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52 Cards in this Set

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Where are electrodes placed?
- on non-bony areas that have minimal movement
- this prevents interference from electrical activity in skeletal muscle
How to place electrode for V1 lead?
- find sternal angle (of louis)
- adjacent is 2nd rib
- find 4th intercostal space
- place electrodes on left and right sternal borders of 4th intercostal space
What does the 12 lead EKG visualize?
- electrical conduction of the heart, primarily the l. ventricle
Explain the significance of each wave in an EKG
- p wave - atrial depolarizatoin
- QRS complex - ventricular depolarization
- T wave - ventricular repolarization
[u wave - occurs after T wave during hypokalemia, HTN, or heart disease]
segments vs intervals?
- segments are between waves
- intervals include wave(s)
A small wave appears ofter T wave. What is it?
- possibly U wave
- thought to be repolarization of purkinje fibers
- seen in hypokalemia, HTN, heart disease
Breakdown of time for EKG squares
.04 sec per mm (small square)
.2 sec per 5 mm (large squares)
6 seconds for 30 large squares
How to determine HR from EKG?
- count number of QRS in 30 large squares
- that amt is 6 sec
- multiply by 10 to obtain HR per 60 sec
How does one place limb leads for a continuous EKG?
V1 - 4th intercostal R sternal border - brown

R side = sky over grass = white RA, green RL

L side = smoke over fire = black LA, red LL

cont EKG is usually only 5 leads
Explain HR as person is dying.
- SA node usually drives HR at 60-100 bpm
- if SA fails, AV node stim HR at 40-60 bpm
- if that fails, purkinje fibers stim HR at 20-40 bpm
A small wave appears ofter T wave. What is it?
- possibly U wave
- thought to be repolarization of purkinje fibers
- seen in hypokalemia, HTN, heart disease
Breakdown of time for EKG squares
.04 sec per mm (small square)
.2 sec per 5 mm (large squares)
6 seconds for 30 large squares
How to determine HR from EKG?
- count number of QRS in 30 large squares
- that amt is 6 sec
- multiply by 10 to obtain HR per 60 sec
How does one place limb leads for a continuous EKG?
V1 - 4th intercostal R sternal border - brown

R side = sky over grass = white RA, green RL

L side = smoke over fire = black LA, red LL

cont EKG is usually only 5 leads
Explain HR as person is dying.
- SA node usually drives HR at 60-100 bpm
- if SA fails, AV node stim HR at 40-60 bpm
- if that fails, purkinje fibers stim HR at 20-40 bpm
Tretment for Sinus Bradycardia
- only need to intervene if dizzy
- atropine is drug of choice, 0.5 mg IV bolus
- max 3g atropine
Catheter ablation
- destruction of cardiac conduction cells --> effect of slowing down heart
Treatement of Sinus tachycardia
- beta blockers, Ca channel blockers
- catheter ablation for persistant sinus tach
PAC
= premature atrial complex
- impulse in atrium starts before next normal sinus impulse
- PAC usually followed by noncompensatory pause
- ratio 1:1
Atrial flutter
= atrial rate 250 - 400, regular rhythm
- saw tooth shape
treatment atrial flutter
- for atrial flutter <48 hours, cardioversion
- for atrial flutter >48 hours, anticoag before cardioversion
- catheter ablation
What is an important question for a person experiencing atrial flutter?
How long have you been experiencing it?

- if greater than 48 hours, person is at risk for clots in heart. cardioversion may cause dislodge of clot, and pulm embol
a fib
- rapid disorganized twitching of atrium
- irregul rhythm for p AND qrs
- atrial rate 300-600
- f waves = fibrillatory waves
a fib treatment
- for atrial fib<48 hours, cardioversion
- for atrial fib>48 hours, anticoag for 3-4 weeks before cardioversion

- iv beta blocker, ca channel blocker
AVNRT
= av nodal reentry tachycardia
- impulse rerouted to AV node, causing tachycardia
- abrupt onset and cessation
AVNRT therapy?
- break reentry of pulse using vagal maneuvers (carotid sinus massage)
- catheter ablation
- adenosine
PVC quadrigeminy vs pvc trigeminy vs bigeminy etc
bigeminy = pvc every other complex
trigeminy = every thired
quadrigeminy = every fourth
PVC
= premature ventricular complex
- imppulse starts in ventricle before normal sinus impulse
- p wave sometimes absent
treatment PVC
- usually not treated if infrequent
- dangerous if >6 per minute
(also dangerous if multifocal polymorphic, if occurs in a pair, if occurs on t wave)
What are the lethal rhythms?
- ventricular tachycardia
- V fib
What are the kinds of v tach?
monomorphic and polymorphic (torsades de pointes)
V tach
- bizarre shape
- regular rhythm
- vent rate 100-200
- p waves rarely seen
Torsades
- undulating pattern
- usually rapidly deteriorates to vtach or v fib
cause of torsades
usullay due to dec Mg
Treatement of polymorphic vtach
- correct any electrolyte imbalance
- isuprel
- ventricular pacemaker
First degree AV block
- PRI > 0.2 sec
Second degree AV block type 1
inc PRI, then QRS dropped
Second degree AV block type 2
PRI constant. QRS dropped randomly
Third dgree AV block
- atria and ventricles follow separate rhythms (SA vs AV node)
treatment for asystole
- CPR continuous, without interruption
- intubation
- epinephrine

- key to successful treatment is rapid assessment for cause
PEA
= pulseless electrical activity
- conduction without pulse
treatemetn for PEA
- epi 1mg IV push repeated every 3-min
- atropine 1 mg IV for rate <60; repeated every 3-5 min for max 3mg
Causes of PEA
- 7 H's and 5 T's
- hypovolemia, hypoxia, hyperkalemia, hypokalemia, hypoglycemia, hypothermia, hydrogen ion (acidosis)
- toxins (overdose), tamponade, tension pneumothorax, thrombosis, trauma
Peaked T's in EKG indicative of
hyperkalemia
cardioversion vs defribrillation
- both are electrical currents used to treat tachydyshrhythmias
- it's all about timing
- cardioversion is synchronized to send a current during QRS
- defib sends current not sync
What safety measures should nurse observe while using cardioversion/defib?
1. ensure good contact between paddles/pads and skin
2. ensure no one is touching patient
What gel should be avoided when using Defib?
ultrasound gel should not be used. it is a poor conductor
proper use of paddles
exert 20-25 lbs of pressure to ensure good skin contact
What should be done post defib
CPR
NASPE BPEG code

DVI
D = dual (both atria and vent) being paced
V = ventricles are sensed
I = inhibited
NASPE BPEG code

AOO
A = atria being paced
O = no sensing
O = no inhibiting or triggering
NASPE BPEG code

VVT
V = ventricles being paced
V = ventricles being sensed
T = triggered response