Introduction to 12 lead ECGs Flashcards
What does aV stand for in cardiac monitoring?
Augmented view
What is the best lead for viewing bundle branch block?
V1 (septal view)
What are continuous leads?
Leads that are beside one another
Leads I, II, and III are called the ____ ____ ____
Standard limb leads
Are leads I, II, and III bipolar or unipolar leads?
Bipolar
Leads aVR, aVL, and aVF are called the ____ ____ ____.
Augmented limb leads
Are leads aVR, aVL, and aVF bipolar or unipolar leads?
Unipolar
Leads V1 through to V6 are called the ____ ____.
Chest leads
Are leads V1 through to V6 bipolar or unipolar leads?
Unipolar
What is a reciprocal change?
An effect mirrored in opposite lead views
What are the diagnostic settings of an ECG?
x1.0
.05-40Mhz
25mm/sec
What is x1.0 on an ECG monitor?
Amplitude
What is .05-40Mhz on an ECG monitor?
Frequency response
What is 25mm/sec on an ECG monitor?
Paper speed
What is the J point?
The junction between termination of the QRS and the ST segment
At which point is ST segment elevation/depression measured?
0.08 seconds from the J point (two small boxes)
How many squares above the isoelectric line are significant when viewed by the limb leads?
One
How many squares above the isoelectric line are significant when viewed by the chest leads?
Two
Which are the lateral leads?
Leads I, aVL, V5, and V6
Which are the inferior leads?
Leads II, III, and aVF
Which are the septal leads?
Leads V1 and V2
Which are the anterior leads?
Leads V3 and V4
When is thrombolysis used?
When you’re more than an hour from a PCI hospital
What drug class is clopidogrel?
Antiplatelet
What is the indication for clopidogrel?
Patients with STEMI who have been accepted for pPCI when the receiving cardiologist is requesting clopidogrel administration OR when the patient has received tenecteplase and has been given aspirin and enoxaparin.
What are the contraindications for clopidogrel?
- KSAR
- Pts contraindicated for fibrinolysis
- Current clopidogrel or ticagrelor therapy
- Pt <18
- Active bleeding (excluding menses)
- Prior intracranial haemorrhage
What are the precautions for clopidogrel?
Severe renal impairment
What are the side effects of clopidogrel?
Haemorrhage
What is the presentation of clopidogrel?
75mg tablet
What is the dosage of clopidogrel?
Cardiologist requested: 600mg
Post-tenecteplase admin: 300mg
What drug class is enoxaparin?
Anticoagulant
What is the indication for enoxaparin?
STEMI pts who will receive tenecteplase as as adjunct to clopidogrel and aspirin
What are the contraindications for enoxaparin?
- KSAR to enoxaparin OR heparin
- Pts contraindicated for fibrinolysis
What are the precautions for enoxaparin?
- Renal/hepatic impairment
- Females <45kg and males <57kg
- Elderly
What are the side effects of enoxaparin?
- Haemorrhage
- Thrombocytopenia
What drug class is tenecteplase?
Fibrinolytic
What is the indication for tenecteplase?
STEMI pts who meet the criteria for prehospital tenecteplase
1% of patients given tenecteplase will have a ____ ____.
Haemorrhagic stroke
What drug class is ticagrelor?
Antiplatelet
What is the indication for ticagrelor?
STEMI pts who have been accepted for pPCI and the receiving cardiologist is requesting ticagrelor administration
What are the side effects of ticagrelor?
Haemorrhage and bradycardia
What are the criteria adult pts must meet for consideration of autonomous fibrinolysis administration?
- Proximity to a pPCI facility (>60 minutes transport time)
- GCS 15 pt with ongoing ischaemic chest pain for <6 hours
- 12 lead ECG is consistent with STEMI
What are the contraindications for autonomous fibrinolysis administration?
- <18 or >75
- Uncontrolled hypertension and/or diastolic BP >110 at any stage in paramedic care
- Known allergy to tenecteplase, enoxaparin, or clopidogrel
- LBBB identified on 12 lead ECG
- Current or hx of thrombocytopenia
- Active tuberculosis
- Known cerebral disease, particularly malignant intracranial neoplasm or arteriovenous malformation
- Prior intracranial haemorrhage
- Ischaemic stroke or TIA in last 3 months
- Hx of significant closed head or facial trauma in last 3 months
- Suspected aortic dissection
- Hx of major trauma or surgery in last 6 weeks
- Internal bleeding in last 6 weeks
- Bleeding or clotting disorder
- Current use of anticoagulants
- Non-compressible vascular punctures
- Prolonged CPR (>10 minutes)
- Known pregnancy or has given birth in last 2 weeks
- Hx of serious systemic disease
- Resident of aged care facility requiring significant ADL
- AMI in traumatic setting
What are the complications of autonomous fibrinolysis administration?
- Life-threatening stroke
- Haemorrhage
- Failure to achieve reperfusion
What are the criteria adult pts must meet for consideration of autonomous primary percutaneous coronary intervention (pPCI) referral?
- Proximity to a pPCI facility (<60 minutes transport time from time of diagnostic 12 lead ECG)
- GCS 15 pt with ongoing ischaemic chest pain for <12 hours
- 12 lead ECG is consistent with STEMI
What are the contraindications for autonomous pPCI referral?
- Hx of serious systemic disease
- Resident of an aged care facility requiring significant ADL
- MI in acute traumatic setting
List things that promote myocardial salvage
- Rest and reassurance
- Oxygen
- GTN
- Aspirin
- Enoxaparin/Clexane
- Heparin
- Clopidogral
- Analgesia
- Methoxyflurane
- Dysrhythmia management
- Beta blockers
- Tirofiban
- ACEls
List what can be used in dsyrhythmia management
- Defibrillation
- Valsalva manoeuvre
- Cardioversion
- Lignocaine
- Atropine
- Beta blockers
- Transcutaneous pacing
- Adrenaline infusion
- Amiodarone
What are beta blockers?
Adrenoreceptor antagonists
What is the effect of beta blockers?
- Decreases the rate of rise of phase 4 in the pacemakers
- Slows down conduction from the SA node through to the AV node
- Creates a partial AV block
- Prophylaxis against recurrent tachdysrhythmias
