Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
86 Cards in this Set
- Front
- Back
What is a tachycardic rate?
|
>100.
|
|
What rhythms can be tachycardic?
|
Sinus tach
SVT A-fib A-flutter MAT V-tach (torsades de pointes) Uncertain tach |
|
What are the causes of sinus tachycardia?
|
hypoxia
hypovolemia some drug OD's fever fear, anxiety exercise caffeine aympathetic response anemia |
|
What are possible signs and symptoms of tachycardia?
|
Possible signs: low BP, diaphoresis, pulmonary edema, acute MI, PVC's.
Possible symptoms: chest pain, shortness of breath, decreased LOC, weakness, dizziness. |
|
Do we treat asymptomatic tachycardia?
|
Probably not.
|
|
Signs and symptoms of instability
|
altered mental status
hypotension significant CP significant SOB |
|
And if the patient is unstable?
|
Cardioversion!!!
|
|
What is the potential problem with converting A-fib with RVR and why?
|
Clots, pooling in the atria...
Even a patient with chronic A-fib must be cardioverted if the rate is fast and the patient is truly unstable. |
|
Rate related symptoms are uncommon if heart rate is <150/min. Does this mean that we will never cardiovert a patient with a rate <150/min?
|
No but it's rare.
|
|
And if the patient is stable?
|
Look at the QRS.
|
|
Narrow, regular?
|
SVT.
Vagal maneuvers. Adenosine. Diltiazem. |
|
Narrow, irregular?
|
A-fib, A-flutter, or MAT.
Diltiazem works for rate control (usually not conversion). |
|
What are the precautions with administering diltiazem?
|
BP may drop after giving diltiazem.
Don't give if patient's systolic BP is <100. |
|
Wide, regular?
|
V-tach.
Amiodarone. Can also be an uncertain rhythm. |
|
What does uncertain rhythm mean?
|
Sometimes it can be difficult to tell V-tach from SVT with a wide QRS.
|
|
Wide, irregular?
|
T. de P. or A-fib with BBB.
|
|
How do we treat T. de P.?
|
Magnesium sulfate.
|
|
WPW has 2 dysrhythmias associated with it:
|
SVT and A-fib.
|
|
What rhythms can be bradycardic?
|
All possible bradycardic rhythms.
|
|
Is the patient symptomatic?
|
If the answer is no, don't treat the bradycardia.
|
|
The cornerstone of bradycardia treatment...
|
Don't treat asymptomatic bradycardia!!!
|
|
"Poor perfusion" implies low ______________.
|
blood pressure
|
|
What are some possible signs and symptoms of hypoperfusion caused by a bradycardic rhythm?
|
Possible symptoms: chest pain, shortness of breath, decreased LOC, weakness, dizziness.
Possible signs: low BP, diaphoresis, pulmonary edema, acute MI, PVC's. |
|
Is it possible to have a patient who is symptomatic and bradycardic, yet the bradycardia does not cause the symptoms?
|
Yes.
|
|
Is the bradycardia causing the symptoms?
|
Don't treat the bradycardia unless the bradycardia is causing the symptoms.
|
|
How shall we treat bradycardia?
|
Always begin treatment with the basics: oxygen, supine positions, possibly fluids.
Both atropine and TCP are considered first-line treatments. |
|
What kind of drug is atropine?
|
Parasympatholytic.
|
|
How does the parasympathetic system affect the heart rate?
|
Decreases HR.
|
|
Why not forget about atropine and always go straight to pacing?
|
It hurts!
|
|
atropine dosage
|
0.5-1 mg every 3-5 minutes (maximum dose is 0.04 mg/kg)
|
|
dopamine dosage
|
5-10 mcg/kg/minute
|
|
epinephrine dosage
|
2-10 mcg/min
|
|
adenosine dosage
|
6 mg IV bolus followed with 20 cc flush. If no response, repeat in 1-2 minutes with 12 mg followed with 20 cc flush. This dose can be repeated one more time
|
|
diltiazem dosage
|
0.25 mg / kg over 2 minutes. Repeat 0.35 mg / kg if no response in 15 minutes. Maintenance infusion of 5 – 15 mg / hr
|
|
amiodarone dosage
|
Infusion of 150 mg over 1st 10 minutes (15 mg/minute). May repeat every 10 minutes as needed.
|
|
magnesium sulfate dosage
|
1-2 grams IV, over 5-60 minutes
|
|
aspirin dosage
|
324 mg (4 baby chewable aspirin
|
|
nitro dosage
|
1 tablet (0.4 mg) given sublingually q 5 minutes, 0.4 mg metered dose spray given sublingually q 5 minutes, 1-2” paste, 5 mcg / min IV (titrate up 5 mcg / min every 5 min until desired effect is achieved)
|
|
morphine dosage
|
2-5 mg slow IV push, titrated to effect. Max dose usually not to exceed 20 mg without OLMC approval. MS can be given IM
|
|
midazolam dosage
|
2.5 – 10 mg IV or IM
|
|
BBB
|
A block in the conduction of one of the bundle branches. It can be permanent or temporary.
|
|
The etiology of a BBB may include:
|
Acute ischemia
Damage from an MI Age related deterioration Drugs Electrolyte imbalance |
|
How does a BBB present on an EKG strip?
|
For a BBB to show, impulse must originate above the ventricles (a supraventricular rhythm). The QRS MUST be > or = 0.12 seconds.
|
|
EKG criteria for RBBB
|
1. QRS > or = 0.12 seconds
2. Look at V1 A. Rabbit ears in V1 B. The deflection just before the J point will be positive |
|
EKG criteria for LBBB
|
1. QRS > or = 0.12 seconds
2. Look at V1: The deflection just before the J point will be negative. 3. Look at V5, V6 and lead I for rabbit ears |
|
Why do we need to recognize BBBs?
|
1. For good EKG recognition
2. To suspect past cardiac history unknown to the patient 3. An LBBB will obscure an acute MI |
|
A standard assessment tool that uses 10 electrodes-one on each limb and six on the chest.
|
12-lead ECG
|
|
Leads V3 and V4, which are positioned over the front (anterior) of the left ventricle.
|
anterior leads
|
|
Augmented voltage leads; they use an average rather than a single identifiable negative lead.
|
aV leads
|
|
Leads I, II, and III.
|
Bipolar limb leads.
|
|
Graphic representation of the electrical activity of the heart.
|
electrocardiogram (ECG)
|
|
An adhesive pad that contains conductive gel and is designed to be attached to the patient's skin
|
electrode
|
|
Leads V5, V6, I, and VL, which look at the heart from the lower and upper aspects of the left side.
|
lateral leads
|
|
Electrodes connected to the monitor or ECG by wires, which relay the electrical impulse from the generator to the myocardium.
|
leads
|
|
Precordial voltage leads, when acquires with a 3- or 4-lead monitor.
|
modified chest left (MCL)
|
|
The six precordial or voltage leads, which are designedated V1 through V6; second type of electrode and true chest leads.
|
precordial lead electrodes
|
|
A dividing wall or membrane, especially between bodily spaces or masses of soft tissue.
|
septum
|
|
Leads aVR, aVL, and aVF.
|
unipolar limb leads
|
|
The bottom of the calibration spike (one millivolt or two large squares), found at the start of the 12-lead printout.
|
isoelectric line
|
|
Millimeters.
|
mm
|
|
Milliseconds.
|
ms
|
|
Millivolts.
|
mv
|
|
Represents depolarization of the left and right atria.
|
P wave
|
|
Represents the conduction of the electrical impulse from the bundle of His throughout the ventricular muscle, or ventricular depolarization.
|
QRS complex
|
|
Refers to the width of the QRS complex; used to determine wide vs. narrow complexes. In adults >120 milliseconds is considered wide.
|
QRS duration
|
|
Determines conditions such as the presence of an enlarged heart, ST segment elevation, or pulmonary conditions stemming from the lack of voltage.
|
QRS-size measurement
|
|
Determines certain drug and electrolyte imbalances and othe conditions of delayed depolarization; it is measures from the start of the QRS complex to the end of the T wave.
|
QT interval
|
|
Refers to the size of the positively deflected R wave in the precordial V leads as they progressively increase in size from Leads V1 to V4.
|
R wave progression
|
|
Seconds.
|
sec
|
|
Represents ventricular repolarization and follows the ST segment.
|
T wave
|
|
Occurs between Leads V3 and V4; it is the point at which the overall R wave should go from predominantly negative to positive.
|
transition zone
|
|
A right bundle branch block combined with a hemiblock or a left bundle branch block.
|
bifascicular block
|
|
An electrical phenomenon characterized by a widened QRS complex of at least 0.12 seconds (120 milliseconds)or greater, and, in most cases, a definitive QRS morphology pattern.
|
bundle branch block (BBB)
|
|
The volume percent of blood ejected in one contraction; one measure of left ventricular effectiveness; the normal range is between 60 and 75 percent.
|
ejection fraction
|
|
The point at which the QRS complex turns into the ST segment.
|
J point
|
|
Cardiac muscle cell groups that are connected together and function collectively as a unit; the feature of the ventricles or the atrium that produces simultaneous depolarization.
|
synccytium
|
|
Used to diagnose bundle branch blocks and works only in Lead MCL-1 (V1) when the QRS is 0.12 seconds (120 milliseconds) or three small squares on the ECG paper.
|
turn signal criteria
|
|
An MI can develop because of an increase in demand...
|
or a decrease in supply.
|
|
In an already diseased artery the precipitating event is commonly the formation of a...
|
thrombus.
|
|
An MI can also be caused by
|
-Coronay artery spasm
-Microemboli (cocaine) -Acute volume overload -Hypotension -Acute respiratory failure -Trauma |
|
In which ventricle do most MI's occur?
|
Left ventricle.
|
|
Ischemia?
|
Inadequate supply of blood.
|
|
Reciprocal changes?
|
Mirror image that occurs when 2 electrodes view the same MI from opposite angles.
|
|
If II, III, and aVF have ST depression the I and aVL have ST _________.
|
elevation.
|
|
With right sided heart failure blood backs up into the venous side. This drops the BP. What happens if we increase venous capacitance?
|
With a confirmed right sided MI consider witholding nitro.
|
|
Some things that masquerade as an MI...
|
LBBB, pericarditis.
|