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49 Cards in this Set
- Front
- Back
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ECG Characteristics of
Sinus Rhythm (NSR, RSR) |
RATE: 60-100 bpm
RHYTHM: Regular P-WAVES: Uniform, upright, normal shape, one before each QRS complex PRI: 0.12 to 0.20 QRS: 0.10 or less; if greater than 0.10 it is termed "wide" |
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ECG Characteristics of
Sinus Bradycardia |
RATE: <60 bpm
RHYTHM: Regular P-WAVE: Uniform, upright, normal shape, one before each QRS complex. PRI: 0.12 to 0.20 QRS: 0.10 or less |
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ECG Characteristics of
Sinus Tachycardia |
RATES: 100-160 bpm
RHYTHM: Regular P-WAVE: Uniform, upright, normal shape, one before each QRS complex. PRI: 0.12 to 0.20 QRS: 0.10 or less |
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ECG Characteristics of
Sinus Dysrhythmia (Sinus Arrhythmia) |
RATE: Usually 60-100 bpm
RHYTHM: Irregular PWAVES: Uniform, upright, normal shape, one before each QRS complex. PRI: 0.12 to 0.20 QRS: 0.10 or less |
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ECG Characteristics of
Sinoatrial Block (Sinus Exit Block) |
RATE: Varies
RHYTHM: Irregular The pause is the same as the distance between two other P-P interval(or an exact multiple of). P-WAVES: Uniform, upright, normal shape, one before each QRS complex. PRI: 0.12 to 0.20 QRS: 0.10 or less |
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ECG Characteristics of
Sinus Arrest |
RATE: Varies
RHYTHM: Irregular The pause is of undetermined length with more than one PQRST complex missing and is Not the same as other P-P intervals. P-WAVES: Uniform, upright, normal shape, one before each QRS complex. PRI: 0.12 to 0.20 QRS: 0.10 or less |
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ECG Characteristics of
Premature Atrial Complexes (PAC) |
RATE: Usually normal, depends on underlying rhythm
RHYTHM: Essentially Regular with premature (early) beats P-WAVES: Early beat Pwave differs from sinus Pwaves; may be flattened, notched, pointed, biphasic or lost in Twave PRI: Varies from 0.12-0.20 when site is near SA node; 0.12 when site closer to AV junction QRS: Usually less than 0.10 |
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ECG Characteristics of
Supraventricular Tachycardia (SVT,PSVT,PAT,A-tach,Narrow-Complex tach) |
RATE: 150-250 bpm
RHYTHM: Regular P-WAVES: Atrial Pwaves may be flattened or notched. May be seen at lower end of rate range, seldom able to be seen at rates greater than 200. PRI: May be less than 0.12; IF Pwaves are visible. QRS: 0.10 or less |
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ECG Characteristics of
Wandering Atrial Pacemaker (Multiformed Atrial Rhythm) AND Multiformed Atrial Tachycardia (MAT) |
RATE: 60-100* bpm
RHYTHM: Irregular P-WAVES: Size, shape & direction may change from beat to beat. MUST have @ least 3 different P-waves for this diagnosis. PRI: Varies QRS: Usually less than 0.10 *If Rate is greater than 100 and meets other criteria, termed Multiformed Atrial Tach (MAT). |
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ECG Characteristics of
Atrial Flutter |
RATE: 250-350 bpm atrial; ventricular rate varies based on the AV blockade.
RHYTHM: Atrial Regular; Ventricular Regular or Irregular P-WAVES: Not identifiable; Saw-tooth flutter waves seen. PRI: None QRS: Usually less than 0.10, may be widened if flutter waves buried in QRS complex. |
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ECG Characteristics of
Atrial Fibrillation (A-fib) Controlled vs Uncontrolled |
RATE: 350-400 bpm atrial; ventricular Variable*
RHYTHM: Irregularly Irregular; MAY be Regular IF due to Digitalis toxicity. P-WAVE: Not identifiable; fibrillatory waves, erratic wavy baseline. PRI: Not measurable QRS: Usually less than 0.10 *Rate under 100 bpm is a Controlled ventricular response. *Greater than 100 bpm is an Uncontrolled ventricular response. |
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ECG Characteristics of
Premature Junctional Complexes (PJC) |
RATE: Usually normal, depends on underlying rhythm
RHYTHM: Essentially regular with premature (early) beats P-WAVES: Ectopic beat Pwave may occur before, during or after the QRS. If visible; it is inverted in leads II, III and aVF. PRI: If Pwave before QRS, usually 0.12 or less. If No Pwave before QRS, No PRI. QRS: Usually 0.10 or less |
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ECG Characteristics of
Junctional Escape Beat(s) |
RATE: Usually normal, depends on the underlying rhythm
RHYTHM: Essentially Regular with LATE beats P-WAVES: Ectopic beat Pwave may occur before, during or after the QRS. If visible; it is inverted in leads II, III and aVF. PRI: If Pwave before QRS, usually 0.12 or less. If No Pwave before QRS, No PRI. QRS: Usually 0.10 or less. |
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ECG Characteristics of
Junctional Escape Rhythm |
RATE: 40-60 bpm
RHYTHM: atrial & ventricular very Regular P-WAVES: May occur before, during or after QRS. If visible, it is inverted in leads II, III & aVF. PRI: If Pwave before QRS, usually 0.12 or less. If No Pwave before QRS, No PRI. QRS: Usually 0.10 or less. |
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ECG Characteristics of
Junctional Escape Rhythm |
RATE: 40-60 bpm
RHYTHM: atrial & ventricular very Regular P-WAVES: May occur before, during or after QRS. If visible, it is inverted in leads II, III & aVF. PRI: If Pwave before QRS, usually 0.12 or less. If No Pwave before QRS, No PRI. QRS: Usually 0.10 or less |
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ECG Characteristics of
Accelerated Junctional Rhythm |
RATE: 60-100 bpm
RHYTHM: atrial & ventricular very Regular P-WAVES: May occur before, during or after QRS. If visible it is inverted in leads II, III & aVF. PRI: If Pwave before QRS, usually 0.12 or less. If No Pwave before QRS, No PRI. QRS: Usually 0.10 or less. |
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ECG Characteristics of
Junctional Tachycardia |
RATE: 100-180 bpm
RHYTHM: atrial & ventricular very regular P-WAVE: May occur before, during or after QRS. If visible, it will be inverted in leads II, III & aVF. PRI: If Pwave before QRS, usually 0.12 or less. If No Pwave before QRS; No PRI. QRS: Usually 0.10 or less |
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ECG Characteristics of
Premature Ventricular Complex (PVC) |
RATE: Usually normal, depends on underlying rhythm.
RHYTHM: Essentially regular w/ premature (early) beats. P-WAVES: No Pwave associated w/ ectopic beat. PRI: None w/ ectopic beat QRS: Ectopic beat: > 0.12, wide & bizarre, Twave frequently in opposite direction of QRS |
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Describe an Interpolated PVC
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1. A PVC that occurs without interfering w/ the normal cycle.
2. When a PVC is "squeezed" between two regular complexes and does Not disturb the underlying rhythm. 3. It does Not have a full compensatory pause. 4. The PRI of the cardiac cycle following the PVC may be longer than normal. |
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1. Describe R on T PVC's
2. List what dangerous dysrhythmia(s) might they precipitate and Why |
1. They occur when the R-wave of a PVC falls on the T-wave of the preceeding beat.
2. Because the T-wave is vunerable (Relative Refractory Period) to electrical stimulation, a PVC occurring during this period may precipitate V-Tach or V-Fib. |
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ECG Characteristics of
Ventricular Escape Beat(s) |
RATE: Usually normal, depends on underlying rhythm
RHYTHM: Irregular, ectopic beat occurs LATE P-WAVES: No Pwave associated w/ ectopic beat(s) PRI: None w/ ectopic beat(s) QRS: Ectopic beat; > 0.12, Wide & Bizarre, T-wave frequently in opposite direction of QRS complex |
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ECG Characteristics of
Idioventricular Rhythm (IVR) |
RATE: 20-40 bpm (ventricular)
RHYTHM: Essentially Regular P-WAVES: None PRI: None QRS: > 0.12, Wide & Bizarre, Twave frequently in opposite direction of QRS complex ***DO NOT GIVE LIDOCAINE*** |
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ECG Characteristics of
Accelerated Idioventricular Rhythm (AIVR) |
RATE: 40-100 bpm (ventricular)
RHYTHM: Essentially Regular P-WAVES: None PRI: None QRS: > 0.12, Wide & Bizarre, Twave frequently in opposite direction of QRS complex ***DO NOT GIVE LIDOCAINE*** |
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ECG Characteristics of
Ventricular Tachycardia (VT, V-Tach) |
RATE: 100-250 bpm (ventricular)
RHYTHM: Essentially Regular P-WAVES: None PRI: None QRS: > 0.12, Wide & Bizarre, T-wave frequently in opposite direction of QRS complex, often resemble "Tombstones" |
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How should proceed when it is unclear whether a regular, wide-complex QRS tachycardia is V-tach OR SVT with an intraventricular conduction defect?
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Treat the rhythm as V-tach until proven otherwise.
***Remember VT is considered a potentially life-threatening dysrhytmia*** |
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1. Define Polymorphic Ventricular Tachycardia
2. What type is often associated with a prolonged QT Interval? |
1. It has more than one shape to its QRS complexes.
2. Torsade de Pointes (TdP) |
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1. Describe the QRS complex(es) of Torsades de Pointes (TdP).
2. List two things that may precipitate this dysrhythmia. |
1. The QRS changes in shape, amplitude & width. It appears to "twist" around the isoelectric line, resembling a spindle.
2. May be precipitated by slow heart rates and is ofter associated w/ drugs/electrolyte disturbances that prolong the QT Interval. **A lengthening QTI may be the only warning sign of impending TdP** |
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List Drug Induced causes of a Prolonged QT Interval
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1. Cyclic Antidepressants
2. Phenothiazines 3. Type IA Antidysrhythmics a) quinidine b) procainamide c) disopyramide 4. Organophosphate insecticides |
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List "Other" two causes of prolonged QT Interval
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1. Eating Disorders
a) bulimia b) anorexia 2. Electrolyte Abnormalities a) Hypomagnesemia b) Hypokalemia c) Hypocalcemia |
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ECG Characteristics of
Torsades de Pointes (TdP) |
RATE: 150-250 bpm (ventricular)
RHYTHM: Regular or Irregular P-WAVES: None PRI: None QRS: > 0.12, gradual alteration in the amplitude & direction of the QRS. Appears to "twist" around the isoelectric line, resembling a spindle. |
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ECG Characteristics of
Ventricular Fibrillation (VF, V-Fib, V-fib) |
RATE: Can Not be determined, No discernible waves or complexes to measure.
RHYTHM: Rapid & Chaotic w/ no pattern or regularity. P-WAVES: Not Discernible PRI: Not Discernible QRS: Not Discernible |
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ECG Characteristics of
Asystole (Ventricular Aystole, Cardiac Standstill) |
RATE: Ventricular indiscernible, May see some atrial activity.
RHYTHM: Atrial May be indiscernible; Ventricular indiscernible. P-WAVES: None PRI: None QRS: None |
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Describe Pulseless Electrical Activity (PEA)
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1. It is a clinical situation, Not a specific dysrhythm.
2. Exists when organized electrical activity (other than VF or VT) is observed on the cardiac monitor, But mechanical contraction does Not occur. Patient is Pulseless. 3. Treatment includes CPR, intubation, IV, AGGRESSIVE search for possible causes and drug therapy per current AHA guidelines. |
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List the "H's" of possible causes of PEA
(total of six) |
1. Hypovolemia
2. Hypoxia 3. Hydrogen ion (acidosis) 4. Hyper/Hypokalemia (potassium) 5. Hypoglycemia 6. Hypothermia |
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List the "T's" of possible causes of Pulseless Electrical Activity (PEA)
(total of five) |
1. Toxins
2. Tamponade (cardiac) 3. Tension Pneumothorax 4. Thrombosis (Coronary & Pulmonary) 5. Trauma |
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Table 7-1: Classifications of Atrioventricular (AV) Blocks
("Degree of Block" section) |
1. PARTIAL BLOCKS:
a) First-degree AV block b) Second-degree AV block Type I (Mobitz I, Wenckebach) c) Second-degree AV block Type II d) Second-degree block 2:1 Conduction 2. Complete Block a) Third-degree AV block |
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Table 7-1: Classifications of AV Blocks
("Site of Block" section) |
1. AV Node:
a) First-degree AV block b) Second-degree Type I c) Third-degree AV block 2. Infranodal A. Bundle of His a) Second-degree Type II (uncommon) b) Third-degree AV block B. Bundle Branches a) Second-degree Type II (more common) b) Third-degree AV block |
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ECG Characteristics of
First-Degree AV Block |
RATE: Atrial & ventricular the same, depends on the underlying rhythm.
RHYTHM: Atrial & ventricular Regular P-WAVES: Normal Size & Shape; only one before QRS PRI: Prolonged but Constant(>0.20) QRS: Usually 0.10 or less |
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ECG Characteristics of
Second-Degree AV Block Type I (Mobitz I, Wenckebach) |
RATE: Atrial > Ventricular; usually both within normal limits
RHYTHM: Atrial Regular, P's plot thru. Ventricular Irregular. P-WAVES: Normal Size & Shape; some not followed by QRS complex, More P's than QRS's. PRI: Gets longer with each cycle until a QRS is dropped. PRI is shorter in the beat after the dropped QRS than the one before it. QRS: Usually 0.10 or less, one is periodically dropped. |
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ECG Characteristics of
Second-Degree AV Block Type II (Classical) |
RATE: Atrial > Ventricular; ventricular rate is often slow.
RHYTHM: Atrial Regular, P's plot thru; Ventricular Irregular P-WAVES: Normal Size & Shape, some are not followed by QRS, More P's than QRS's. PRI: May be normal or prolonged, always CONSTANT when QRS is conducted. QRS: Usually 0.10 or greater, absent after some Pwaves. |
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ECG Characteristics of
Second-Degree AV Block 2:1 Conduction |
RATE: Atrial > Ventricular
RHYTHM: Both Regular (P's plot thru) P-WAVES: Normal Size & Shape, only every other Pwave is followed by a QRS, More P's than QRS's. PRI: Constant QRS: Within normal limits; if block above the bundle of His, Probably Type I. QRS will be wide; if block below the bundle of His, Probably Type II. Both types: absent after everyother P wave. |
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ECG Characteristics of
Complete (Third-degree) AV Block |
RATE: Atrial > Ventricular; ventricular rate is based on the origin of the escape rhythm.
RHYTHM: Both Regular PWAVES: Normal Shape & Size PRI: None; the atria & ventricles are beating independently of one another. QRS: Narrow or Broad, depending on the location of the escape pacemaker site. NARROW: Junctional pacemaker BROAD: Ventricular pacemaker |
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State and Compare the QRS durations for:
1. Complete AV block with a Junctional pacemaker 2. Complete AV block with a Ventricular pacemaker |
1. Duration of 0.08 - 0.10 (2-2.5 small boxes)
2. Duration of 0.12 - 0.14 (3-3.5 small boxes) |
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List the Four Indications for Transcutaneous Pacing (TCP)
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1. Significant bradycardias unresponsive to Atropine therapy OR if atropine is not immediately available.
2. May be used as a "bridge" until cause of brady-dysrhythmia is reversed (Drug OD or Hyperkalemia) OR until transvenous pacing established at hospital 3. Consider in cardiac arrest from Drug OD, Especially if Profound Bradycardia or PEA 4. Consider in Asystolic cardiac arrest (Down time <10min) and witnessed asystolic arrest |
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1. What does transcutaneous pacing involve?
2. What is the preferred electrode placement position and why? |
1. TCP involves attaching two pacing electrodes to the patient's thorax.
2. Anterior-Posterior position is preferred because this position causes less stimulation of the pectoral muscles and does not interfere with w/ ECG electrode or defibrillator paddle placement. |
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With Anterior-Posterior positioning, describe location of:
1. Negative electrode 2. Positive electrode |
1. Negative (anterior) placed to the Left of the sternum, 1/2 way between the xiphoid process & Left nipple. The top edge should be just below nipple line.
2. Positive (posterior) placed on the Left posterior thorax (back) below the scapula, lateral to the spine at the level of the heart. |
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Electrodes should:
(list three things) |
1) ...fit completely on patient's torso.
2)...have a minimum of 1"-2" between electrodes. 3)...NOT overlap bony prominences of the sternum, spine or scapula. |
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If anterior-posterior is contraindicated, what position should be used?
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Anterior-Lateral electrode position
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With Anterior-Lateral positioning, describe location of:
1. Negative electrode 2. Positive electrode |
1. Negative (anterior) placed on the Left chest, just lateral to Left nipple, in the midaxillary line.
2. Positive (posterior) placed on Right upper chest in the subclavicular area. |
