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36 Cards in this Set

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wilkins chapter 10 page 207 to 215

Egans chapter 18, 381 to 388


Workbook Chapter 18 page 141 to 146

summary of normal values for electrocardiogram interpretation and common alterations

Rate 60 to 100 /min

SInus bradycardia

Meets all the criters for NSR but is too slow


:Rate: less than 60 bpm


:Rhythm: regular


:P waves normal and is followed by a QRS


:PR interval 0.12 to 0.2 seconds

SInus Tachycardia

Meets all criteria for NSR but is too fast


:Rate 100 to 150 bpm


Rhythm regular


P waves normal but increased

SInus Tachycardia

Meets all the criteria for NSR but is too fast


:Pr interval: 0.12 to 0.2 second


:QRS less than 0.12 seconds

SInus dysrhythmia

Meets all the criteria for normal sinus rhythm but is irregular


:Rate 60 to 100 beats per minu, may also be bradycardia


:Rhythm: irregular


:P waves: normal and followed by a QRS complex


:PR interval 0.12 to 0.2 second in length


:QRS: less than 0.12 second in width

Atrial FLutter

Distinct rapid swtooth pattern between normal WRS


:Rate: atrial rates 180 to 400; ventricular rate is slower


:Rhythm: regular


:P waves, sawtooth and uniform

Atrial FLutter

Distinct rapid sawtooth pattern between normal WRS


:PRI: not measurable


:QRS less than 0.12 second

Atrial fib

Characterized by chaotic baseline between WRSs


:Rate: variable (count WRSs in 6 second strip)


:Rhythm: irregularly irregular


:P waves: fibrillatory waves that all vary

Atrial fibrillation

Characterized by chaotic baseline between WRSs


:PRI not measurable


:QRS is less than 0.12 seconds


Premature ventricular contractions

Underlying rhythms is interrupted by wide QRS (greater than 0.12 seconds) not preceded by a P wave and has an inverted T


:Rate: that of the underlying rhythm


:Rhythm: regular rhythm is interrupted by PVC


:P waves: not associated with the PVC


Premature ventricular contractions


Underlying rhythm is interrupted by wide QRS so greater than 0.12 sec, and is not preceded by a P wave, and has an inverted T


:PR interval not measurable


:QRS is greater than 0.12 sec, premature, abnormal configuration,

Ventricular Tachycardia

Wide QRS occuring rapidly without P waves


:Rate of 140 to 300 bpm


:Rhythm is regular


:P waves not associated with QRS complexes

VVentricular tachycardia

Wide QRS occuring rapidly without P waves


:PR interval: not measurable


:QRS: abnormal and greater tthan 0.12 second in width

Ventricular fib

Chaotic rhythm, characterized by wavy irregular pattern


:Rate: none


:Rhythm, irregular, chaotic waves


:P waves: none



:PRI, non


:QRS: none or sporadic low amplitutde

Asystole

Characterized by a straight or almost flat line


Rate: none


:Rhythm non


:P waves non


:PRI non


;QRS none

AV Heart block

General term: problems conducting impulses from the atrial to the ventricules


Blocks can occur at the AV node, bundle of His or the bundle branches


Complete heart block may be associated with hypotension


Milkder forms of heart block often cause no symptoms

First degree AV block

Looks like NSR but a prolonged PR interval (greater than 0.2 seconds)


:Rate: underlying rhythm rate


:Rhythm: regular


:P waves: normal, each preceding a QRS complex

Radiograph views

Standard views


:Anteroposterior (film behind your back, camera in front)


:Posterior anterior view


Special views


:Lateral decubitus


:Apical lordotic


:Oblique (side of lungs)


:expiratory


Anterior Posterior view

Indications for AP portable films


:Evaluate the lung status


:evaluate lines and tubers


:See results of invasive therapeutic maneuvers



:Portable chest film


Film cassette placed behind patients back


X ray beam moves from front to back


:anterior to posterior) 4 feet from beams origin


:More magnification artifact that PA Chest X ray

Evaluation of the chest radiograph

Recognition of anatomic landmarks


Review clinical finding before viewing CXR


Placing the chest film


:Patient facing clinician


:cardiac shadow more prominent

Xray

Penetration inversely proportional to density of structure


Normal lung density tissue has low density


:Cavities, blebs darkers


Consolidation increases density


:Pneumonia, tumer, collapse (white patch)


Greatest density in the chest: bones


Systemic review of all structures


:A through Z


Determine quality of the film

Visualize vertebral bodies through cardiac shadow


:If easily seen, overexposed, recognize rotation of the patient


SPnous processes to medial ends of clavicles


Degree of patients inspiratory effort


:10 posterior ribs on PA film


Silhouette Sign and air bronchogram

Silhouette sign


:infiltrate that obliterates heart border or


:diaphragm must be located in anterior segments of the lung


Air bronchogram


:visible bronchi when surrounded by consolidated alveoli


:Confirms intrapulmonary disease


Clinical and radiographic findings in lung disease

Atelectasis


Hyperinflation


Interstitial lung disease

Atelectasis

Compressive atelectasis


:pleural effusion, pneumothorax, hemomthorax


:If severe, mediastinal shift


Obstructive atelectasis


:Tumor, aspirated foreign body, mucus plugging


Posteroperative atelectasis


:Microatelectasis


CXR: lung volume loss, mediastinal shift


Emphysema

Anatomic alterations of the lungs


Permanent enlarbement of alveoli


Results in dereased surface area for optimum gas exchange


Causes ventilation in excess of perfusion which is deadspace


Wasted ventilation



Distal airways, weakended in the process, then collapse during expiration


trapped gas is a result in the alveoli


This leads to increased alveolar deadspace increase Vd alv


Increase PaCO2


Alveolar ventilation and PaCO2 are inversely related


Emphysema

Alpha 1 antitrypsin deficiency


Alpha 1 is secreted by the liver


When white blood cells are destroyed in the lungs the alpha 1 is released that destroys elastic tissue


CXR COPD

Translucent (dark lung fields)


Density of the lungs decreases because of the air trapping


Decrease in the lung recoiling


Flattened diaphragms


Long narrow heart

Pneumothorax

Tall, thin young males


COPD with bullous dissease


Trauma


:Broken ribs


:Puncture wound


:latrogenic



Air enters pleural space


Pleura separate


Affected lung collapses

Tension pneumothorax is a medical emergency

Needs immidiate relief via tube thoracostomy


Pleural diagnostic evaluation

Size of pleural effusion


:To see on chest film


:200 cc



Radography


Thoracentesis


Thoracoscopy


:Video assisted thoracic surgery


Thoracotomy

Thoracentesis

Insertion of needle into pleural space


:Use of local anesthetic


:sample for cell counts, cultures, chemistries, cytology and pH


Catheter placed


:If theres a lot of fluid to be drained


:Lung re expansion needed



Needle placed just superior to a rib


3 major risks


:intercostal artery laceration, infection, pneumothorax


Thoracoscopy

Video assisted thoracic surgery


Local anesthesia and conscoius sedation


Thoracoscope placed through intercostal incision


:Visualization of lung surfaces


:drainage of pleural fluid


:Biopsy under direct visualization

Chylothorax

Chyle in pleural space


:Milky appearance


:leakage of thoracic duct


Ruptures into pleural space

Hemothorax

Blood in pleural space(usually occures cause of trauma)


Life threatening