Week 10- Cardiac Monitor Flashcards
1
Q
What does the cardiac monitor, monitor?
A
- Heart rhythm
- ETC02- ventilation
- Sp02- oxygenation
- NIBP
- Defibrillator
2
Q
What are the MOH equipment standards for PCP services?
A
- Be capable of monitoring & manual/ SAED defibrillating abilities
- Should features alarms voice prompts
- Be able to preform basic ECG 12 lead monitoring Sp02 monitoring
- Be able to print ECG recording vital sign collection
- Have a carrying case
- Easy to clean
3
Q
According to BLS pt Care Standards, the paramedic will initiate cardiac monitoring if the pt is exhibting s/s of…
A
- Cardiovascular, respiratory or neurological compromise
- All VSA pt’s except obviously dead pt’s
- Unconscious or altered LOC collapse or syncope (fainting)
- Suspected cardiac ischemia
- Moderate to severe SOB
- CVA, OD’s
- Major or multi system trauma/ electrocution submersion injury
- Hypothermia, heat exhaustion or heat illness
- Abnormal vital signs as per ALS PCS
4
Q
What is the ALS standards on age and vital signs?
A
- The general age cut off between adults and pediatrics is 18 yrs.
- There is a wide range of “normal” for vital signs in adults and especially pediatrics.
- Ages for pediatrics and cut off points for vital signs have been kept consistent throughout the Medical Directives.
- However, clinical research and expert opinion have resulted in a number of expectations which in each case has been deliberately chosen and is clearly noted in each Medical Directive.
- There is a deliberate gap in the definition of normotension and hypotension in adults
5
Q
What is the normotension for adults?
A
- SBP >100 mmHg
6
Q
What is hypotension for adults?
A
- SBP <90 mmHg
7
Q
Heart rate
A
Hr is always in b/min according to a cardiac monitor when it is applied. In situations where a cardiac monitor is not indicated then the heart rate is equal to the pulse rate
8
Q
Bradycardia
A
HR <50 BPM
9
Q
Tachycardia
A
HR <100 BPM
10
Q
Tachypnea
A
RR >28 breaths/min
11
Q
What is 0-3 months old normal HR and RR?
A
HR: 90-180 BPM
RR: 30-60 BPM
12
Q
What is 3-6 months old normal HR and RR?
A
HR: 80-160 BPM
RR: 30-60 BPM
13
Q
What is 6-12 months old normal HR and RR?
A
HR: 80-140 BPM
RR: 24-45 BPM
14
Q
What is 1-3 year old normal HR and RR?
A
HR: 75-130 BPM
RR: 20-30 BPM
15
Q
What is 6 year old normal HR and RR?
A
HR: 70-110 BPM
RR: 16-24 BPM
16
Q
What is 10 years old normal HR and RR?
A
HR: 60-90 BPM
RR: 14-20 BPM
17
Q
Formula for normotension
A
SBP <90mmHg + (2x age in yrs)
18
Q
Formula for hypotension
A
SBP >70mmHg + (2x age in yrs)
19
Q
Formula for determining weight
A
Age x 2 + 10= wt in KG
20
Q
What is the defibrillation pad placement?
A
The first pad is placed on chest beneath the pt’s collarbone, and the second pad is placed on the left chest wall, underneath the armpit area
21
Q
What are the two shockable rhytms?
A
- ventricular fibrillation
- Pulseless ventricular tachycardia
22
Q
What are the two types of Sp02 sensors?
A
- Finger probes
- Soft tape
23
Q
What is Sp02 an indication of?
A
- Oxygenation
- Hr is also calculated through Sp02
24
Q
Non Invasive Bp
A
- Select the proper size cuff
- MOH states: adult & pediatric
25
Application of ETC02- Nasal Prongs
- SOB calls
- Breathing assessments
26
Inline with BVM
- During ventilation
- Both will activate an ETC02 waveform, numerical value & respiratory rate
27
What is the application of 4 limb leads?
- Ensure not on bone
- Ensure skin is dry/ no excessive hair (use razor if needed)
- Ensure good contact
- Interpret the rhythm in Lead 2
28
Electrode vs Lead
- Allow attachment of leads to the patient
- Electrodes are disposable
- Attach the electrode to the lead 1st prior to putting onto pt
29
What does cardiac monitor paper tell?
- Time
- Amplitude
- It will help you interpret a cardiac rhythm
30
Cardiac paper- 5 big boxes
1 sec
31
Cardiac paper- 30 boxes
6 sec
32
What is the 12 lead placement?
RA- right forearm or wrist
LA- left forearm or wrist
LL- left lower leg, proximal to ankle
RL- right lower leg, proximal to ankle
V1- 4th intercostal space, right sternal edge
V2- 4th intercostal space, left sternal edge
V3- midway between V2 and V4
V4- 5th intercostal space, mid-clavicular line
V5- anterior axillary line in straight line with V4
V6- mid-axillary line in straight line with V4 and V5
33
ST-Elevation
- This is where we look for myocardial infarction (MI)
34
How to fit using a cardiac monitor into a call
1. Approach pt- turn monitor on
a. This will mark your "pt arrival time, which will later be required on your ACR."
b. Turning the monitor on does not mean you have to apply- example if the patient is a trauma L&G patient the monitor will stay on stretcher & not actually be applied until later in call
c. Remove the monitor from the stretcher if you are going to apply on scene
35
How to fit using a cardiac monitor into a call
2. Start your initial assessment
a. Airway assessment: you may have driver initiate airway maneuvers as applicable, airway adjuncts as needed, & apply Sp02 probe to pt's finger
b. Breathing: you may have driver apply oxygen to pt based on pt's needs
c. Circulation: you may have driver apply ECG leads- will be applying 4 limb leads. You may have partner run a "6 second" strip for you to view & interpret the ECG rhythm your pt is generating
36
What are the steps to reading a 4 lead?
1. Calculate the rate
- 300 rule
- 6 sec rule
2. Regular or irregular
3. P waves, present and upright?
- The p-wave is evidence of martial contraction
- Should be upright in lead 2
4. PR interval
- Normal PR interval is: 0.12-0.20 sec (3 to 5 small boxes)
5. QRS Duration
- Normal Duration: 0.08-0.12 sec (less than 2 small boxes)
- The QRS is ventricular contraction
- The atria is in diastole
- The T wave is evidence of ventricular repolarization
6. Interpreation
37
Normal Sinus Rhythm
Rhythm: regular
Rate: 80 bpm (normal range= 60-100 bpm)
P waves: upright & regular
P-R Interval: 0.16 sec (normal range= 0.12-0.20), one P wave for each QRS
QRS: 0.08 sec (normal range= 0.04-0.12)
38
What is the clinical significance of normal sinus rhythm?
- unless the pt has no pulse or other serious s/s, there is no significance to this cardiac rhythm
39
Sinus Tachycardia
Rhythm: regular
Rate: 130 bpm (normal range= 60-100 bpm)
P waves: upright & regular
P-R Interval: 0.16 sec (normal range= 0.12-0.20), one P wave for each QRS
QRS: 0.04 sec (normal range= 0.04-0.12)
40
What is the clinical significance of sinus tachycardia?
- needs no treatment.
- It is most often a compensatory mechanism to an underlying cause such as fever, anxiety, hypovolemia, or shock.
- It is most important to identify and treat the underlying cause as needed.
- Rate less than 150 bpm don't usually cause serious signs and symptoms.
- Rates over 150 bpm may cause reduced cardiac input and may require treatment.
- Synchronized cardioversion is the first choice.
- If regular narrow QRS complex, consider adenosine.
41
Artial Fibrillation
Rhythm: irregular
Rate: 90 bpm (Atrial rate is very fast and chaotic, and can't be counted)
P waves: Not discernible. Chaotic
P-R Interval: None
QRS: 0.04 sec (normal range= 0.04-0.12)
42
What is the clinical significance of atrial fibrillation?
- Treatment is not normally necessary.
- Rather an expert consultation is required.
- Patients will often feel weak or dizzy.
- For unstable pt's, preform synchronized cardioversion with 200 joules with a monophasic or 120 to 200 joules with a biphasic defibrillator.
- Pharmacologic therapy should be done only upon expert consultation or medical control direction.
43
Sinus Bradycardia
Rhythm: regular
Rate: 50 bpm (normal range= 60-100 bpm)
P waves: Not discernible. Chaotic
P-R Interval: 0.16 sec (normal range= 0.12-0.20), one P wave for each QRS
QRS: 0.08 sec (normal range= 0.04-0.12)
