medullary paralysis (moribund)
Progressive cardiovascular collapse (way too deep)
stage 4
Guedel’s Stages of Anesthesia:
ideal stages
plane 2 and plane 3 (of stage 3)
Tissue stress is directly related to ____ and applied __________
Vt + pressure
anesthesia leads to
_____________ FRC, compliance, and muscle tone and
_____________ resistance
decreased FRC, compliance, muscle tone
increased resistance
Causes of Ventilator-Induced Injury:
Overdistention (volume) of alveoli
VOLUtrauma
Causes of Ventilator-Induced Injury:
Excessive pulmonary pressures
BAROtrauma
Causes of Ventilator-Induced Injury:
Repeated opening and collapse of atelectatic lung units (derecruitment)
ATELECtrauma
Causes of Ventilator-Induced Injury:
Inflammatory mediator release into alveoli and surrounding bronchiole spaces
(can be caused by the atelectrauma, volutrauma, barotrauma)
BIOtrauma
what is the range for mild/permissive hypercarbia (to protect the lungs)
pCO2 40-45 mmHg
Compliance is __________ at the ______________ of inspiration*
compliance is GREATER at the BEGINNING of inspiration
(think of a balloon)
Beginning of inspiration=_____ pressure=high compliance=_____ flow
low pressure=high flow
Vt / plateau pressure – PEEP**
compliance
Increased airway resistance contributes to a ____________ in dynamic compliance*
decrease in DYNAMIC compliance
Decreased COMPLIANCE = increased plateau pressure = increased _________ pressure*
driving pressure
Increased resistance = ____________ peak pressure*
increased PiP
Pplat (plateau pressure) – PEEP**
driving pressure
The LOWER the driving pressure, the ___________ the pulmonary compliance
(this is a good thing)
greater the compliance
increase in PEEP = ___________ in driving pressure
decrease in driving pressure!
increase in fresh gas flow = ____________ in Vt, MV, and PiPs
increase!
*unless using a ventilator compensator
Disconnect= immediately falls flat*
Small leak= gradually descends*
ascending/standing bellows
disconnect=still filled*
ascend during inspiration
descend during expiration
less safe
descending/hanging bellows
initial ventilator settings:
RR: ___-___ bpm
Vt: ___-___ ml/kg ideal body weight
PiP: < ____ cmH2O
Driving pressures: < ___ cmH2O
PEEP: ___-___ (2-3 from bellows weight)
FiO2: ___-___%
I:E Ratio: __:__
RR: 8-12 bpm
Vt: 6-8 ml/kg ideal body weight
PiP: < 30 cmH2O
Driving pressures: < 15 cmH2O
PEEP: 4-5 (2-3 from bellows weight)
FiO2: 40-50%
I:E Ratio: 1:2
what is the SAFEST way to increase MV
increase in RR
what is the most EFFICIENT way to increase MV
increase in Vt
Vt – _________ ____________ = what is delivered to the patient
Circuit Compliance
- Historically: around 100ml
- Present day: around 35-40ml
What is the PAO2 in a patient who is breathing room air and pCO2 is 80 mmHg?
- Lower (around 40-50 mmHg)
The “higher” the I:E ratio, the _____________ the inspiratory time=________ driving pressure**
the higher I:E, the GREATER the inspiratory time, the LOWER the driving pressure
Longer expiratory phase=____________ in ETCO2
reduction
Increase in respiratory rate=____________ pressure and flow
increase
Increase in inspiratory flow=___________ in I:E ratio
decrease
If you are using pressure control ventilation and compliance changes from low to high how will volume change?
volume will increase
ventilator modes:
Most common
Rate can change
Constant flow
PiP/pressure will vary
Barotrauma can occur
VOLUME controlled ventilation
ventilator modes:
Indication
Patients with no respiratory effort
Volume control
ventilator modes:
Indications
LMA, emphysema, neonates, children
Low lung compliance
Laparoscopy, pregnancy, children, ARDS, obesity
pressure control
ventilator modes:
Vt can vary
Varying/decelerating flow
Mandatory rate and inspiration time
Inspiratory times are longer
pressure control
ventilator modes:
Caution: changes in compliance or resistance can dramatically affect Vt delivery!
You can go from Vt 200ml to 1400ml very quickly with a chance in compliance
pressure control
ventilator modes:
decelerating flow waveform
pressure control
ventilator modes:
constant flow waveform
volume control
pressure control with volume guarantee
ventilator modes:
Best option!
Ventilator attempts to guarantee a set volume in PCV
Lung safety is improved
pressure control with VG
ventilator modes:
Pressure support (5-10 cmH20) will overcome the negative inspiratory pressure resistance due to ETT, circuit, filters, etc.
Only inspiratory pressure and breath trigger are set
RR is determined by patient
Amount of inspiratory flow can be programed for sensitivity:
* 200ml/min trigger for sicker patients
* 2000ml/min for patients that are doing well
pressure support ventilation
ventilator modes:
Indications
Spontaneous breathing support to increase comfort
Decreased work of breathing
pressure support ventilation
ventilator modes:
Synchronizes the patient’s efforts with ventilator
Senses negative pressure inside the chest cavity created by diaphragm
Ventilator knows the patient initiated a patient driven breath
If patient does not inspire within trigger synchronization window waiting time, ventilator then will deliver a breath
synchronized intermittent mandatory ventilation (SIMV)
ventilator modes:
Patient breath does NOT compete with ventilator
“Backup” ventilation to maintain normocarbia
SIMV
Vt and flow are _________ dependent
volume
PiP, plateau pressure are __________ dependent
pressure
increase in auto-PEEP = __________ pressure and a ____________ volume
increased pressure, decreased volume
What artery is the SA node fed by?
Right coronary artery
(if affected, will lead to a heart block)
Can be from electrolytes or abnormality
Non-pacemaker cells
QRS and T look the same
ectopic site/foci
what is ventricular THRESHOLD potential
-70 mV
SODIUM ENTERS the cell to make it more positive; 30 mV
phase 0
potassium exits the cell
phase 1, phase 2, phase 3
calcium enters slowly, facilitating prolonged conduction;
potassium still exits the cell
phase 2
RESTING membrane potential: _____mV
-90
phase 4
what is DEPOLARIZATION ____ mV
30 mV
A picture between 2 electrodes
(one + and one -)
lead
Electricity flowing toward a positive lead is viewed as an __________ line
upward
leads:
Between the R arm, L arm, and L leg
BIPOLAR LIMB leads
leads:
Between a limb lead and a reference point (AV node)
unipolar AUGMENTED leads
leads:
Between a chest lead and a reference point (AV node)
unipolar PRECORDIAL leads
leads:
I, II, III
bipolar (limb)
leads:
o aVR (looks right)
o aVL (looks left)
o aVF (looks to the foot)
unipolar (AUGMENTED)
leads:
V1, V2, V3, V4, V5, V6
unipolar (PRECORDIAL)
Einthoven’s Triangle*
right arm is always ____
negative –
Einthoven’s Triangle*
left arm is both ___ and ___
+ and -
Einthoven’s Triangle*
left leg is always ____
+
looks from right arm to left arm
lead I
looks from right arm to left leg
lead II
looks from left arm to left leg
lead III
modified chest leads uses lead ____
lead III
What lead is the most commonly monitored*
lead II
Looks for:
Presence and location of MI, axis deviation, chamber enlargement
DIAGNOSTIC monitoring
Explains HR, regularity, rhythm, conduction patterns
ROUTINE monitoring
4th ICS, RIGHT sternal border
V1
4th ICS, LEFT sternal border
V2
5th ICS, mid-clavicular line
V4
5th ICS, mid-axillary line
V6
Small box: ____ seconds
.04 seconds
large box: ___ seconds
.2
Small box: ___ mV (__ mm)
.1 mV = 1 mm
large box: ___ mV (__ mm)
.5 mV = 5 mm
2 large boxes: __ mV (___ mm)
1 mV= 10 mm
EKG:
standard calibration is ____ mm or ___ mV
10 mm or 1 mV (2 large boxes)
EKG
More sensitivity allows greater reception, but may __________ artifact
increase artifact (so be careful)
EKG
filter mode
sharp
EKG
monitor mode
blurry/fuzzy
what are the 5 parts of interpretation
rate
regularity
p waves
PR interval
QRS complex
PR interval should be less than ____ seconds
< .2 seconds (1 big box)
QRS complex should be less than ___ seconds (less than ___ small boxes)
< .12
< 3 small boxes
p wave ____–____ seconds
< ____ mm in height
.06-.1 seconds
<2.5 mm in height
EKG
Intervals=______ throughout all leads
Picture/tracing=____________ for the leads
intervals=same
picture/tracing=different
Dysrhythmias originate in the SA node
sinus
sinus tachy is 100 to _____ bpm
150
Dysrhythmias originate in the ATRIA
atrial/SUPRAventricular rhythms
Dysrhythmias originate in the AV node
junctional
Inherent/junctional/junctional escape rate
____–____ bpm
40-60
Accelerated junctional ___–___ bpm
60-100
junctional tachy >____
> 100
SVT >____
> 150
ALL ventricular rhythms have a _____ complex QRS
wide complex
what is another name for idioventricular rhythm
ventricular escape rhythm
agonal rhythm
___ or more beats = “run of VT”
> 3 or more
idioventricular/ventricular escape/agonal
is ________ rhythm with ____ P waves
regular rhythm
NO p waves
true or false
with bigeminy PVCs, rate by 60-100, but mechanical rate can be 30-50
true
which heart block has a irregular R-R interval
2nd degree type 1 (wenkebach)
(p-p is still constant, but PR interval changes!)
which heart block has regular p-p, regular pr interval, regular QRS
but multiple p waves per QRS complex?
2nd degree type 2 (classical)
which heart block has a variable PR interval, regular p-p, regular r-r
third degree/complete
pacers:
position I
chamber paced (what the action is)
pacers:
position II
chamber sensed
pacers:
position III
response
pacers:
position IV
modulation (speeding up or slowing down)
pacers:
position V
antitachyarrhythmia functions
true or false
ventricular paced is ALWAYS a wide complex
true
how can you tell the difference between hyperkalemia and an MI
it will be in all leads
look at patient age
which lead can cause false ST elevation
red
RIGHT axis deviation = ____________ movement
clockwise
LEFT axis deviation = _______________ movement
counterclockwise
axis deviation:
Infarct: deviates ______
AWAY
Electricity does not like dead tissue!
axis deviation:
Hypertrophy: deviates ___________ the muscle
TOWARD
axis deviation:
obesity and pregnancy
LEFT shift
axis deviation:
Thin/OSA
RIGHT shift
true or false
Bundle branch block always have a WIDE complex QRS
true
Bundle branch block:
R-R is found in V1 or V2
RIGHT
“right=up”
Bundle branch block:
Deep Q wave is in V1 or V2
R-R is found in V5 or V6
LEFT
“left=down”
Bundle branch block:
can be confused with an MI
LEFT BBB
It may give a false positive for Q wave/infarction, and may also give a false positive on ST change
EKG:
REVERSIBLE category
ischemia
EKG:
tissue compromise
injury
EKG:
irreversible, tissue death
infarction
EKG:
tall/peaked T waves
or
inverted/symmetrical T waves
ST depression
ischemia
EKG:
ST elevation (with troponin release)
injury
EKG:
Q wave formation
(>.04 seconds, >1/3 height of the R wave)
infarction
what is a pathological Q wave
>___ seconds
>___ height of R wave
> .04 seconds
1/3 height of R wave
Sub-ENDOcardial = Non-Q wave MI
– Less than 1/2 of endocardial wall infarcted
– T wave changes peaked/inverted
– ST depression/elevation, no Q wave
what is another term for subendocardial/non-q wave MI
NSTEMI
transmural = sub-EPI cardial = Q wave MI
– More than 1/2 of wall infarcted
– T wave inversion
– ST elevation
– Q wave
what is another term for transmural = sub-EPI cardial = Q wave MI
STEMI
true or false
for diagnostics, there must be an ST elevation in 2 or more leads
true
what is the overall best lead for detecting ISCHEMIA*
V5
what is the best combo for leads*
Lead V4 + V5: best combo (but usually not allowed)
so use: Lead II + V5!!!!
what is the best lead for detecting atrial dysrhythmias
lead II
what leads is hypertrophy detected in
all V leads
atrial hypertrophy:
NOTCHED (mcdonalds hump) p wave
BIPHASIC p wave
WIDENED p wave
LEFT atrial hypertrophy
atrial hypertrophy:
afib and MITRAL regurgitation
LEFT atrial hypertrophy
atrial hypertrophy:
TALL/PEAKED p wave
RIGHT atrial hypertrophy
atrial hypertrophy:
OSA and tricuspid regurgitation
RIGHT atrial hypertrophy
left ventricular hypertrophy:
S wave (in V1 or V2)
+
R wave (in V5 or V6)
=
>____ mm
look for OVERLAP throughout the V leads
> 35 mm
what is an easy way to determine a long QT interval
if it is greater than HALF the distance of an R-R
