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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
Q

What can this show : not normal Q wave or QRS complex

A

Necrosis or infarction

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26
Q

LIMB leads include

A

1, 2, 3

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27
Q

Augmented limb leads include

A

AVR (right arm)
AVL (left arm)
AVF (foot)

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28
Q

PRECORDIAL leads include

A

V1-V6 (CHEST LEADS)
V1, V2 —> activity in AVR
V3,V4 —> anterior wall and ventricular septum activity
V5,V6 —> lateral wall of ventricle

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29
Q

What leads get activity from lateral heart

A

1, AVL, V5, V6

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30
Q

What leads get activity from inferior or diaphragmatic heart

A

2, 3, AVF

31
Q

What leads get activity from anterior heart

A

V1-V4

32
Q

How do you know the ECG is normal

A

The lead 1 is upright = positive impulse
The AVF is upright
*sinus rhythm

33
Q

What happens with a notched broad looking P wave

A

Mitral stenosis (P-mitrale)
Patient can come in with atrial fibrosis
*most prominent in lead 1)

34
Q

What happens with a tall pointed and peaked looking P wave

A 
Lung problems  (P-Pulmonale)
COPD, emphysema, RESP failure , pulmonary HTN
*flat P in lead 1, tall pointed in lead 2,3
35
Q

What happens with a inverted looking P wave

A

Leads 2,3 has short PR interval (AV-Junctional Rhythm)

36
Q

4 things that can shorten the PR interval

A
  1. AV- Junctional and atrial rhythm is low
  2. Wolf-Parkinson- white syndrome
  3. Lawn - Gangong- Levine syndrome
  4. Glycogen storage disease
37
Q

2 things causing prolonged PR interval

A
  1. AV block : due to coronary disease, rheumatic disease

2. Some hyperthyroidism

38
Q

Double R wave

A

Right bundle block

39
Q

Deep Q wave

A

Old heart attack

40
Q

When can you have ST depression normally

A

After exercise

41
Q

Deep Inverted T wave

A

Anterior infarction

42
Q

Tall upright T wave

A

Inferior infarction

43
Q

Extreme tall T wave that i height or QRS

A

Myocardial ischemia no infarction

44
Q

Sinus rhythm

A

P wave comes before QRS

45
Q

PR interval should not be higher then

A

0.2sec

= no AV block

46
Q

QRS should not be higher then

A

0.12sec

= no bundle branch block

47
Q

Best leads to look at P wave

A

LEAD 2 and V1

48
Q

U wave is what

A

Bundle or His and Purkinje fibers repolarize

Hypokalemia

49
Q

How to treat tachycardia or bradycardia

A

Depends on the cause

50
Q

How to calculate HR

2 ways

A

300/dark lines
OR
Number of beats in 3sec X 20
(Number of beats in 6sec X 10)

51
Q

How to calculate HR if you want to use number of small boxes

A

1500/ number of small boxes

52
Q

P : QRS ratio

A

= 1

53
Q

What does it mean if the P wave comes after the QRS

A

SVT (AV nodal re-entry tachycardia)

Junctional rhythm

54
Q

What happens if there is no P wave

A

Atrial fibrillation
Atrial flutter
Junctional or ventricular escape rhythm
Junctional tachycardia

55
Q

How are the leads intersecting

What are perpendicular to each other

A

LEAD 1 perpendicular to AVF
LEAD 2 perpendicular to AVL
LEAD 3 perpendicular to AVR

56
Q

What is the normal degree
What is the 90-180 degree
What is the negative degree

A

0-90 is normal (positive)
90-180= Right ward axis (positive)
0-90 (negative) = leftward axis
90-180 (negative) = extreme RIGTH axis deviation

57
Q

What makes a normal EKG 0-90 positive degrees

A

The Lead 1 (x axis) and the AVF (y-axis) are both positive

58
Q

How does the locations of each lead look on the circle diagram

A

Here

59
Q

POSITIVE AXIS

A

+ lead 1

+ AVF

60
Q

LEFT AXIS

A

+ lead 1

- AVF

61
Q

RIGHT AXIS

A
  • lead 1

+ AVF

62
Q

EXTREME RIGHT AXIS

A
  • lead 1
  • AVF

(-90 to 180 positive)

63
Q

Lead 1 +
AVF -
Lead 2 +

A

0-30 to (negative) left axis deviation

64
Q

Lead 1 +
AVF -
Lead 2 -

A

30-90 (negative) left axis deviation

65
Q

Lead 1 -

AVF +

A

Right axis deviation greater then 100 degrees (positive)

66
Q

How to treat low HR

A

Atropine

67
Q

How to find the isoelectric lead

A

The QRS that has half above base line and half below the base line (half negative and half positive)

68
Q

If the isoelectric lead is lead 3 and lead 1 and AVF are + what is the degree

A

Perpendicular to lead 3 is AVR which is negative pole is at +30 degrees

69
Q

What is the rate rhythm and axis here

A

75 HR sinus
Isoelectric is AVL,
Lead 2 is perpendicular to it and so = +60 degrees

70
Q

What is the rate rhythm and axis here

A

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
Q

What is the rate rhythm and axis here

A 
75HR - 100HR sinus
LEAD 1 -
AVF +
= right axis deviation 
Most isoelectric is AVR, perpendicular is lead 3 = +100 degrees at its positive pole
72
Q

What is the rate rhythm and axis here

A

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
Q

What is the rate rhythm and axis here

A 
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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