UNIT 1 - ECG interpretation & Treatment Flashcards
RA Electrode Placement
Right forearm or wrist
LA Electrode Placement
Left forearm or wrist
LL Electrode Placement
Left lower leg, proximal to ankle
RL Electrode Placement
Right lower leg, proximal to ankle
V1 Electrode Placement
4th intercostal space, right sternal edge
V2 Electrode Placement
4th intercostal space, left sternal edge
V3 Electrode Placement
Midway between V2 and V4
V4 Electrode Placement
5th intercostal space, mid-clavicular line
V5 Electrode Placement
Anterior axillary line
V6 Electrode Placement
Mid-axillary line
The H causes of cardiac arrest
Hypovolemia
Hypoxia
Hypothermia
Hypo/hyperkalemia
Hypoglycemia
H+ acidosis
The T causes of cardiac arrest
Tension pneumothorax
Tamponade
Toxins
Trauma
Thrombosis
A patient comes into the emergency room with shortness of breath and epigastric pain. The doctor is querying an MI, what enzymes would be tested?
Creatine-Kinase (Ck-MB)
Troponin T
How long do heart enzymes increase after pain of an MI has started?
3 - 6 hours
How long do heart enzymes remain elevated for?
14 - 21 days
How long does Troponin I levels rise after an Acute MI?
7 - 14 hours
What is the treatment for STEMI?
Aspirin 300 mg
O2 therapy
IV Nitroglycerin
Streptokinase
Tissue-type plasminogen activator (t-PA)
Josh’s ECG shows electrical activity but when feeling for a pulse, none is absent. What is your next course of action?
Commence CPR
Treat H’s and T’s
Give Epinephrine 1 mg
Patient has pulseless electrical activity
Your patient experiences a flat line (code blue/asystole), what is your next course of action?
Commence CPR
1 mg Epinephrine
Treat H’s and T’s
On your patient’s ECG, there is an irregular rhythm, atrial rate 400 bpm, ventricular rate 160 - 180 bpm and absent P wave. What is this rhythm and what is your next course of action>
A fib
Use a biphasic defibrillator for electrical conversion or use chemical conversions such as Amiodarone, procainamide or diltiazem.
Provide Heparin to prevent atrial thrombus
Brian has a HR 100-250 bpm and expresses that they are experiencing feelings of impending death. His ECG shows absent P waves and QRS complex > 0.12 seconds. What is this rhythm and what is your next course of action?
V tach
Amiodarone 150 mg IV slow bolus over 10 minutes
Repeat 150 mg IV (over 10 minutes) every 10 - 15 minutes.
What do you do for pulseless VT?
Defibrillation 200
Chest compressions
1 mg Epinephrine q 5 mins
Amiodarone 300mg IV push
What is an alternate infusion of Amiodarone for VT?
360 mg over 6 hours then 540 mg over the remaining 18 hours.
1mg/min over 6 hours - 0.5 mg/min
The ECG of Katyln reveals regular narrow QRS complexes with a HR 150 - 250 bpm. What is this rhythm and what do you give?
PSVT
Adenosine 6 - 12 mg IV
This rhythm has a regular r-r interval, HR 125 bpm and a PR interval 0.16 sec. What is this?
Sinus Tachycardia
Lian is experiencing SOB, altered LOC, pulmonary edema and her ECG shows a PR interval <0.2. What is this rhythm?
Sinus Bradycardia
Explain the protocol for a client experiencing symptomatic bradycardia?
Assess signs & symptoms.
IDENTIFY & TREAT UNDERLYING CAUSES
Maintain patent airway
Administer O2
Cardiac monitoring to identify rhythm, monitor BP and SPO2
IV access
Assess 12 lead ECG
If it is present and causes hypotension, altered LOC, signs of shock, chest pain and acute CHF then administer atropine 1mg bolus then q 3 - 5 minutes to 3mg max dose
If atropine doesn’t work for bradyarrhythmia, what can you do?
Dopamine 2 - 50mcg/kg per min
Epinephrine 2 - 10 mcg per min
Transcutaneous pacing
How do you ventilate a patient with bradycardia?
Start @ 10 - 12 breaths/min until partial pressure of end tidal CO2 is 35 - 40 mmHg
Normal PR interval
0.12 - 0.20 sec
Normal QRS complex
0.06 - 0.12
Big box method
Number of big boxes between two R waves then divide it into 300
Atrial contraction/depolarization
P wave
Time it takes for the impulse to spread from the atria to the ventricles
PR interval
Ventricular contraction/depolarization
QRS complex
Electrical systole
QT interval
Ventricular depolarization is complete and repolarization about to begin.
ST segment
Repolarization of the ventricles
T wave
How does the conduction of the heart go?
Sinoatrial node (60 - 100 bpm) -> Atrioventricular node (40 - 60 bpm)-> Bundle of His (40 - 60 bpm)-> Left and right bundle branch (20 - 40 bpm) -> Perkinjie fibers (20 - 40 bpm)
