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1
Q

segment is a

A

line connected by two points

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2
Q

what is a normal PR interval

A

0.12-0.20 seconds; 3-5 small boxes

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3
Q

normal QRS

A

Normal: 0.08-0.12 seconds; 2-3 small boxes

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4
Q

” QT Interval normal

A

max: 0.45 seconds (11-12 boxes);

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5
Q

prolonged QT

A

over 12 boxes?

prolonged QT = @ risk for sudden death (hypokalemia, hypomagnesemia, hypocalcemia)

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6
Q

SA nodes bpm

A

60-100

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7
Q

Atrial muscle BPM

A

60-80

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8
Q

AV node BPM

A

40-60

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9
Q

placement of precordial leads

A

V1 4th intercostal space to right of atrium
V2 same as V1 but to the left
V3 directly between 2 and 4
V4 5th intercostal midclavicular
v5 to the left of V4 left anterior axillary line
V6 to the left of V5 midaxillary line

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10
Q

which precordial leads give us a view of the septum

A

V1 and V2

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11
Q

Which precordial leads give us a view of the anterior heart

A

V3 and V4

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12
Q

which anterior leads give us a view of the lateral heart

A

V5 and V6

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13
Q

What are the labels of the limb leads

A

I, II, II

aVR, aVF, aVL

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14
Q

where should a normal heart sit

A

between 0 and 90 degrees

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15
Q

what does isoelectric line refer to

A

if the mean depolarization path is directed at right angels (perpendicular) to any lead there will be a biphasic deflection and the isoelectric line can be drawn through this

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16
Q

1st area of ventricular muscle to be activated is is the inter-ventricular septum which is seen as what on a EKG

A

Q wave

negative

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17
Q

impulse travel at what speed through the AV node

A

slowly

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18
Q

impulse typically travels at what speed through the bundle of his

A

very quickly

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19
Q

where does impulse travel once thru the AV node

A

bundle of his–> BB>–> ventricualr muscle

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20
Q

what does the R wave represent

A

left and right ventricular muscle activation (endocardial first followed by epicardial)

big positive

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21
Q

s waves

A

a few small areas of ventricles are activated at a late stage and this is represented by the s wave

typically seen as negative

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22
Q

atrial depolarization is represented by the

A

p wave

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23
Q

intervals are

A

wave(s) and segments

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24
Q

order of signals starting with pacemaker cells in the SA

A 
sa
atrial syncytium
juntional fibers
atrioventricular node 
BB
PF
ventricular synctium
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25
which atrium contracts first
the right
26
usually SA node stimulus appears as a
P wave
27
AV node signal is delayed by
.12 seconds this is important because AV node blocks will prolong this signal
28
AV junction is made up of
AV node bundle of his R and L bb
29
SA node typically beats around
60-100
30
atria beats typically
40-60
31
ventricles bpm
20-40
32
atrial junction is typically seen with what bpm
60-80
33
1st degree normal AV block might be seen in what pt population
athletes
34
things that can change the conductions in a EKG
hair wheelchair bra pacemaker, bone, muscle movement, dried out electrodes, heavy breathing and sweating
35
V1 and V2 will tell you the
septum
36
V3 and V4 will tell you
the anterior
37
V5 and V6 will tell you
lateral
38
V1 is lovated where
4th intercostal space to right of sternum
39
V2 is located
4th intercostal space to left of sternum
40
V3 placement
directly between V2 and V4
41
v4 placement
5th intercostal space at midclavicular line
42
v5
level with V4 at left anterior axillary line
43
v6 location
level with v5 at left midaxillary line
44
positive electrode will appear on a ekg
as a positive wave (mountain top)
45
isoelectric line what is it?
is the straight line drawn across a depolarization path that is at a right angle ( or perpenducular ) to any lead
46
1st area of ventricular muscle to be activated is the interventricular septum which activates L--> R and is represented as the
Q wave
47
L& R ventricular muscle walls get activated after w/ the endocardial surface BEING activate before epicardial surface creating the
R wave
48
a few small areas of ventricles are activated in the late stage known as the
S wave
49
ventricular muscle repolarizes and is represented as a
T wave
50
QRS complex represents
ventricular depolarization/ventricular contraction
51
atrial depolarization is represented by
p wave
52
U waves are usually detected in the presence of
Electrolyte imbalance usually this U wave is merged with the T wave
53
i small box is what amount of time
.04 seconds
54
5 small boxes represent what amt of time
.2 seconds
55
1 big box is
1 mv (10 small boxes)
56
i small box is
.1 mv
57
TELEMETRY
putting pt on EKG monitor and observing continuously | Long-term ekg
58
two thumbs up method
looking at AVF and I to determine deviation
59
if I and AVF are positive
heart is in normal placement
60
if I is positive and AVF is negative
left axis deviation
61
negative I and negative avf
indeterminate axis
62
negative I and positive avf
right axis deviation
63
depolarization is synonymous with
contraction
64
QRS complex is representative of
ventricular depolarization
65
ventricular repolorization is seen as the
T wav
66
U wave
after potential of ventricular muscle and re-polarization of purkinje fibers
67
why would se typically see a U wave
electrolyte imbalance.
68
1. Identify the differences between analog imaging and digital imaging and some of the advantages of digital over analog.
Digital imaging can be sent and viewed anywhere. It can also be manipulated without having to re-expose the patient
69
Define PACS. Identify and recognize correct view box placement of films.
PACS = Picture Archiving and Communication Systems Viewbox films are placed with the pts R on your L Old → new films are placed L → R
70
b. Two things make an image more radiopaque:
Identify and recognize radiolucent and radiopaque. i. Density ii. Thickness radiopaque is more white radio lucent is less
71
a. Pt must remain still b. Magnification issues. Objects are magnified when: i. Beam is close to the pt ii. Pt is far from cassette surface c. Distortion issues. ii. Example is "lordotic CXR" where pt is in bed, angled 1. This makes the base of the heart look larger 2. You can tell it's lordotic if the clavicles are high d. *Never judge cardiomegaly from a CXR unless it's a perfect PA!!
4. Identify those factors which must be considered by an x-ray technician before obtaining a plain film, including positioning of the patient, the cassette and the beam.
72
i. Beam is close to the pt | ii. Pt is far from cassette surface
magnifications issues occur when
73
Objects aren't perpendicular when
objects are distorted in xray when
74
where pt is in bed, angled 1. This makes the base of the heart look larger 2. You can tell it's lordotic if the clavicles are high
"lordotic CXR
75
a. Frontal (from the front, coronal), same as PA b. PA (from behind, coronal) c. Oblique (anything other than the cardinal planes d. Cephalo-caudal (birds eye view) → AKA "axial"
5. Identify and recognize frontal projection, lateral view, posteroanterior, anteroposterior and oblique views.
76
CT and MRI both use the_______ to describe the views
CT and MRI both use the three cardinal planes to describe the views
77
a. Contrast is bright white (e.g. barium) b. Don't use it if the thing you're looking for is also high attenuation! c. PO and IV contrast both are eliminated by the kidneys. (They will appear as high attenuation either way!)
9. Recognize a CT scan with and without oral and/or IV contrast
78
d. Contraindications ofr CT contrast
CI for contrast w/ d. Contraindications: i. Allergy ii. Renal insuff. (creatinine >1.5) → CT, Contrast, Creatinine! iii. Current metformin (d/c 24 before and resume 48h after)
79
iii. Current metformin (d/c 24 before and resume 48h after) | 10. Recognize 3-D CT image reconstruction. Identify how this technique is useful in contrast to non-enhanced CT images.
a. Can give you a 3D orientation | b. Can subtract out stuff you don't want to see (e.g. isolate renal vessels)
80
11. Identify those patients for whom MRI is not an option and identify why.
a. Unstable patients (can't run a code until the machine powers down) b. Pacemakers c. Other ferrous metal implantations (titanium & stainless steel ok)
81
when would you not want to use a xray (what are they not good at evaluating)
detail, precise location, solid organs, brain, or vasculature
82
what imagining would you want to run for a pt coming in with a new seizure or changed mental status
CT
83
when would you want a CT of the chest vs CXR
CT:lung tumor, effusion, infxn, PE, etc) CXR: resp sx, chest pain, upper GI, trauma, procedures, fever)
84
two tests for the detection of a metallic fb
XRAY and CT
85
what imaging would you need for ligament or tendon injuries
MRI Exceptional detail Contrast not renal toxic unless GFR <30 Safe in pregnancy
86
what imaging would you do for a pt with a CVA
CT 1st followed by MRI MRI is more subtle
87
how do you describe an ULS black whiter darker casts shadow
``` Anechoic (black) Hyperechoic (whiter) Hypoechoic (darker) Echogenic (casts acoustic shadow, Ca+2) ```
88
Biliary tract stuff (stones, etc) would be evaluated best with what imagining
MRI
89
V/Q scan (PEmbolus) is an example of what type of imaging
nuclear studies
90
HIDA scan (gallbladder) is an example of what type of imaging
nuclear scan
91
Vessels (DVTs) are evaluated best with what type of imagery
ULS
92
low attenuation refers to
Low attenuation = less dense Shades of grey to black CT

EKG (7 decks)

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