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Telemetry Certification Flashcards

1
Q

PR interval

A

0.12-0.20 seconds

Represents electrical depolarization of the atria or the time it takes for the electrical impulse to travel from atria to ventricles

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2
Q

QRS complex

A

less than 0.10-0.12 seconds

Represents ventricular depolarization

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3
Q

QT interval

A

0.44 seconds

Reflects both ventricular depolarization and repolarization

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4
Q

one small box

A

.04 seconds and 1mm

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5
Q

one large box

A

0.2 seconds and 5mm

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6
Q

15 large boxes

A

3 seconds

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7
Q

30 large boxes

A

6 seconds

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8
Q

7 steps method to interpreting cardiac rhythm

A
  1. is the rhythm regular or irregular. measure the p:p and the r:r
  2. calculate the atrial rate and calculate the ventricular rate
  3. is there a p wave for every QRS?
  4. measure the QRS complexes (normal 0.10-0.12)
  5. measure the PR intervals (normal: <0.20) if > 0.20 you have a block
  6. interpretation of rhythm
  7. intervention
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9
Q

bradycardia intervention

A

atropine

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10
Q

focal atrial tachycardia intervention

A

adenosine

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11
Q

ventricular fibrillation intervention

A

defibrillation and cpr

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12
Q

torsades de pointes intervention

A

check for pulse

unsynchronized defibrillation

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13
Q

P wave

A

Represents electrical depolarization of the atria

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14
Q

T wave

A

Represents ventricular repolarization

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15
Q

ST segment

A

Represents ventricular repolarization

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16
Q

Normal Sinus Rhythm

A
  1. Rhythm: Regular
  2. Rate: Atrial 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Normal Sinus Rhythm
  7. Intervention: Continue to Monitor Patient
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17
Q

Sinus Bradycardia

A
  1. Rhythm: Regular
  2. RATE: Atrial <60 ; Ventricular <60
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Bradycardia
  7. Intervention: Continue to monitor and call physician if new onset

SLOW RATE

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18
Q

Sinus Tachycardia

A
  1. Rhythm: Regular
  2. RATE: Atrial 100-160 ; Ventricular 100-160
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Tachycardia
  7. Intervention: continue to monitor patient and call physician if new onset

FAST RATE

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19
Q

Sinus Arrhythmia

A
  1. RHYTHM: Irregular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Arrhythmia
  7. Intervention: Continue to monitor patient

IRREGULAR RHYTHM

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20
Q

Sinus Arrest/Pause

A
  1. RHYTHM: Irregular; need to find underlying rhythm
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Arrest with second pause
  7. Intervention: call physician

IRREGULAR RHYTHM & PAUSE

arrest: more than 2 p-p
pause: less than 2 p-p

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21
Q

Premature Atrial Complex (PAC)

A
  1. Rhythm: underlying rhythm is regular, individual PAC is irregular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes, p wave conducted with PAC will have different shape
  4. QRS complex: 0.10-0.12
  5. PR interval: <0.20
  6. Interpretation of Rhythm: Need to identify underlying rhythm and label accordingly
  7. Intervention: call MD

IRREGULAR RANDOM SHAPED P WAVE

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22
Q

Atrial Tachycardia (SVT)

A
  1. Rhythm: Regular
  2. Rate: Atrial: 100-250 ; Ventricular: 100-250
  3. P wave: often indiscernible, can be buried in T wave. If you have P wave will be different shape
  4. QRS complex: 0.10-0.12
  5. PR interval: UTA
  6. Interpretation of Rhythm: Atrial Tachycardia
  7. Intervention: Call MD

FAST P WAVE IN T WAVE

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23
Q

Atrial Flutter

A
  1. Rhythm: regular
  2. Rate: Atrial: 220-350 ; Ventricular:
  3. P wave: replaces by flutter waves
  4. QRS complex: 0.10-0.12
  5. PR interval: UTA
  6. Interpretation of Rhythm: Atrial Flutter
  7. Intervention: Call MD

SAW TOOTH, NO P WAVES

24
Q

Atrial Fibrillation

A
  1. Rhythm: irregularly irregular
  2. Rate: Atrial: UTA ; Ventricular: variable
  3. P wave: no, will see fibrillation line
  4. QRS complex: 0.10-0.12
  5. PR interval: UTA
  6. Interpretation of Rhythm: Atrial Fibrillation
  7. Intervention: Call MD

FIBRILLATORY WAVES, NO P WAVES

25
Q

Junctional Rhythm

A
  1. Rhythm: regular
  2. Rate: Atrial: 40-60; Ventricular: 40-60
  3. P wave: yes; inverted, during, absent, or after QRS
  4. QRS complex: 0.10-0.12
  5. PR interval: <0.20, if there are P waves
  6. Interpretation of Rhythm: Junctional rhythm
  7. Intervention: Call MD

40-60 BPM & P WAVES INVERTED, DURING, ABSENT OR AFTER QRS, PR INTERVAL <0.20 IF THERE ARE P WAVES

3 or more consecutive junctional beats

26
Q

Accelerated Junctional

A
  1. Rhythm: regular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes; inverted, during, absent or after QRS
  4. QRS complex: 0.10-0.12
  5. PR interval: <0.20
  6. Interpretation of Rhythm: accelerated Junction
  7. Intervention: Call MD

60-100 BPM, P WAVES INVERTED, DURING, ABSENT OR AFTER QRS, PR <0.20

27
Q

Junctional Tachycardia

A
  1. Rhythm: regular
  2. Rate: Atrial: 100-160 ; Ventricular: 100-160
  3. P wave: yes; inverted, during, absent or after QRS
  4. QRS complex: 0.10-0.12
  5. PR interval: < 0.20
  6. Interpretation of Rhythm: Junctional Tachycardia
  7. Intervention: Call MD

100-160 BPM, P WAVES INVERTED, DURING, ABSENT, OR AFTER QRS, PR <0.20

28
Q

Ventricular Tachycardia

A
  1. Rhythm: regular
  2. Rate: Atrial: UTA ; Ventricular: 100-220
  3. P wave: No
  4. QRS complex: UTA, will be wide and bizarre
  5. PR interval: UTA
  6. Interpretation of Rhythm: ventricular tachycardia
  7. Intervention: LETHAL call code!

VENTRICULAR RATE 100-220, NO P WAVE, WIDE QRS, CALL CODE

29
Q

Ventricular Fibrillation

A
  1. Rhythm: irregular
  2. Rate: Atrial: UTA ; Ventricular: UTA
  3. P wave: No
  4. QRS complex: UTA, only have fibrillation wave
  5. PR interval: UTA
  6. Interpretation of Rhythm: Ventricular fibrillation
  7. Intervention: LETHAL call code!

IRREGULAR RHYTHM, NO P WAVE, VFIB WAVE, CALL CODE

30
Q

Idioventricular

A
  1. Rhythm: can be regular and irregular
  2. Rate: Atrial: < 40 ; Ventricular: < 40
  3. P wave: No
  4. QRS complex: wide and bizarre
  5. PR interval: UTA
  6. Interpretation of Rhythm: Idioventricular
  7. Intervention: LETHAL call code!

RATE<40, NO P WAVE, WIDE QRS, CALL CODE

31
Q

Accelerated Idioventricular

A
  1. Rhythm: regular
  2. Rate: Atrial: 40-100 ; Ventricular: 40-100
  3. P wave: No
  4. QRS complex: Wide and bizarre
  5. PR interval: UTA
  6. Interpretation of Rhythm: Accelerated Idioventricular
  7. Intervention: LETHAL call code!

RATE 40-100, NO P WAVE, WIDE QRS, CALL CODE

32
Q

Torsades de Pointes

A
  1. Rhythm: Irregular
  2. Rate: Atrial: UTA ; Ventricular: 250-350
  3. P wave: No
  4. QRS complex: UTA, wide and bizarre, twisting
  5. PR interval: UTA
  6. Interpretation of Rhythm: Torsades de Pointes
  7. Intervention: LETHAL call code!

IRREGULAR RHYTHM, VENTRICULAR RATE 250-350, NO P WAVE, TWISTING WIDE QRS, CALL CODE

33
Q

Premature Ventricular Complex (PVCs)

A
  1. Rhythm: regular, except for early beat
  2. Rate: Atrial: determine underlying rhythm ; Ventricular: determine underlying rhythm
  3. P wave: may or may not be visible with PVC
  4. QRS complex: wide and bizarre
  5. PR interval: < 0.20
  6. Interpretation of Rhythm: Sinus rhythm with premature ventricular complex
  7. Intervention: call MD

EARLY BEAT IRREGULAR, P WAVE MAY OR MAY NOT BE VISIBLE, WIDE QRS, PR <0.20

34
Q

Sinus Rhythm with First Degree

A
  1. Rhythm: regular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: > 0.20
  6. Interpretation of Rhythm: Sinus rhythm with first degree AV block
  7. Intervention: Call MD

PR >0.20

35
Q

Second Degree- Mobitz 1 (Wenckebach)

A
  1. Rhythm: Usually Irregular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100, is dependent on underlying rhythm
  3. P wave: yes
  4. QRS complex: 0.10-0.12, will have missing QRS complexes
  5. PR interval: > 0.20, lengthens until a QRS is dropped
  6. Interpretation of Rhythm: Second degree- Mobitz 1
  7. Intervention: call MD

Longer longer longer drop thats the sound of Wenckebach

IRREGULAR, DROPPED QRS, CYCLIC LENGTHENING OF PR INTERVAL

36
Q

Second degree- Mobitz 2

A
  1. Rhythm: atrial rate: regular ; ventricular: irregular
  2. Rate: Atrial: faster than ventricular
  3. P wave: yes
  4. QRS complex: wider than normal
  5. PR interval: constant on conducted beats, may be normal or prolonged
  6. Interpretation of Rhythm: Second degree- Mobitz 2
  7. Intervention: call physician

ATRIAL FASTER THAN VENTRICULAR RATE, R WAVES IRRGULAR, WIDE QRS, DROPPED QRS

37
Q

Complete Heart block (3rd Degree)

A
  1. Rhythm: atrial is regular. ventricular is regular but they are not communicating, beating independently of each other
  2. Rate: Atrial: 60-100 ; Ventricular: <40 or can be junctional >40
  3. P wave: normal, but not related to QRS
  4. QRS complex: depends on the level of escape rhythm. can be normal or wide
  5. PR interval: UTA
  6. Interpretation of Rhythm: third degree heart block
  7. Intervention: LETHAL call code!

P & R WAVES ARE INDEPENDENT, QRS CAN BE NORMAL OR WIDE

38
Q

Atrial Pacemaker

A
  1. Rhythm: identify underlying rhythm
  2. Rate: Atrial: depends on what the pacemaker is set at. a pacer spike before the P wave
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: <0.20
  6. Interpretation of Rhythm: atrial paced
  7. Intervention: continue to monitor patient

PACER SPIKE BEFORE P WAVE

39
Q

Ventricular pacemaker

A
  1. Rhythm: identify underlying rhythm
  2. Rate: Atrial: depends what the pacemaker rate is set at, pacer spike before Q waves
  3. P wave: yes
  4. QRS complex: wide
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: ventricular paces
  7. Intervention: continue to monitor patient

SPACER SPIKE BEFORE Q WAVE, WIDE QRS

40
Q

AV paced or Dual camber pacemaker

A
  1. Rhythm: identify underlying rhythm
  2. Rate: Atrial: depends what pacemaker is set at. pacer spine before p wave; Ventricular: depends on what pacemaker is set at, pacer spike before Q wave
  3. P wave: yes
  4. QRS complex: usually wide
  5. PR interval: < 0.20
  6. Interpretation of Rhythm: dual chamber paces
  7. Intervention: continue to monitor patient

SPACER SPIKE BEFORE P WAVE & PACER SPIKE BEFORE Q WAVE, WIDE QRS

41
Q

Failure to sense- undersense or overpacing

A
  1. Rhythm: pacemaker paces when it shouldn’t “overpacing” irregular due to spike occurring too close to a previous beat
  2. Rate: Atrial: depends what the pacemaker is set at ; Ventricular: depends what the pacemaker is set at
  3. P wave: yes
  4. QRS complex: wide
  5. PR interval: <0.20 seconds
  6. Interpretation of Rhythm: ventricular paced with failure to sense
  7. Intervention: call MD

OVERPACING, SPIKE OCCURING TOO CLOSE TO PREVIOUS BEAT, WIDE QRS

42
Q

failure to sense- oversees or underpacing

A
  1. Rhythm: pacemaker fails to pace when it should
  2. Rate: Atrial: depends on what rate the pacemaker is set at ; Ventricular: depends on what rate the pacemaker is set at
  3. P wave: yes
  4. QRS complex: wide
  5. PR interval: <0.20
  6. Interpretation of Rhythm: atrial paced with failure to sense
  7. Intervention: call physician

UNDERPACING, PACEMAKER FAILS TO PACE WHEN IT SHOULD, WIDE QRS

43
Q

failure to capture

A
  1. Rhythm: pacemaker is firing appropriately, no corresponding complex after spike
  2. Rate: Atrial: depends on rate pacemaker is set at ; Ventricular: depends on rate pacemaker is set at
  3. P wave: atrial paced and failure to capture = no p wave
  4. QRS complex: ventricular paced and failure to capture = no QRS. <0.12 for captured complexes
  5. PR interval: <0.20 for captured intervals
  6. Interpretation of Rhythm: AV paced with failure to capture
  7. Intervention: call MD

NO CORRESPONDING COMPLEX AFTER PACER SPIKE, NO P WAVE NO QRS WHEN NOT CAPTURED

44
Q

failure to fire

A
  1. Rhythm: varies according to present pacer rate, pacer is not firing, will see a pause
  2. Rate: Atrial: depends on rate pacemaker is set ; Ventricular: depends what rate pacemaker is et at
  3. P wave: atrial faced and failure to fire = no P wave
  4. QRS complex: ventricular paces and failure to fire = no QRS
  5. PR interval: < 0.20
  6. Interpretation of Rhythm: atrial paced with failure to fire
  7. Intervention: call MD

WILL SEE A PAUSE, NO P WAVE NO QRS DURING PAUSE

45
Q

asytole

A
  1. Rhythm: UTA
  2. Rate: Atrial: UTA ; Ventricular: UTA
  3. P wave: UTA
  4. QRS complex: UTA
  5. PR interval: UTA
  6. Interpretation of Rhythm: systole
  7. Intervention: CALL CODE. check pulse and check rhythm in another lead. START CPR

CALL CODE

46
Q

artifact

A
  1. Rhythm: UTA
  2. Rate: Atrial: UTA ; Ventricular: UTA
  3. P wave: UTA
  4. QRS complex: UTA
  5. PR interval: UTA
  6. Interpretation of Rhythm: UTA
  7. Intervention: check patient and leads, continue to monitor

LOOKS LIKE SKETCH

47
Q

Sinoatrial Exit block

A

less than or equal to 2 p-p intervals

48
Q

sinus node dysfunction

A

often <50 bpm with short runs over 100 bpm

49
Q

focal atrial tachycardia

A

normal sinus QRS followed by tachycardia

50
Q

wandering atrial pacemaker

A

3 different p wave shapes

51
Q

multifocal atrial tachycardia

A

3 different shaped p waves, rate greater than 100 bpm

52
Q

premature junctional complex

A

early beat before next P wave

53
Q

junctional escape beat

A

late beat, p waves before, after or buried in QRS and inverted

54
Q

ventricular escape beat

A

late beat originating in the ventricles, no p wave on late beat

55
Q

capture beats

A

narrow QRS between wide QRS complexes

56
Q

fusion beats

A

hybrid QRS

57
Q

LETHAL RHYTHMS

A 
ventricular tachycardia
ventricular fibrillation
complete heart block
idioventricular rhythm 
accelerated idioventricular
torsades de pointes 
asytsole
PEA

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