Resuscitation and ECG Flashcards
how long till clinical death (reversible state) becomes biologic death (irreversible state of cellular destruction)
3-6 mins
how do you confirm cardiac arrest
patient response open airway check for normal breathing (caution agonal breathing) Check for signs of life- pulse (this should take less than 10 seconds)
what are good chest compressions
30:2
centre of chest 5-6 cm depth 2 per second (100-120 min-1) minimal interruptions (<5secs) After each compression, release all the pressure on the chest without losing contact between your hands and the sternum to allow for recoil
how quickly should the ventilations be done
2 within 10 seconds
what is important when putting on defib pads
shave chest if hairy
get good contact, avoid air trapping
what is transthoracic impedance
bodys resistance to current flow
varies due to body mass, age, disease, skin resistance, tissue type and amount
what is VF like on ECG
irregular waveform
no recognisable QRS complexes
random frequency and amplitude
uncoordinated electrical activity
exclude artefacts- movement/ electrical interference
what are the shockable rhythms
VF and pulseless VT
what is pulseless VT like on ECG
can be monomorphic:
- broad complex rhythm
- rapid rate
- constant QRS morphology
or polymorphic:
-torsade de pointes
when should you stop compression in defibrillation
to check rhythm
when shock delivered
(not when defib charging)
in resus when do you give medications
give adrenaline every 3-5 mins
give amiodarine after 3 consecutive shocks
what medications do you give in resus
adrenaline 1mg IV (potent vasoconstrictor)
amiodarone 300mg IV
what is asytole like on ECG
absent ventricular activity
atrial activity (P waves) may persist
usually a wavy line
what is the management for asytole
cant shock
CPR
adrenaline 1mg IV every 3-5 mins
DO NOT give amiodarone
what is pulseless electrical activity like on ECG
usually associated with an output, can be normal
just no pulse and features of ardiac arrest
what is the management for PEA
cant shock
CPR
adrenaline 1mg every 3-5 mins
what does SVT look like on ECG
narrows QRS’s
P waves present
fast rate
what are the reversible causes of cardiac arrest
hypoxia
hypothermia
hyperkalaemia
hypovolaemia
tamponade
thrombosis
toxins
tension pneumothorax
what management for hyperkalaemia
calcium gluconate (protect heart)
insulin with dextrose
salbutamol
what test for hypo/hyperkalaemia and metabolic disorders
ABG machine
management for hypothermia
active rewarming techniques
consider cardiopulmonary bypass
what are the clinical signs of a tension pnuemothorax
decreased breath sounds
hyper resonant percussion note
tracheal deviation
treatment for cardiac tamponade
neddel pericardiocentesis/ resuscitative thoracotomy
in PE how long should you continue CPR after fibrinolytic therapy given
60-90 mins
what is the P wave
atrial depolarisation
what is the PR interval
delay of AV node to allow filling of ventricles
what is the QRS complex
depolarisation of ventricles
what is the T wave
ventricular repolarisation
what is the ST segment
ventricular systole
where does depolarisation start in the heart
pacemaker cells in SA node close to entry of SVC into RA
when in ECG is the depolarisation of the bundle of his
QRS complex
how long should a normal QRS complex be
<0.10 s (less than 3 squares)
how long should a p wave last
0.08-0.1 seconds
when in ECG is diastole
TP segment
what is the PR Interval
AV node delay
how long should the PR interval last
0.12-0.2 seconds
how long does a little square last in ECG
0.04 seconds
how long does a big square last on ECG
0.2 seconds
how do you calculate HR on ECG
300/ number of large squares either between beats or between RR interval
or
Number of cardiac cycles that occur in 6 s (30 large squares) and multiply by 10.
what is the role of the rhythm strip
allows detects of rhythms abnormalities
what are the 6 steps to analysing an ECG
name and DOB check date check calibration determine axis work out rhythm: 1 Is electrical activity present? 2 Is the rhythm regular or irregular? 3 What is the heart rate? 4 P-waves present? 5 What is the PR interval? 6 Is each P-Wave followed by a QRS complex? 7 Is the QRS duration normal? look at individual leads for ST or T waves changes
where on ECG is inferior
leads III, IIII, AVF
where on ECG is anterior
leads V1-6
where on ECG is anteroseptal
leads V1-4
where on ECG is lateral
lead I, AVL
where on ECG in anterolateral
lead I, AVL, V1-6
what does AF look like on ECG
no P waves, irregularily irregular, rate >300, normal QRS, irregular baseline
what does atrial flutter look like on ECG
saw tooth, fast atrial rate, normal QRS
Atrial rate 250-350bpm.
what does LBBB look like on ECG
W in V1
M in V6 (william)
what does LBBB look like on ECG
M in V1
W in V6
what does 1st degree HB look like on ECG
prolonged PR (>0.2sec)
what does 2nd degree heart block mobitz type 1 look like on ECG
progressively longer PR until a QRS dropped
regularly irregular
what does 2nd degree heart block mobitz type 2 look like on ECG
atrial rate faster than ventricle, more P waves than QRS complexes
QRS normal/ wide, smae PR interval for all conducted beats
(constant PR but not all followed by a QRS)
can be 2:1 or 3:1
what does 3rd degree heart block look like on ECG
atrial rate faster than ventricle, PR absent, atria and ventricles beat independently
what does V fib look like on ECG
unmeasurable rate, absent P wave, irregular, wide QRS
what does VT look like on ECG
absent P waves, wide QRS, fast rate 100-120, regular
what does WPW look like on ECG
short PR
QRS usually wide
delta waves
tall tented T waves+ ?
hyperkalaemia
what QRS in leads V4,5 and 6 =?
left ventricular hypertrophy
PR depression and saddle shaped ST elevation =?
pericarditis
what does a broad QRS mean
ventricular problem
tall P waves and T wave depression =?
hypokalaemia
what are signs of a STEMI
ST elevation (at least 2mm in adjacent leads/ 1mm in associated leads) with Q wave formation
how do you work out the axis of an ECG
Right axis deviation= Lead 1 down, lead aVF up
Left axis deviation= Lead 1 positive, lead aVF negative
what does torsade de pointes look like on ECG
Twisting of the axis.
Rate 200-250bpm.
Regular or irregular.
Sinusoidal pattern.
what drug for torsades de pointes
magnesium sulfate
what causes first degree heart block
block in AV node- medication, vagal stimulation, disease
what causes mobitz type 1
Diseased AV node with long refractory period
what coronary artery: leads I, aVL, V5, V6
(lateral) circumflex
what coronary artery: leads II, III, aVF
(inferior) RCA
what coronary artery: leads V1-2
(septal) LAD
what coronary artery: leads V3-4
(anterior) V3-4
what are the features of a non stemi
ST depression, T wave flattening/ inversion
treatment for hypoxia
high flow oxygen 15 litres non rebreather
