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CPR Exam 1 > Normal EKG Readings - Dr. Johnston > Flashcards

Normal EKG Readings - Dr. Johnston Flashcards

1
Q

When do you see the U wave

A

Hyperkalemia

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2
Q

How much in time and length is each line on the ECG (each light line)

A 
1mm = 0.04sec (HORIZONTALLY)
1mm = 0.1mV (VERTICALLY)
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3
Q

How much time and length is each dark line on the ECG

A 
5mm = 0.2sec (HORIZONTALLY)
5mm = 0.5mV (VERTICALLY)
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4
Q

How long should the PR interval be

A

*not over 0.20sec

NORMAL : 0.12sec - 0.20sec

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5
Q

PR interval is what

A

From beginning of P to beginning of Q

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6
Q

PR segment is what

A

From end of P to beginning of Q

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7
Q

QRS interval is how long in normal ECG

A

Less than 0.12sec

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8
Q

What happens in T wave

A

Ventricular repolarization when K+ leaves the myocytes

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9
Q

QT interval is what

A

From beginning of Q to end of T

*VENTRICULAR SYSTOLE

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10
Q

How long is a normal QT interval

A

LESS then HALF of previous RR interval

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11
Q

P wave should look how

A
  1. Upright above baseline in*
    - LIMB LEADS 1 and 2
    - CHEST LEADS V4 and V6
    - AVF
  2. inverted in*
    - AVR
  3. Variable in
    - 3
    - AVL
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12
Q

What happens if AVR in P wave is not inverted

A

Junctional beat

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13
Q

What happens during the PR interval in the heart

A

The SA node fires and sends signal to Ventricular muscle fibers (0.12sec-0.20sec)
*not greater then 0.20sec

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14
Q

QRS complex should be how long

A

0.05sec- 0.10sec

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15
Q

Q wave should be how long

A

No more then 0.03sec

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16
Q

When would you see small narrow 1mm-2mm height Q waves

Which leads

A

LEADS 1
AVL, AVF
LEADS V5 + V6

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17
Q

ST segment is what kind of line

A

Isoelectric line (same level as PR segment)

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18
Q

ST segment can be elevated or depressed as a normal sign in what leads

A 
NORMAL ELEVATION : 
1. only up to 1mm (standard leads)
2. Only up to 2mm (chest leads)
NORMA DEPRESSION :
* only is less then 0.5mm in any lead
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19
Q

ST depression is due to

A

Subendocardial injury

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20
Q

ST elevation is due to

A

Subepicardial injury
Transmural injury
Ischemia

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21
Q

T wave shape

A 
Round and asymmetrical 
UPRIGHT IN: 
- LIMB LEAD 1 and 2
- CHEST LEAD V3-V6
INVERTED IN:
-AVR
VARIABLE IN:
- AVL, AVF, V1, V2
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22
Q

T wave should be how high

A

Up to 5mm only (STANDARD LEADS)

Up to 10mm only (PRECORDIAL LEADS)

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23
Q

What can this show : inverted T waves or tall upright T waves,

A

HYPERKALEMIA

Ischemic patterns

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24
Q

What can this show : elevated ST segment

A

Pattern of injury

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25
What can this show : not normal Q wave or QRS complex
Necrosis or infarction
26
LIMB leads include
1, 2, 3
27
Augmented limb leads include
AVR (right arm) AVL (left arm) AVF (foot)
28
PRECORDIAL leads include
V1-V6 (CHEST LEADS) V1, V2 —> activity in AVR V3,V4 —> anterior wall and ventricular septum activity V5,V6 —> lateral wall of ventricle
29
What leads get activity from lateral heart
1, AVL, V5, V6
30
What leads get activity from inferior or diaphragmatic heart
2, 3, AVF
31
What leads get activity from anterior heart
V1-V4
32
How do you know the ECG is normal
The lead 1 is upright = positive impulse The AVF is upright *sinus rhythm
33
What happens with a notched broad looking P wave
Mitral stenosis (P-mitrale) Patient can come in with atrial fibrosis *most prominent in lead 1)
34
What happens with a tall pointed and peaked looking P wave
``` Lung problems (P-Pulmonale) COPD, emphysema, RESP failure , pulmonary HTN *flat P in lead 1, tall pointed in lead 2,3 ```
35
What happens with a inverted looking P wave
Leads 2,3 has short PR interval (AV-Junctional Rhythm)
36
4 things that can shorten the PR interval
1. AV- Junctional and atrial rhythm is low 2. Wolf-Parkinson- white syndrome 3. Lawn - Gangong- Levine syndrome 4. Glycogen storage disease
37
2 things causing prolonged PR interval
1. AV block : due to coronary disease, rheumatic disease | 2. Some hyperthyroidism
38
Double R wave
Right bundle block
39
Deep Q wave
Old heart attack
40
When can you have ST depression normally
After exercise
41
Deep Inverted T wave
Anterior infarction
42
Tall upright T wave
Inferior infarction
43
Extreme tall T wave that i height or QRS
Myocardial ischemia no infarction
44
Sinus rhythm
P wave comes before QRS
45
PR interval should not be higher then
0.2sec | = no AV block
46
QRS should not be higher then
0.12sec | = no bundle branch block
47
Best leads to look at P wave
LEAD 2 and V1
48
U wave is what
Bundle or His and Purkinje fibers repolarize | Hypokalemia
49
How to treat tachycardia or bradycardia
Depends on the cause
50
How to calculate HR | 2 ways
300/dark lines OR Number of beats in 3sec X 20 (Number of beats in 6sec X 10)
51
How to calculate HR if you want to use number of small boxes
1500/ number of small boxes
52
P : QRS ratio
= 1
53
What does it mean if the P wave comes after the QRS
SVT (AV nodal re-entry tachycardia) | Junctional rhythm
54
What happens if there is no P wave
Atrial fibrillation Atrial flutter Junctional or ventricular escape rhythm Junctional tachycardia
55
How are the leads intersecting | What are perpendicular to each other
LEAD 1 perpendicular to AVF LEAD 2 perpendicular to AVL LEAD 3 perpendicular to AVR
56
What is the normal degree What is the 90-180 degree What is the negative degree
0-90 is normal (positive) 90-180= Right ward axis (positive) 0-90 (negative) = leftward axis 90-180 (negative) = extreme RIGTH axis deviation
57
What makes a normal EKG 0-90 positive degrees
The Lead 1 (x axis) and the AVF (y-axis) are both positive
58
How does the locations of each lead look on the circle diagram
Here
59
POSITIVE AXIS
+ lead 1 | + AVF
60
LEFT AXIS
+ lead 1 | - AVF
61
RIGHT AXIS
- lead 1 | + AVF
62
EXTREME RIGHT AXIS
- lead 1 - AVF (-90 to 180 positive)
63
Lead 1 + AVF - Lead 2 +
0-30 to (negative) left axis deviation
64
Lead 1 + AVF - Lead 2 -
30-90 (negative) left axis deviation
65
Lead 1 - | AVF +
Right axis deviation greater then 100 degrees (positive)
66
How to treat low HR
Atropine
67
How to find the isoelectric lead
The QRS that has half above base line and half below the base line (half negative and half positive)
68
If the isoelectric lead is lead 3 and lead 1 and AVF are + what is the degree
Perpendicular to lead 3 is AVR which is negative pole is at +30 degrees
69
What is the rate rhythm and axis here
75 HR sinus Isoelectric is AVL, Lead 2 is perpendicular to it and so = +60 degrees
70
What is the rate rhythm and axis here
75HR sinus Lead 3 is isoelectric, AVR = +30 degrees HOWEVER you use the smallest QRS if there is one* = AVL = lead 2 = +60 degrees ****
71
What is the rate rhythm and axis here
``` 75HR - 100HR sinus LEAD 1 - AVF + = right axis deviation Most isoelectric is AVR, perpendicular is lead 3 = +100 degrees at its positive pole ```
72
What is the rate rhythm and axis here
50HR sinus LEAD 1 + AVF - = left axis deviation Isoelectric is lead 2, however AVR is the smallest Lead 3 is perpendicular which is negative pole at = - 60 degrees
73
What is the rate rhythm and axis here
``` 100HR sinus LEAD 1 + AVF - = left axis lead Isoelectric is AVR, perpendicular to it is a negative lead 3 = -60 degrees ```

CPR Exam 1 (20 decks)

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