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Advanced Health Assessment > Advanced EKG > Flashcards

Advanced EKG Flashcards

(79 cards)

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1
Q

The more leads…

A

the more specific the findings

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2
Q

3-lead EKG

A

single view of the heart’s electrical pattern; only able to monitor one lead at a time

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3
Q

5-lead EKG

A

multiple views; able to monitor in two or more concurrent leads at once

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4
Q

Lead I, II, & III tracing

A

upright

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5
Q

How to confirm Asystole in the OR

A

confirm in a second lead (might have just fallen off)

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6
Q

Recommended lead of choice for electrical cardioversion

A

Lead II

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7
Q

Lead III gives a better view of

A

the left ventricle

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8
Q

The purpose of the EKG dictates the…

A

lead placement

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9
Q

Lead III baseline…

A

wanders up and down d/t the positive electrode being located on the diaphragm

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10
Q

Best pt position for EKG

A

supine

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11
Q

Ways to optimize EKG

A

shave hairy chests, place in proper place around large breasts, dry skin, use alcohol to make it sticky

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12
Q

What should you not use to help leads stick?

A

deodorant (arid extra dry, ban roll on)

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13
Q

How many electrodes do 12-lead EKGs use?

A

10 electrodes; one on each limb, six on left chest

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14
Q

Avoid putting leads on

A

bony prominences (shoulders)

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15
Q

V4 is placed

A

Mid-clavicular

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16
Q

V5 is placed

A

Anterior axillary

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17
Q

V6 is placed

A

Mid-axillary

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18
Q

Inferior Leads

A

II, III, avF

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19
Q

Septal Leads

A

V1 & V2

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20
Q

Anterior Leads

A

V3 & V4

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21
Q

Lateral Leads

A

V5 & V6
I & avL (high lateral)

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22
Q

RSR prime complex indicative of

A

RBBB in lead MCL1

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23
Q

Two reasons J-point is important

A

it is the point of reference for determining BBB & for measuring ST elevation/depression

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24
Q

Rapid axis is used to diagnose

A

Hemiblocks

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25
Axis =
predominant flow of electricity through the heart (V2)
26
What do we look at for ventricular axis
QRS complexes
27
Normal Axis
0-90 degrees; positive in all three leads
28
Physiological Left Axis Deviation
0 to -40 degrees; Lead I = positive Lead II= either Lead III = negative
29
Pathological Left Axis Deviation & associated block
-40 to -90 degrees; I = positive II = negative III = negative Anterior hemiblock
30
Right Axis Deviation & associated block
90-180 degrees; I = negative II = either III = positive Posterior hemiblock
31
Extreme right axis deviation
-90 to 180 degrees; all negative deflections; ventricular in origin
32
causes of LV hypertrophy
HTN, extreme exercise, aortic disease, obesity
33
causes of RV hypertrophy
severe lung disease pulmonary valve disease PE
34
is a right axis deviation physiological or pathological in adults?
pathological
35
bundle branches facilitate
syncytium = both ventricles contracting in sync
36
QRS in BBB
must be wider than .12 seconds (120 milliseconds) or 3 little squares
37
BBB is a great risk factor for
CHB
38
BBB negatively affects
contractility
39
BBB in setting of acute MI
4 times higher mortality rate
40
Do NOT give Lidocaine (or procainamide) to someone with
BBB in setting of acute MI Bifascicular blocks
41
3 types of bifascicular blocks
RBBB + Anterior Hemiblock RBBB + posterior hemiblock LBBB (bifascicular all by itself)
42
type of QRS complex with hemiblock
Narrow
43
if you say block two different times in a diagnosis...
the patient is at high risk for CHB
44
High LBBB takes out
both anterior and posterior
45
RCA supplies blood to
Posterior & inferior LV Right ventricle SA & AV nodes Posterior fascicle of LBB
46
RCA blocks present as
bradycardia, heart block, elevated CVP, JVD, poor lung perfusion
47
LAD supplies blood to
Anterior wall of LV Septal wall of LV Bundle of His bundle branches "widow maker"
48
Circumflex supplies blood to
Lateral wall of LV *SA & AV nodes *Posterior wall of LV
49
Meds to interrupt atherosclerotic plaque formation
heparin and aspirin
50
posterior MI presents as
back pain (same as AAA)
51
Arterial clots present as
cold, ischemia, pain, loss of pulses
52
PE presents as
SOB, hypoxia, AMS, air hungry, abdominal pain
53
AMI interventional plan
O2, nitro, pain control, ASA/heparin
54
percentage of MIs missed on an EKG
50%
55
MI triad
history, physical exam, EKG
56
Time and extent of necrosis after MI
30 mins - 10% 1 hour - 30% 2 hours - 50% 3 hours - 60% 6 hours - 90% 24 hours - 100%
57
Presentation of ischemia
symmetrical inverted T waves in 2 or more related leads (normal for T-wave to be inverted in lead III & MCL1)
58
Presentation of Injury
ST elevation in two or more related leads greater than 1mm
59
ST depression in the absence of ST elevation
ischemia or subendocardial injury drug and electrolyte problems - digitalis & hypokalemia
60
Presentation of infarction
pathologic Q waves (>40 ms wide or 1/3 depth of R wave height) and ST elevation death or necrosis of tissue
61
Pathologic Q wave without acute changes
"old" or age undetermined infarction
62
Inferior (blood supply, leads and reciprocal)
RCA II, III, aVF I & aVL
63
septal (blood supply, leads and reciprocal)
LAD V1 & V2 no reciprocal leads
64
anterior (blood supply, leads and reciprocal)
LAD V3 & V4 II, III, aVF
65
lateral (blood supply, leads and reciprocal)
Circumflex V5 & V6; I & aVL (high) II, III, aVF
66
Posterior (blood supply, leads and reciprocal)
RCA V8 & V9 (R>S in V1) V1-V4 (ST depression)
67
Right ventricle (blood supply, leads and reciprocal)
RCA V4R no reciprocal leads
68
Most common detected MI
inferior (50% have posterior and RV involved)
69
Presentation of inferior MI
Brady, hypotensive, nausea 1st degree HB or 2nd degree type 1
70
Do you use nitrates with inferior MI
First fluids; use nitrates with caution because RV infarction is pre-load dependent
71
What type of EKG should be ran if suspected RCA occlusion
15-lead
72
Most lethal MI
Anterior can suddenly develop CHB, VT/VF
73
Who do we need to immediate place combo pads on?
BBB + Anterior wall MI
74
Anterior MIs can extend to
septum and/or lateral
75
What do you give for anterior MI?
Nitrates; fluid spared
76
Infarct imitators
LBBB LV hypertrophy Disecting thoracic aorta aneurysm Pericarditis
77
Pericarditis
ST elevation in all leads with NO reciprocal ST depression Pt feels better when they lean forward Flu-like symtpoms
78
Dissecting Thoracic Aortic Aneurysm
dangerous if missed diagnosed as MI - do not want this patient getting heparin NO reciprocal changes
79
Do you give nitrates to DTAA?
with caution, if at all, d/t heart's attempt to compensate for decreased after load by increasing HR and contractility causing undue stress on a weak area of aorta

Advanced Health Assessment (1 decks)

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