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80 Cards in this Set
- Front
- Back
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What can an EKG tell us about electrical function?
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Rhythm Disturbances
Conduction Disturbances |
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What can an EKG NOT tell us about?
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Structural Disorders
Perfusion disorders Assess BP and pulses for that |
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What is a P wave the result of?
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electrical stimulation through atrial muscle
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What is the QRS complex the result of?
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ventricle muscle stimulation
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What is the T wave a result of?
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ventricular re-polarization (rest)
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What are the emergency electrical rhythm conductors?
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SA Node at 60-100
AV junction at 40-60 Ventricles at 20-40 the pacemaker site with the fastest rate will generally control the heart |
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What artery supplies the SA node and the AV junction?
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Right Coronary Artery
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What does the atrial muscle rest?
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During the QRS interval
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How does the Sympathetic Nervous System affect the heart?
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Increases HR, conduction, irritability
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How does the Parasympathetic Nervous System affect the heart?
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Dec HR, conduction, irritability
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How many seconds is one box?
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0.04 seconds
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What should you always determine about an EKG when reading it?
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1. Is the rhythm regular?
2. Calculate the HR 3. Identify the P wave 4. Measure the P-R interval 5. Measure how fat the QRS complex is |
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How do you calculate the HR from EKG?
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Count the number of QRS in 6secs and multiply by 10
1500/ # of boxes btw QRS to QRS |
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How do you calculate the P-R Interval?
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by counting the boxes starting at the beginning of the P wave ending at the beginning of the Q wave
take that number and multiply by .04 |
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What is normal P-R interval?
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.12-.20 seconds
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How do you calculate the QRS interval?
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count the boxes of the QRS interval x .04
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What is a normal QRS interval?
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.06-.12 seconds
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How do you treat Sinus Bradycardia?
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Atropine will inc the automaticity of the SA node
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Is a Premature Atrial Contraction (PAC) regular?
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usually except for the PAC
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What do the P waves look like in PAC?
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P wave differs from others - can be flattened or notched , may be lost in preceding T waves
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What is the PRI in PAC?
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.12 -.20, can be greater than .20 secs
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What is the QRS like in PACs?
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less than .12 seconds
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What is the cause of a PAC?
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Caffiene
Theophillin Albuterol |
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What is the treatment for PACs?
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nothing, not life threatening
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Is atrial tachycardia a regular rhythm?
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YES (important)
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What is the rate of atrial tachycardia?
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150-250 beats per minute
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What is the p wave like for atrial tachycardia?
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can be lost in preceding T wave
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What is the PRI like for atrial tachycardia?
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.12-.20 but if not present can't measure this
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What is the QRS like in atrial tachycardia?
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less than .12 seconds
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What are the symptoms of Atrial Tachycardia?
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Result of low CO
Dizziness Dec Capillary Refill LOC usually ok, might be woozy or light headed |
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Is Atrial Tachycardia an emergency?
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yes
Tx: Vagal Maneuvers: bear down, massage carotids Adenosine Shock Digoxin, Ca Channel Blockers, Beta Blockers |
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Is the Atrial Flutter regular?
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Atrial Rhythm regular
Ventricular rhythm usually regular but can be irregular if there is a variable block Ex: If AV node blocks every 2nd beat when heart is beating 300 bpm, the ventricular rhythm is 150bpm |
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What is the Atrial Flutter heart rate?
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250-350bpm, ventricular rate varies (150)
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What do the P waves look like in Atrial Flutter?
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saw tooth pattern (f waves)
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What is the PRI interval in atrial flutter?
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unable to determine
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What is the QRS like in atrial flutter?
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normal less than .12sec
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What is the treatment for atrial flutter?
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Oxygen
IV Shock |
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What is the patho behind atrial fibrillation?
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there are multiple irritable spots in atria
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Is Afib regular?
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NO irregular **hallmark
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What is the rate of Afib?
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>350
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What is the P wave like in Afib?
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No discernable P waves
atrial activity is referred to as fibrillatory waves (f waves) |
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What is the PRI for Afib?
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none
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What is the QRS for Afib
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Normal less than .12 sec
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How should older adults with Afib be treated?
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Lovenox because clots form due to not enough blood flow and the shock shakes them loose
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What part of the heart is stimulated first in junctional arrhythmias if its located at the end of the SA node?
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Atria
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What part of the heart is stimulated first if the Junctional arrhythmia is located in the middle?
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Both at the same time
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What part of the heart is stimulated first if the junctional arrhythmia is located at the lower part of the heart?
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ventricular first
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Is a Premature Junctional Contraction (PJC) regular?
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depends on the rhythm of underlying arrhythmia
same for HR |
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In PJC, why would the P wave precede the QRS complex?
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if the atria are depolarized before the ventricles
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In PJC, why would the P wave be hidden?
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if the atria and ventricles are depolarized at the same time (because its hidden behind the QRS)
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What is the cause of the Junctional Escape Rhythm?
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SA node is gone
too much digoxin |
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Is the JER regular?
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yes
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What is the rate of JER?
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40 - 60 beats (remember the AV junction is taking over)
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Is Accelerated junctional rhythm regular?
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yes
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What is the rate for AJR?
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60-100
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AJR does not occur if ______ is present
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SA Node
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Is Junctional Tachycardia regular?
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yes
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What is the rate of Junctional Tachycardia?
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100-180
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Are Premature Ventricular Contractions (PVS) regular?
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ectopics will disrupt the regularity of underlying rhythm
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What is the rate of PVC?
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depends on underlying rhythm
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What does the p wave look like in PVCs?
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there are none, no PRI
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What is the QRS complex in PVC?
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Wide
>.12 T wave in opposite direction from R wave |
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What is a unifocal PVC?
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the PVC are the same direction - no pulse felt
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What is multifocal PVC?
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the PVCs are in different directions
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What is a PVC couplet?
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two PVCs in a row
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What is a PVC run?
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3 PVCs in a row or more
Ventricular Tachycardia |
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What is Bigeminy?
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WHen theres a beat then PVC
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What is trigeminy?
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When theres 2 beats and a PVC
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WHat is a quadrademiny?
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when there are 4 beats and one PVC
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How many PVCs does it take for Tx?
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>6 in a min calls for tx
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Is ventricular tachycardia regular?
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yes, but slightly irregular
occurs when it fires more than three times in a row usually preceded by a PVC |
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What is ventricular tachycardia's rate?
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150-250
<150 is slow VT >250 is ventricular flutter |
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What are the symptoms of Ventricular Tachycardia?
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Can have a pulse with rhythm: Tx cardiovert "i don't feel good"
No pulse with rhythm: Tx: like Cardiac arrest, CPR, Defib, Litocane, O, Amnioterone |
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What are the characteristics of Vfib?
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No PQRST
START CPR |
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What is the Tx for Vfib?
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If PEA: CPR then AED shock
if pulse present and stable: O, IV access, Lidocaine, Lidocaine again, Preocainamide, Cardiovert If pulse present and unstable: O, IV access, Cardiovert x3 (up to 300joules), if recurrent add lidocaine and cardiovert, procainamide or Bretylium |
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What is asystole ?
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flat line
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In a First Degree Heart Block, what is abnormal about it?
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Upright P wave followed by a QRS
>.20 secs for PRI, constant |
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In Second Degree Heart Block, what is abnormal?
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Rate: usually bradycardia
Pwaves: uniform but 2 ps to one QRS PRI: constant, can be >.20 |
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What is abnormal about Complete Heart Block?
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Regular Beat
40-60 beats Junctional, 20-40 if ventricular Pwaves: more P waves than QRS QRS: Junctional <.12, ventricular >.12 |
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What is abnormal about wenckebach?
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increasingly longer PRI until one P is blocked
Irregular beat More than one P for QRS |
