Module 9 Flashcards
AANA standard #_____ addresses monitoring and alarms
9
Document blood pressure, heart rate, and respiration at least every ____ minutes for all anesthetics
5 minutes
What is the standard initial medication (name & dosage) used for the treatment of MH?
Dantrolene 10mg/kg
Electrical depolarization with systolic contraction
HR
Detectable peripheral arterial pulsation
Pulse rate
pulse rate is less than heart rate (Afib, PVCs, PEA)
Pulse deficit
Tall ____ waves can be mistaken for R waves and “double count” HR
T waves
ST segment trending monitors have an average sensitivity of ___% and an average specificity of ___% in detecting myocardial ischemia.
74%
73%
Approximately _______ of patients scheduled for noncardiac surgery have risk factors for coronary artery disease (CAD)
one-third
The overall incidence of perioperative ischemia in patients with CAD scheduled for cardiac or noncardiac surgery ranges from ___% to ___%.
20% to 80%
defined as where the QRS complex ends and the ST segment begins
ST junction
ST junction is synonymous with the ___ point
J
Two standard monitoring leads?
leads II & V5
Which lead has the highest sensitivity for myocardial ischemia detection?
V5
Which lead is the best for RV ischemia detection?
V4
When V4 & V5 are used together, they have a ___% sensitivity for myocardial ischemia detection
90%
best lead for monitoring P waves, enhancing diagnosis of dysrhythmias
Lead II
Einthoven’s standard (limb) leads
I, II, III
Goldberger’s augmented leads
aVR, aVF, aVL
Precordial (chest) leads
V1-V6
Name the 3 bipolar leads
I, II, III
Name the 6 unipolar precordial leads
V1-V6
Name the 3 modified unipolar leads
aVR, aVF, aVL
With a 3-lead system, you cannot see the ______ portion of the heart
anterior
Aleadcomposed of two electrodes of opposite polarity is called______ lead
bipolar
Aleadcomposed of a single positive electrode and a reference point is a _______lead
unipolar
How many leads for the standard of care for at risk pts?
5-lead
In a 5-lead setup, which lead is preferred for arrhythmia monitoring?
V1
In a 5-lead setup, which 3 leads are preferred for myocardial ischemia monitoring?
V3-V5
In leads I, II, and III, all waveforms should be _______ deflected
positively
In this augmented lead, all waveforms are positive
aVF
In this augmented lead, all waveforms are negative
aVR
In this augmented lead, the P wave & T wave are negative, and the QRS is biphasic
aVL
In the precordial leads, the P wave and T wave are _______, and the QRS (in ascending order V1, V2, V3……..) starts ______ and ends _______.
Positive
Negative
Positive
The ___ wave represents atrial depolarization
P wave
The _____ ______ represents the bridge between atrial and ventricle activation
PR interval
Within the PR interval, name the electrical pathway (in order) from atrium to ventricles.
AV node
Bundle of His
Bundle branches
Ventricles (purkinje fibers)
A conduction delay within the PR interval likely represents slow ___ node conduction
AV node
What is the normal PR interval duration?
0.12-0.2 seconds
What is the normal QRS duration?
0.06-0.1 seconds
This represents ventricular depolarization on an ECG
QRS complex
The ___ wave represents ventricular repolarization
T wave
What is the Q wave? Why is it there? Why do we care? (Probably not a test question, but important to know and will help in understanding pathological Q waves)
Physiologic activation of the ventricles begins at the left side of the interventricular septum. These early septal depolarization forces are oriented anteriorly and to the right. As a result, small (<0.04 sec in duration) “septal” Q waves typically occur in the lateral precordial leads (which have a left-right spatial orientation) and in one or more of the limb leads (except aVR).
https://www.uptodate.com/contents/pathogenesis-and-diagnosis-of-q-waves-on-the-electrocardiogram?search=q%20wave&source=search_result&selectedTitle=1~125&usage_type=default&display_rank=1
What segment represents ventricular repolarization?
ST segment
The ____ segment is most sensitive to myocardial ischemia
ST segment
With this type of ischemia, you will see ST elevation with/without tall T waves
Transmural ischemia
This type of ischemia is secondary to acute coronary artery occlusion or spasm
Transmural ischemia
With this type of ischemia, you will see ST depression
subendocardial ischemia
This type of ischemia is secondary to stable angina or
significant but stable CAD
subendocardial ischemia
decreased R wave amplitude, pathologic Q wave
MI
abnormal Q wave
Transmural MI
less likely to have Q wave
Subendocardial MI
ST depression, flat T wave, prominent U wave
Prolongs repolarization
Long QT syndrome
Torsades de points
hypokalemia
Narrow, peaked T wave, short QT interval
QRS widening, flat P wave, PR prolongation, 2nd & 3rd degree block
ventricular flutter, asystole
hyperkalemia
short QT, decreased T wave amplitude or inversion
hypercalcemia
prolonged QT
hypocalcemia
