Advanced EKG 2/4 Flashcards by Shirica Shaw

If my pt goes into cardiac arrest while getting anesthesia, what is the first thing I should do?

Stop all anesthetics
-consider reversing NMB

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What are EKG signs of hyperkalemia?

P wave: widen/flatten

QRS: widened (may lose fuse w/ T wave & lose ST segment)

T wave: Tall tented

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Purkinje fibers are ______ sensitive to hyperkalemia

less

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What are EKG signs of hypokalemia?

ST depression
T wave: flattened/negative
U wave: may be present after T wave

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What is a symptom of hypokalemia?

muscle cramps

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What are EKG signs of mild hypercalcemia?

T waves: broad based tall peaking

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What are EKG signs of severe hypercalcemia?

P wave: none
QRS: extremely wide w/ low R wave (low amplitude)
T waves: tall peaking

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What types of Sx cause hypercalcemia?

Neck Sx:
Thyroids/parathyroids

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What are EKG signs of hypocalcemia?

PR: reduced
QRS: narrowed
QT: Prolonged
ST: prolonged/depressed
T wave: flattened/inverted
U wave: prominent

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Where does a J wave appear? What causes it? What leads does it appear in?

J-point: immediately after QRS

Causes: hypothermia & hypercalcemia

precordial & true limb leads

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What leads will J waves appear negative in?

AVR & V1

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What is a Delta wave? What is it commonly seen in?

Slurred upstroke in QRS complex

Causes: WPW (Wolff-Parkinson-White) which is a congenital syndrome what has extra electrical pathways between the atria and vent that can cause arrthmias

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When a delta wave is present, what medication should we be cautious to give?

Cardizem

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What is lead I good at looking at? Why?

Atrial arrhythmias

It goes across the top of the heart

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What is the recommended lead for cardioversion?

Lead II

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Where is lead III placed?

(-) left shoulder
(+) under left pectoral

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Lead III is a better view of the ______ and has _____ waveforms

L ventricle

upright

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If I see an arrhythmia in 1 lead, what should I do?

Switch to another lead and see if I see the same thing.

Dont depend on 1 lead even if its vtach/vfib. switch leads, it could be artifact.

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If my pt is having breathing problems that is presenting artifact in my EKG, what should I do?

Im going to need to get another EKG without artifact

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What position is my pt supposed to be in for EKG? Why? What is my alt?

SUPINE.. FLAT

sitting up increases tissue motion which causes disturbances

If my pt cannot tolerate this, sit this, sit them up to the flattest point they can tolerate

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How many electrodes does a 12 lead EKG use?

4 for each limb

6 precordial leads on chest

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T/F: I can put my limb leads on my shoulder

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Where do you place the precordial leads? (V leads)

V1: 4th ICS R sternum
V2: 4th ICS L sternum
V3: between V2 & V4
V4: 5th ICS L sternum
V5: 5th ICS L sternum
V6: 5th ICS L sternum

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Precordial leads =

V leads

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What leads look at inferior wall?

II III aVF

What leads look at the septum?

V1 V2

What leads look at the anterior wall?

V3 V4

What leads look at the lateral wall?

V5 V6

What leads look at the high lateral wall?

I aVL

If I have a R wall infarct, what leads will I see this in?

inferior leads: II, III, aVF septum leads: V1, V2

By definition, what is a Q wave?

First negative deflection after P wave

What is the R wave?

First positive deflection after the P wave

What is an S wave?

Negative deflection below the baseline after R or Q wave

Where does the J point occur? Why is it important?

Where QRS ends & ST segment begins Reference point for determining BBB & measuring ST elevation/depression

What will my leads look like with pathological L axis deviation?

Lead I: (+) Lead II: (-) Lead III: (-)

What will my leads look like with pathological R axis deviation?

Lead I: (-) Lead II: (-) Lead III: (+)

What will my leads look like with pathological extreme R axis deviation?

Lead I: (-) Lead II: (-) Lead III: (-) V1: (+)

What axis deviation is pathologic in all adults?

R axis

What is a common cause of axis deviation?

hypertropy

What medications do I not give if they have a BBB? Why?

Lidocaine Slows conduction rate with ventricles already not contracting correctly.

BBB put pts at higher risk for what?

Mortality -heart blocks

What lead to we identify BBB in? How do we identify them?

V1 The QRS has to be longer than .120 secs --> find J point --> draw line into complex, then go up or down with the LAST DEFLECTION (-) LBBB (+) RBBB

Bifascicular block puts pts at a high risk of _____

Vfib

What does the RCA supply blood to?

R vent inferior wall posterior wall SA/AV node Posterior LBB

How can we indentify a RCA infarct on EKG?

ST depression in leads V1, V2

How will a RCA infarct present clinically?

Bradycardia Increased CVP JVD Difficulty breathing

What does the LAD (Left anterior descending) supply blood to?

L vent Septal wall Anterior wall of L vent Bundle of His & BB

Why is the LAD called the widow maker?

Since it supplies blood to bother the Bundle of His and BB, it can stop the flow of blood to vents and quickly kill.

What does the circumflex supply blood to?

Lateral wall of L vent SA/AV node Posterior wall of L vent

What 2 drugs do I want to give to prevent the clotting from happening?

Aspirin heparin

Chest pain on exertion means there is ___ of occlusion, at rest it is ______ of occlusion, and unrelieved by nitroglycerin is _____ occluded.

70-85% 90% 100%

If my patient BP is low & is having an AMI, what pain med can I give them instead of morphine?

Fentanyl

What is important to get along with an EKG is I suspect and MI?

Cardiac Enzymes

T/F: You can have a normal EKG and have an MI

T This is why we need to get cardiac enzymes

How does a necrotic part of the ventricle look on the ultrasound?

Its not squeezing at all --> looks non compliant

What is demand ischemia?

Decreased BP --> Changes on EKG When BP is corrected the changes on the EKG go away

You will see symmetrical ______ in 2 or more related leads in ischemia

inverted T waves

You will see reciprocal changes for the posterior heart in what leads?

V1 - V4

What causes ST depression?

Reciprocal changes to other ST elevation -subendocardial injury -ischemia -Drug or electrolytes

Which drugs/electrolyes cause ST depression?

Digoxin Hypokalemia

How can we identify tissue death/necrosis on EKG? What does this tell me?

Pathologic **Q waves**: > 40ms wide or 1/3 depth of R-wave height Pt has had a previous infarct

If I see patholgic Q waves with ST elevation what is happening>?

AMI

The inferior leads are ______ and are effected by the _____. I see reciprocal changes in _______

II, III, aVF RCA I, aVL

The Spetal leads are ______ and are effected by the _____.

V1, V2 LAD

The Anterior leads are ______ and are effected by the _____. I see reciprocal changes in _______

V3, V4 LAD II, III, aVF

The Lateral leads are ______ and are effected by the _____. I see reciprocal changes in _______

V5, V6 I, aVL (high lateral) Circumflex II, III, avF

The posterior heart are shown by ______ and are effected by the _____.

ST depression in V1-V4 RCA

What is the most lethal MI? Why?

Anterior wall MI Can suddenly develop complete heart block, vtach, vfib

If my patient has a BBB or hemiblock and has an anterior wall MI, what should i do?

Immediately put pads on my patient to prepare for CPR

L vent hypertropy can imitate an MI but wont have what?

reciprocal changes

What can mimic an MI? What should you do to differentiate?

LBBB cardiac enzymes

How does pericarditis present on the EKG? How do we differentiate this from an MI?

ST elevation in all leads When the pt leans forward they will feel better

T/F: Percarditis will have ST depression in reciprocal leads

F It will be elevation in all leads

What type of patients do we see pericarditis in?

Sepsis IV drug users

What must we see on the EKG to confirm an MI? Why is this important?

Reciprocal changes If we dont see reciprocal changes we could misdiagnose an MI with something else

How does an thoracic Aortic Aneurysm present on the EKG?

ST elevation but NO RECIPROCAL CHANGES

Why dont we give nitroglycerin to AAA pts?

decreases afterload and will cause the heart to try to compensate by increasing HR and contractility. This would cause undue stress on a weakened aorta area.

Advanced EKG 2/4 Flashcards

Test 1 (77 cards)