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Back to Basics > Module 1 - ECG and IABP monitoring > Flashcards

Module 1 - ECG and IABP monitoring Flashcards

1
Q

Anterior MI - Coronary artery affected - 12 Lead

A

Coronary artery affected - 12 Lead

LAD V3, V4

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2
Q

Inferior MI - Coronary artery affected - 12 Lead

A

Coronary artery affected - 12 Lead

RCA II, III, aVF

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3
Q

Lateral MI - Coronary artery affected - 12 Lead

A

Coronary artery affected - 12 Lead

LCX I, aVL, V5, V6

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4
Q

Septal MI - Coronary artery affected - 12 Lead

A

Coronary artery affected - 12 Lead

LAD V1, V2

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5
Q

Posterior MI - Coronary artery affected - 12 Lead

A

Coronary artery affected - 12 Lead

LCX or RCA V1 - V4, ST depression, tall R-wave progression

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6
Q

Coronary Circulation

A

Consists of R&L Coronary Arteries that arise from the coronary ostia at the aortic root.
Fills during Ventricular Diastole

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7
Q

Left main coronary artery

A

Branches into LAD & LCX

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8
Q

LAD supplies

A

Supplies:
the Anterior surface of the heart
the anterior 2/3 of the septum
and part of the lateral wall

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9
Q

LCX supplies

A

Primarily supplies lateral wall of LV

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10
Q

RCA supplies

A

Supplies:
RA
RV
Inferior and posterior walls of the LV

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11
Q

Leads V1-V6 are also known as

A

Chest leads
precordial leads
unipolar leads

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12
Q

Leads V1-V6 view heart on what plane

A

Horizontal plane

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13
Q

I, II, II leads are also known as

A

Limb leads

bi-polar leads

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14
Q

aVL, aVR, aVF are also known as

A

Augmented leads

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15
Q

The augmented leads view the heart from what plane

A

Vertical plane

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16
Q

Most common lead used for transport

A

Lead II

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17
Q

The J Point

A

area where S wave changes direction

can be used to determine: ST depression/elevation, and/or QRS duration

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18
Q

Delta wave

A

associated with WPW

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19
Q

Osborne wave

A

associated with hypothermia

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20
Q

Z point is

A

reference point when measuring hemodynamic waveforms

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21
Q

[image posterior MI]

A

Posterior MI =
R waves increase,
ST segment depression present in V1-4
Tall R-waves in Right precordium

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22
Q

ST changes: ST Elevation is

A

Injury (acute MI)

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23
Q

ST changes: ST Depression is

A

Ischemia

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24
Q

ST changes: Pathological Q wave

A

Infarction (necrosis) = > 25% of R-wave

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25
Q

Q wave significance:

A

Acute injury = Q wave with ST elevation
Indeterminate = Q wave with ST depression
Old infarction = Q wave without ST changes

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26
Q

ST measurement: Limb leads / Precordial leads

A

Limb/Bi-polar leads : > 1mm above or below in 2 contiguous leads
Precordial/chest/Unipolar : > 2mm above or below in contiguous leads

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27
Q

Tented/peaked T waves

A

> 5mm can indicate Hyperkalemia [image]

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28
Q

Flattened T waves / U waves

A

U waves occur just after the T and are usually smaller than the T wave and can indicate hypokalemia

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29
Q

Short PRI

A

may indicate WPW - delta wave is due to early conduction through the accessory pathway [image]

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30
Q

Wide QRS

A

possible: BBB present, TCA overdose

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31
Q

Prolonged QT interval

A

possible TCA overdose [image]
QT interval measuring R-R interval.
QT interval measuring > 1/2 R-R is prolonged until proven otherwise

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32
Q

Salvador Dali’s Mustache

A

DIG DIP - presenting as ST depression; may indicate digitalis toxicity. [image]

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33
Q

Pericarditis/Infection on ECG

A

Diffuse ST elevation on entire ECG in conjunction with PR depression
Presenting with pericardial friction rub or fever [image]

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34
Q

Electrical Alternans on ECG

A

Suspect pericardial effusion/ cardiac tamponade [image]

R-wave amplitude changes across ECG

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35
Q

12 Lead Interpretation

A

L - lateral wall - I, aVL, V5, V6
I - inferior wall - II, III, aVF
S - septal wall - V1, V2
A - anterior wall - V3, V4

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36
Q

3rd degree heart block description

A

aka: Complete HB, AV disassociation

QRS interval and P-P interval are regular, but disassociated with each other [image]

37
Q

2nd degree Type I heart block description

A

aka: 2nd degree AVB, Type I, Mobitz I, or Wenckebach [image]

R-R is irregular because there is a dropped QRS complex. PRI lengthens until it drops a beat.

38
Q

2nd degree Type II heart block description

A

aka: 2nd degree AVB, Mobitz II, Type II [image]

PRI is constant and there are more P waves than QRS complexes. Can be various ratios 2:1, 3:1 etc

39
Q

1st degree Type II heart block description

A

description [image]

40
Q

What type of injury? [image]

A

Acute injury is indicated by ST elevation.

41
Q

What type of injury? [image]

A

Ischemia / Old Infarction / Digitalis Toxicity can present with ST depression

42
Q

Q waves present with ST elevation can indicate [image]

A

Acute myocardial injury is occurring

43
Q

Q waves present with ST depression or T-wave inversion can indicate [image]

A

Indeterminate

44
Q

Q waves present without ST changes can indicate [image]

A

Old injury / Infarction

45
Q

How does paced rhythm appear on ECG?

A

100% paced rhythms have ventricular spikes present before the QRS [image]

46
Q

[Image] Torsades

A

Polymorphic V-Tach - Torsades de pointes; can occur with or without a pulse.

47
Q

What is concern with a inferior MI?

A

Patients presenting with an inferior wall MI may also have a right ventricular MI present which would affect filling pressures. Medications that decrease preload are not recommended, unless the patient has been managed with IV fluids prior to administration. Diagnosis of a right ventricular myocardial infarction (RVMI) can be done by obtaining a right-sided 12-lead ECG. The presence of ST elevation in RV4 is a highly sensitive marker for right ventricular involvement.

Lopez, Orchid Lee (2011-02-15). Back To Basics: Critical Care Transport Certification Review (p. 38). Xlibris. Kindle Edition.

48
Q

Pericardium

A

Double-walled fibrous sac surrounding the heart

49
Q

3 layers of the hearts myocardium

A

Epicardium—thin, outermost layer
Myocardium—thick, muscular middle layer
Endocardium—thin, innermost layer

50
Q

Valve order

A

T-P-M-A (remember Toilet Paper My A$$)

Tricuspid, pulmonic, mitral, aortic

51
Q

Serum potassium is usually > ____ when ECG changes are present?

A

7.0

Normal range of Potassium 3.5 - 5.0

52
Q

[afib with ST elevation image]

A

Atrial fibrillation with ST elevation. R-R intervals are irregularly irregular with no obvious P waves present.

53
Q

[afib with BBB image]

A

Atrial fibrillation with bundle branch block. R-R intervals are irregularly irregular with no discernable P waves present.

54
Q

[image 2nd degree type I]

55
Q

[image second degree type II]

56
Q

[image 1st degree type I]

57
Q

[image Complete HB]

58
Q

Inferior wall MI is caused by occlusion of which coronary artery?

59
Q

A patient with hx of TCA OD can exhibit

A 
Prolonged QT (>1/2  R-R) [Monitor QTc value > 540]
QRS > 0.12 seconds
60
Q

Normal K+ is

A

3.5-4.5 can be as 5.5 and still be considered normal

61
Q

Atrial Tachycardia is

A

aka Supraventricular Tachycardia
Narrow QRS
Regular R-R at a rate > 160 bpm

62
Q

IVR is

A

Idioventricular rhythm -
ventricular rate of 20-40
wide QRS > .120
no P waves

63
Q

AIVR is

A

Accelerated IVR
ventricular rate of 40-60
wide QRS > .120
no P waves

64
Q

QRS is measured

A normal QRS is _____ seconds.

A

measured from beginning of QRS to the J

Normal QRS is 0.04-0.12 seconds long

65
Q

Diagnosis of a Right sided MI includes

A

Right sided 12-lead with ST elevation in V4

Place lead V4 in same spot on right side

66
Q

IABP begins to purge during ascent, this is a reflection of what gas law?
Equipment affected -
Conditions affected -

A

Boyle’s Law -
Expansion of gas - Ascent / Contraction of gas - Descent
Other equipment that may be affected: BP Cuff, ET tube
Other conditions that may be affected: Pneumothorax

67
Q

The balloon for the IABP has dislodged which pulse site is most likely affected?

A

The L radial is most commonly affected.
Balloon placement in the descending Aorta
Distal tip sits near L subclavian - Decrease/Absent Radial pulse
Proximal end is positioned just above renal arteries - Decrease/Absent urine output

68
Q

What do Rust colored flakes indicate in IABP?

A

Balloon rupture

69
Q

[Image: IABP EI]

A

Early Inflation - If greater than 2mm from diacritic notch

70
Q

[Image: IABP LI]

A

Late Inflation

71
Q

[Image: IABP ED]

A

Early Deflation

72
Q

[Image: IABP LD]

A 
Late Deflation - 
if AIDA (Assisted Diastole) > DIA (unassisted diastole)
AIDA < DIA = Normal timing
73
Q

The primary trigger for the IABP is the

A

Patients ECG, using the R wave

74
Q

Timing should always be assessed in a __:__ ratio.

A

1:2 ratio to compare between assisted and unassisted landmarks

75
Q

IABP’s improve hemodynamic effects by

A

increasing coronary blood flow

decreasing workload

76
Q

The ______ waveform is used to set and assess timing.

A

Arterial pressure waveform

77
Q

PAEDP

A

Patient Aortic End Diastolic Pressure -

This is patients unassisted diastole

78
Q

PSP

A

Peak Systolic Pressure -

This is the patients unassisted systole

79
Q

PDP or DA

A

Peak Diastolic Pressure or Diastolic Augmentation -

This is the pressure generated in the aorta as a result of inflation

80
Q

BAEDP

A

Balloon Aortic End Diastolic Pressure -
This is the lowest pressure produced by deflation of the IAB;
this is Assisted Diastole (ADIA)

81
Q

APSP

A

Assisted Peak Systolic Pressure -

this systoles follows ballon deflation and should reflect the decrease in LV work

82
Q

DN

A

Diacrotic Notch - closure of the aortic valve

83
Q

Balloon inflation occurs at the onset of

A

Ventricular Diastole -

Indicated on the Arterial waveform as the diacritic notch.

84
Q

Ballon deflation should occur

A

at the end of diastole, just prior to the onset of ventricular systole.

85
Q

Late deflation can:

A

Decrease: Arterial Pressure, Cardiac Output, Ejection Fraction
Increase: Heart Rate, Pulmonary Artery Diastolic pressure, Capillary Wedge Pressures

86
Q

LVAD criteria

A

Heart Transplant Candidate
demonstrate reversible endstage organ disease
BSA large enough for device
NY Heart Association - Class IV heart failure criteria
Hemodynamic deterioration: CI < 2.0; MAP < 65;
Ability to manage device

87
Q

If IABP fails

A

cycle balloon every 30 minutes

88
Q

Most lethal IABP timing errors

89
Q

IABP inflates

IABP deflates

A

at onset of Ventricular diastole

at onset of Ventricular systole

Back to Basics (11 decks)

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