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Acute cardiac life support > Rhythms and Management (Chapter 3) > Flashcards

Rhythms and Management (Chapter 3) Flashcards

1
Q

Blockage of which coronary a. can result in MI and/or AV nodal block

A

RCA

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2
Q

Blockage of this coronary artery often leads to sudden cardiac death, earning it’s name as the “widowmaker”

A

LCA

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3
Q

Blockage of what artery leads to lateral wall infarct

A

Left circumflex a.

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4
Q

Blockage of what artery leads to posterior wall MI

A

RCA (most common) or left circumflex (if pt has a left dominant heart)

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5
Q

What is responsible for the ability of the cardiac myocytes to propagate impulses (i.e. what is responsible for conductivity)

A

Intercalated disks

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6
Q

Why can you not get tetanic contractions in myocardial cells

A

Absolute refractory period

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7
Q

The absolute refractory period last until about what point on an ECG

A

Midway through the T wave

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8
Q

When is the relative refractory period on an ECG

A

From the top of the T-wave to the end of the T-wave (i.e. the downslope)

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9
Q

What is the supranormal period?

A

Period right after the relative refractory period where the myocytes are more sensitive stimuli than normal

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10
Q

When is the supranormal period on the ECG

A

Right after the end of the T-wave (i.e. after the end of the RRP)

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11
Q

Intrinsic rate of the SA node

A

60-100 beats

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12
Q

What does the AV junction consist of

A

AV node and the non-branching portion of the Bundle of His

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13
Q

Intrinsic rate of the bundle of His

A

40-60

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14
Q

Intrinsic rate of the Purkinje fibers

A

20-40

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15
Q

What is the record of electrical activity b/w 2 electrodes

A

A lead

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16
Q

What leads make up the frontal plane

A

I, II, III (standard leads)

aVR, aVL, and aVF are called augmented leads

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17
Q

Lead that is right arm to left arm

A

Lead I (only one “L”)

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18
Q

Lead that is right arm to left leg

A

Lead II (2 “L’s”)

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19
Q

Lead that is left arm to left leg

A

Lead III (3 L’s)

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20
Q

Which frontal plane lead most closely follows the normal pathway of current in the heart

A

Lead II

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21
Q

General rule for which limb the + electrode is on in a lead

A

Whichever lead has the most L’s (e.g. III is left arm to left leg, so the + node is on the left leg (2 L’s))

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22
Q

Heart surface viewed by lead I

A

Lateral

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23
Q

Heart surface viewed by leads II and III

A

Inferior

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24
Q

Heart surface viewed by aVR

A

NONE

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25
Q

Heart surface viewed by aVL

A

Lateral

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26
Q

Heart surface viewed by aVF

A

Inferior

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27
Q

What horizontal leads monitor the interventricular septum

A

V1 and V2

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28
Q

What horizontal leads monitor the anterior heart surface

A

V3 and 4

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29
Q

What horizontal leads monitor the lateral heart surface

A

V5 and 6

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30
Q

What surface of the heart is not directly viewed by any leads on a standard 12 lead ECG

A

Posterior surface

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31
Q

15 lead EKG has what additional leads

A

V4R, V8 and V9

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32
Q

In a normally conducted beat, QRS complex mainly represents electrical activity of what

A

LV

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33
Q

What leads monitor the inferior heart wall

A

II, III, aVF

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34
Q

What leads monitor the septum

A

V1 and 2

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35
Q

What leads monitor the anterior wall

A

V3 and 4

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36
Q

What leads monitor the lateral wall

A

I, aVL, V5, V6

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37
Q

What is one horizontal unit on ECG a measure of

A

0.04 seconds

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38
Q

What is measure by the thicker horizontal lines on the ECG

A

.2 seconds (made up of 5 single unit intervals)

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39
Q

What does one vertical unit on an ECG measure

A

.1 mV

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40
Q

What does a thick line on the vertical axis measure

A

.5 mV (5 single unit intervals)

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41
Q

Normal Q wave is how long?

A

.04 second (one small box)

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42
Q

About how much vertical distance on the Q wave is considered abnormal

A

> 1/3 the height of the R wave

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43
Q

Normal duration of QRS complex

A

.11 s or less

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44
Q

QRS duration in an incomplete bundle branch block

A

B/w .10 and .12

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45
Q

Duration of QRS complex in a complete BBB

A

Greater than or equal to .12

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46
Q

From which lead should you measure the QRS complex width

A

Whichever has the longest duration and the most clear onset and end.

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47
Q

Wider QRS complexes mean what

A

Delay in conduction through ventricles

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48
Q

What does the U wave represent and where is it on an ECG

A

Represents Purkinje fiber repolarization and is after the T wave

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49
Q

What conditions may cause deviation in ST-segment

A

MI, myocardial injury, or infarction

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50
Q

ST depression in a pt with acute coronary syndrome (ACS) represents what

A

Myocardial ischemia

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51
Q

ST elevation in a pt w/ ACS represents what

A

Myocardial damage

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52
Q

What part of the ST segment are we most interested in looking at when looking for ST elevation or depression

A

Early portion next to the J-joint

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53
Q

Normal duration of PR interval

A

.12-.20

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54
Q

What does the QT interval represent

A

Total ventricular activity (Depol and repol)

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55
Q

What happens to the QT interval as the HR increases

A

QT interval decreases

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56
Q

Corrected QT intervals more than what time are considered high risk for life-threatening arrhythmias

A

> 0.5 s

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57
Q

What normal physiological event can mess with sinus rhythm

A

Breathing (can cause a respiratory sinus arrhythmia)

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58
Q

What happens to HR during inspiration

A

Increases

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59
Q

What happens to HR during expiration

A

Decreases

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60
Q

How can you tell if a sinus arrhythmia is due to breathing or not?

A

Have the pt hold their breath (if due to breathing it disappears)

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61
Q

Do sinus arrhythmias usually need treatment?

A

No, but if hemodynamic compromise is present (due to a slow rhythm) atropine may be indicated

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62
Q

When do tachycardias start to cause problems

A

When ventricular rate is >150 beat/min

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63
Q

When is a tachycardia considered unstable

A

Serious signs and symptoms w/ HR usually >150

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64
Q

What should you do in an unstable pt w/ a pulse and serious S&S due to tachycardia

A

Cardiovert!

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65
Q

What is considered tachycardia in an infant

A

> 200 beats/min

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66
Q

What is considered tachycardia in children >5

67
Q

Sinus tachycardia

A

B/w 101-180

68
Q

What is sinus tachycardia normally caused by

A

Normal response to demand for an increased CO

69
Q

How do you treat a sinus tachycardia?

A

Treat the underlying cause, give fluid replacement, and relieve pain.

NEVER SHOCK A SINUS TACHYCARDIA

70
Q

Irritable site in the atria fires automatically at a rapid rate

A

Atrial tachycardia

71
Q

Fast and slow pathways in the AV node form an electrical circuit or loop

A

AV nodal reentrant tachycardia (AVNRT)

72
Q

Impulse begins above the ventricles but travels via a pathway other than the AV node and bundle of His

A

AV reentrant tachycardia (AVRT)

73
Q

What kind of tachycardia is Wolff-Parkinson-White

74
Q

Which SVT need the AV node to continue the tachycardia

A

AVNRT and AVRT

75
Q

What SVT use the AV node only to conduct the rhythm to the ventricles

A

atach, aflutter, afib

76
Q

Conduction of atrial impulses to the ventricles in atach (ratio)

A

1:1

One P wave for every QRS

77
Q

Atach with a small cluster of cells with altered automaticity and often involves a “warm up” and “cool-down” period

A

ectopic atach

78
Q

What is considered a “sustained rhythm”

A

Rhythm >30 seconds

79
Q

If vagal maneuvers fail to terminate an atrial tachycardia, what do?

A

Antiarrhythmic medications; adenosine is the DOC

80
Q

When is adenosine contraindicated

A

Asthmatics

81
Q

What can you use to slow ventricular rhythm in an atrial tachycardia

A

BB or CCBs

82
Q

When is cardioversion considered in atrial tachycardias (ATs)?

A

Drug-resistant arrhythmias

83
Q

Dihydropyridine CCBs

A

Amlodipine and nifedipine

84
Q

Nondihydropyridine CCBs

A

Verapamil and diltiazem

85
Q

Major AEs of CCBs

A

Hypotension, HF, bradycardia, AV block

86
Q

When should you avoid doing a carotid sinus massage

A

Older patients, pts w/ hx of stroke, known carotid stenosis, carotid bruit on auscultation

87
Q

Cold water as a vagal maneuver is useful in what kinds of patients

A

Infants and young children

88
Q

What is an AVNRT usually caused by

A

premature atrial complex

89
Q

If pt is stable and has an AVNRT, what do you do

A

O2, IV access and vagal maneuvers

If those fail, first antiarrhythmic tried is adenosine

90
Q

Tx for unstable pt w/ AVNRT

A

O2, IV access, sedation, synchronized cardioversion

91
Q

A narrow QRS tachycardia that starts and/or ends suddenly

A

Paroxysmal supraventricular tachycardia

92
Q

What kind of ST segment changes do you usually see with an SVT

A

Usually depression

93
Q

Rhythm that originates above the ventricles but the impulse travels a pathway other than the AV node/bundle of His

A

Pre-excitation

94
Q

What is the accessory pathway in WPW

A

Kent bundle (connects atria directly to ventricles

95
Q

Accessory pathway in LGL

A

James bundle (connects the atria directly to the lower portion of the AV node)

96
Q

Most common tachycardias WPW predisposes you to

A

Afib, aflutter, or PVST

97
Q

Why should you not give drugs that slow AV node conduction in someone with a pre-excitation syndrome

A

This will actually speed up conduction through the accessory pathway and INCREASE the HR

98
Q

Ectopic rhythm that begins in cells in the bundle of His

A

Junctional tachycardia

99
Q

Usually rate for nonparoxysmal junctional tachycardia

100
Q

What will the P wave look like in leads II, III and aVF if the AV node paces the heart?

A

Upside down because the impulse is traveling away from the + electrode

101
Q

Common causes of junctional tachycardia

A

ACS, HF, theophylline, or digitalis

102
Q

What constitutes a “wide-QRS” tachycardia

A

QRS >.12 s

103
Q

DOC if pt is stable, QRS is wide, rhythm is regular, and QRS complexes are of similar shape

104
Q

Drugs used to terminate wide-QRS tachycardia due to VT

A

Procainamide, amiodarone, sotalol

Lidocaine is 2nd line

105
Q

Dosage for procainamide

A

20-50 mg/min IV

106
Q

Dosage of amiodarone

A

300 mg IV bolus, can be followed by 150 mg

107
Q

Dosage for Sotalol

A

1.5 mg/kg IV

108
Q

2 conditions that must be met for BBB

A
  1. QRS complex must have an abnormal duration

2. QRS must arise as a result of supraventricular activity

109
Q

QRS complex duration in an incomplete BBB

110
Q

Accelerated idioventricular rhythms are common after what

A

Successful reperfusion therapy

111
Q

Typical rate of monomorphic VT

112
Q

A rapid, wide-QRS rhythm w/ pulselessness, shock, or HF should be presumed to be what?

113
Q

Tx of a pt w/ stable but symptomatic VT

A

O2, IV access, and ventricular antiarrhythmics (amiodarone, sotalol, procainamide)

114
Q

Avoid what antiarrhythmics if VT is due to prolonged QT interval

A

Sotalol and procainamide

115
Q

Tx of unstable pts w/ VT

A

O2, IV access, sedation (if awake) and cardioversion

116
Q

Venricular rate >100, size, shape, and direction of P-waves change from beat to beat

A

Multifocal atrial tachycardia (MAT)

117
Q

When is afib/aflutter described as “uncontrolled”

A

Ventricular rate > 100

118
Q

Polymorphic VT in the presence of long QT interval

A

Torsades de pointes

119
Q

Dosing for Mg Sulfate

120
Q

What is “absolute” bradycardia

A

HR < 60 BPM

121
Q

If someone has a bradycardia but no symptoms, should you treat?

A

No, but you should observe them

122
Q

1st line drug for symptomatic bradycardia

123
Q

What do if atropine doesn’t work in symptomatic bradycardia

A

Epi, dopamine, or isoproterenol

124
Q

Dosing for atropine

A

.5 mg every 3-5 minutes for a total dose of 3 mg

125
Q

Sinus bradycardia is HR < what?

126
Q

Tx for symptomatic sinus bradycardia

A

O2, start an IV, give atropine

127
Q

Is the QRS complex wide or narrow in a junctional escape rhythm

A

Narrow (b/c it starts from above the ventricles)

128
Q

Epi dosage for symptomatic bradycardia

A

2-10 mcg/min

129
Q

Dosing for dopamine

A

2-10 mcg/kg/min

130
Q

Dosing for isoproterenol

A

IV 2-10 mcg/min

131
Q

What happens when SA node and AV junction fail to initiate an electrical impulse

A

Ventricular escape rhythm

132
Q

Tx for ventricular escape rhythm

A

Try atropine first, but it’s unlikely to be effective
If atropine doesn’t work try dopamine, epinephrine, isoproterenol or transcutaneous pacing

AVOID lidocaine b/c it may stop ventricular activity

133
Q

What the main purpose of give Epi in pulseless VT/VF

A

vasoconstriction, even though it can increase HR and other beneficial effects

134
Q

These drugs can be given via trachea

A

Naloxone, atropine, vasopressin, epinephrine, lidocaine

135
Q

Dose of vasopressin

A

40 U IV/IO; may be used in place of 1st or 2nd dose of epi in cardiac arrest

136
Q

When doyou give antiarrhythmics in cardiac arrest (pulseless VT/VF)

A

If pulseless VT/VF continues despite CPR, defib, and vasopressors

137
Q

1st antiarrhythmic to give during cardiac arrest

A

Amiodarone, then lidocaine if amiodarone isn’t working

138
Q

Dosing for lidocaine

A

1-1.5 mg/kg IV, consider repeat dose in 5-10 minutes

139
Q

Total absence of ventricular activity

140
Q

What does PATCH-4-MD’s a mnemonic for and what do the letters stand for

A 
Reversible causes of cardiac arrest
PE
Acidosis
Tension pneumothorax
Cardiac Tamponade
Hyperkalemia
Hypokalemia
Hypoxia
Hypovolemia
MI
Drugs
Shiver (low body temp)
141
Q

Tx for asystole and PEA

A

CPR, IV access, consider treatable causes, epi, advanced airway

142
Q

Goals of resuscitation team

A

Restore breathing/circulation, preserve organ function

143
Q

Resuscitation effort requires coordination of 4 critical tasks

A
  1. chest compressions
  2. Airway management
  3. ECG monitoring and defib
  4. Vascular access and drug administration
144
Q

Phase I of the “Phase Response” in code organization

A

Anticipation

145
Q

Phase II of the “Phase Response” in code organization

146
Q

Phase III of the “Phase Response” in code organization

A

Resuscitation

147
Q

2 most important priorities in cardiac arrest

A

CPR and defibrillation (if shockable rhythm)

148
Q

Why is a pulse-ox helpful in cardiac arrest situations

A

May be able to indicate a return to spontaneous circulation

149
Q

Preferred sites for IV access in cardiac arrest

A

External jugular vein or antecubital

150
Q

Phase IV of the “Phase Response” in code organization

A

Maintenance phase (pt has stabilized)

151
Q

Is having family members in the room during the resuscitation beneficial to the patient and family

A

Yes; it comforts the pt and helps with the grieving of the pts family.

152
Q

Phase V of the “Phase Response” in code organization

A

Family notification

153
Q

Phase VI of the “Phase Response” in code organization

154
Q

Phase VII of the “Phase Response” in code organization

155
Q

Immediate postarrest phase

A

1st 20 mins after ROSC

156
Q

Early postarrest phase

A

20 minutes to 6-12 hours after ROSC

157
Q

Intermediate phase

A

6-12 hours to 72 hours after ROSC

158
Q

Recovery phase

A

Beyond 3 days

159
Q

What should you do immediately after primary survey

A

Repeat primary survey

160
Q

Elevating the head of the bed 30 degrees does what

A

Reduce incidence of cerebral edema, aspiration, and ventilatory-associated pneumonia

161
Q

IVs should contain what fluids

A

Saline or lactated ringers

162
Q

Hypotonic solutions increase the risk of what if given IV

A

Edema (including cerebral edema)

163
Q

Therapeutic hypothermia should be part of a standardized tx of what kind of patients

A

Comatose survivors of cardiac arrest

Acute cardiac life support (5 decks)

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