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22 Cards in this Set
- Front
- Back
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ECG :Shortcut to left axis deviation
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I, aVF: both positive, normal
if aVF is ambiguous or negative, check II: if II is also negative, then LAD |
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ECG :Shortcut to right axis deviation
ECG :Extreme right axis deviation |
I negative, avF positive
I negative, avF negative |
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To check P waves, look at leads ?
What do you look for? |
II, V1
P should be < 0.12 and no taller than 2.5 mm P in V1 should be BIPHASIC |
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ECG :Right atrial enlargement
Best observed in which leads? |
In lead II, P wave is taller than 2.5 mm
In lead V1, first half of the biphasic wave is taller RAE seen mainly in inferior leads |
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ECG : Left atrial enlargement
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Increase in duration of P wave
terminal portion of P wave > 1 block In lead II, notched P wave, terminal portion taller In V1, terminal portion of biphasic P wave dips 1 mm or more below isoelectric line |
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ECG: Right atrial enlargement causes "P ?"
common cause? |
pulmonale
severe lung dz is often a cause |
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ECG : Left atrial enlargement causes "P ?"
common cause? |
mitrale
mitral valve dz is a common cause of LAE |
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ECG : right ventricular hypertrophy
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Right axis deviation (> 100 degrees)
R > S in V1 S > R in V6 (i.e., R wave progression reversed) V1 is over the hypertrophied right ventricle; V6 is over the left ventricle, which is now "electrically humble." |
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ECG : left ventricular hypertrophy
(full criteria: precordial leads) |
left axis deviation is NOT highly diagnostic!
Instead: increased R wave amplitude over left ventricle, increased S wave amplitude over right ventricle. 1. R in V6 is greater than R in v5. 2. Big Rs in v5 and v6 generally: v5 -- R > 26 v6 -- R > 18 3. R in v5 or V6 + S in V1 or V2 > 35. Not very useful if patient is under 35 years old! |
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ECG : for left ventricular hypertrophy, look for large ? waves in the most lateral leads over the left ventricle (v5-v6)
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R
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ECG : There are limb lead criteria for LVH? as well as precordial criteria. You should look for tall R waves in which leads?
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I, aVL, aVF
avL > 13 |
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ECG :What is a secondary repolarization abnormality and when is it seen?
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Seen in ventricular hypertrophy (L or R), often severe and becoming symptomatic:
1. downsloping ST depression, connecting to 2. inverted T wave. cause unknown; used to be attributed to strain |
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T/F In COPD, inhalers do not change the course of the disease.
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True; they only improve quality of life
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If a patient has O2 sat above 90% resting but drops to mid 80s with exertion, what O2 therapy do you prescribe?
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You can prescribe none if patient is satting well and asymptomatic at rest; have pt cehck back in 4-6 weeks. The evidence for oxygen is based on resting measures only. It wouldn't be wrong to prescribe 2L for exertion, though.
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What is the treatment for COPD exacerbation?
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Oral antibiotics and prednisone
Main antibiotics: BAD exacerbation Bactrim Azithromycin Doxycycline |
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What are the criteria for diagnosing a COPD exacerbation?
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2 out of 3:
increased dyspnea increased sputum volume change in sputum color |
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If blood gases (CO2) worsen during a COPD exacerbation, what is the first step?
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noninvasive ventilation
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What is the problem with giving oxygen to a COPD patient during an exacerbation?
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Chronic retainers will have CO2 go up as oxygen returns to normal.
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clinical definition of chronic bronchitis (COPD)
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productive cough > 3 months per year, for 2 or more years
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COPD: DLCO is reduced in [chronic bronchitis, emphysema, both].
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emphysema
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What is the mnemonic for general treatment of COPD?
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COPDer:
corticosteroids oxygen therapy < 55 prevention: flu/pnvx, smoking cessation dilators experimental: LVR surgery rehab / exercise |
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What are the indications for invasive mechanical ventilation for COPD?
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resp rate > 35
paradoxical breathing severe hypoxemia: PaO2/FIO2 < 200 complications: PNA, PE, sepsis, hypotension, AMS failure of noninvasive ventilation |
