Adult Health Ii - Week 3 - Ekg

Front 1

Where are electrodes placed?

Back 1

- on non-bony areas that have minimal movement
- this prevents interference from electrical activity in skeletal muscle

Front 2

How to place electrode for V1 lead?

Back 2

- 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

Front 3

What does the 12 lead EKG visualize?

Back 3

- electrical conduction of the heart, primarily the l. ventricle

Front 4

Explain the significance of each wave in an EKG

Back 4

- p wave - atrial depolarizatoin
- QRS complex - ventricular depolarization
- T wave - ventricular repolarization
[u wave - occurs after T wave during hypokalemia, HTN, or heart disease]

Front 5

segments vs intervals?

Back 5

- segments are between waves
- intervals include wave(s)

Front 6

A small wave appears ofter T wave. What is it?

Back 6

- possibly U wave
- thought to be repolarization of purkinje fibers
- seen in hypokalemia, HTN, heart disease

Front 7

Breakdown of time for EKG squares

Back 7

.04 sec per mm (small square)
.2 sec per 5 mm (large squares)
6 seconds for 30 large squares

Front 8

How to determine HR from EKG?

Back 8

- count number of QRS in 30 large squares
- that amt is 6 sec
- multiply by 10 to obtain HR per 60 sec

Front 9

How does one place limb leads for a continuous EKG?

Back 9

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

Front 10

Explain HR as person is dying.

Back 10

- 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

Front 11

A small wave appears ofter T wave. What is it?

Back 11

- possibly U wave
- thought to be repolarization of purkinje fibers
- seen in hypokalemia, HTN, heart disease

Front 12

Breakdown of time for EKG squares

Back 12

.04 sec per mm (small square)
.2 sec per 5 mm (large squares)
6 seconds for 30 large squares

Front 13

How to determine HR from EKG?

Back 13

- count number of QRS in 30 large squares
- that amt is 6 sec
- multiply by 10 to obtain HR per 60 sec

Front 14

How does one place limb leads for a continuous EKG?

Back 14

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

Front 15

Explain HR as person is dying.

Back 15

- 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

Front 16

Tretment for Sinus Bradycardia

Back 16

- only need to intervene if dizzy
- atropine is drug of choice, 0.5 mg IV bolus
- max 3g atropine

Front 17

Catheter ablation

Back 17

- destruction of cardiac conduction cells --> effect of slowing down heart

Front 18

Treatement of Sinus tachycardia

Back 18

- beta blockers, Ca channel blockers
- catheter ablation for persistant sinus tach

Front 19

PAC

Back 19

= premature atrial complex
- impulse in atrium starts before next normal sinus impulse
- PAC usually followed by noncompensatory pause
- ratio 1:1

Front 20

Atrial flutter

Back 20

= atrial rate 250 - 400, regular rhythm
- saw tooth shape

Front 21

treatment atrial flutter

Back 21

- for atrial flutter <48 hours, cardioversion
- for atrial flutter >48 hours, anticoag before cardioversion
- catheter ablation

Front 22

What is an important question for a person experiencing atrial flutter?

Back 22

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

Front 23

a fib

Back 23

- rapid disorganized twitching of atrium
- irregul rhythm for p AND qrs
- atrial rate 300-600
- f waves = fibrillatory waves

Front 24

a fib treatment

Back 24

- for atrial fib<48 hours, cardioversion
- for atrial fib>48 hours, anticoag for 3-4 weeks before cardioversion

- iv beta blocker, ca channel blocker

Front 25

AVNRT

Back 25

= av nodal reentry tachycardia
- impulse rerouted to AV node, causing tachycardia
- abrupt onset and cessation

Front 26

AVNRT therapy?

Back 26

- break reentry of pulse using vagal maneuvers (carotid sinus massage)
- catheter ablation
- adenosine

Front 27

PVC quadrigeminy vs pvc trigeminy vs bigeminy etc

Back 27

bigeminy = pvc every other complex
trigeminy = every thired
quadrigeminy = every fourth

Front 28

PVC

Back 28

= premature ventricular complex
- imppulse starts in ventricle before normal sinus impulse
- p wave sometimes absent

Front 29

treatment PVC

Back 29

- 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)

Front 30

What are the lethal rhythms?

Back 30

- ventricular tachycardia
- V fib

Front 31

What are the kinds of v tach?

Back 31

monomorphic and polymorphic (torsades de pointes)

Front 32

V tach

Back 32

- bizarre shape
- regular rhythm
- vent rate 100-200
- p waves rarely seen

Front 33

Torsades

Back 33

- undulating pattern
- usually rapidly deteriorates to vtach or v fib

Front 34

cause of torsades

Back 34

usullay due to dec Mg

Front 35

Treatement of polymorphic vtach

Back 35

- correct any electrolyte imbalance
- isuprel
- ventricular pacemaker

Front 36

First degree AV block

Back 36

- PRI > 0.2 sec

Front 37

Second degree AV block type 1

Back 37

inc PRI, then QRS dropped

Front 38

Second degree AV block type 2

Back 38

PRI constant. QRS dropped randomly

Front 39

Third dgree AV block

Back 39

- atria and ventricles follow separate rhythms (SA vs AV node)

Front 40

treatment for asystole

Back 40

- CPR continuous, without interruption
- intubation
- epinephrine

- key to successful treatment is rapid assessment for cause

Front 41

PEA

Back 41

= pulseless electrical activity
- conduction without pulse

Front 42

treatemetn for PEA

Back 42

- epi 1mg IV push repeated every 3-min
- atropine 1 mg IV for rate <60; repeated every 3-5 min for max 3mg

Front 43

Causes of PEA

Back 43

- 7 H's and 5 T's
- hypovolemia, hypoxia, hyperkalemia, hypokalemia, hypoglycemia, hypothermia, hydrogen ion (acidosis)
- toxins (overdose), tamponade, tension pneumothorax, thrombosis, trauma

Front 44

Peaked T's in EKG indicative of

Back 44

hyperkalemia

Front 45

cardioversion vs defribrillation

Back 45

- 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

Front 46

What safety measures should nurse observe while using cardioversion/defib?

Back 46

1. ensure good contact between paddles/pads and skin
2. ensure no one is touching patient

Front 47

What gel should be avoided when using Defib?

Back 47

ultrasound gel should not be used. it is a poor conductor

Front 48

proper use of paddles

Back 48

exert 20-25 lbs of pressure to ensure good skin contact

Front 49

What should be done post defib

Back 49

CPR

Front 50

NASPE BPEG code

DVI

Back 50

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

Front 51

NASPE BPEG code

AOO

Back 51

A = atria being paced
O = no sensing
O = no inhibiting or triggering

Front 52

NASPE BPEG code

VVT

Back 52

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