Chapter 36

Question 1

What are the intervalves of conduction?

Answer 1

P-R interval
QRS interval
Q-T interval

Question 2

P-R interval

Answer 2

Amount of time to fill the ventricles
.20 or less
If >.20 we have a 1 degree AV block

Question 3

ORS Interval

Answer 3

Represents time taken for deplarization (contraction) of both ventricles (systole)
.12 or less
If

Question 4

Q-T interval

Answer 4

Represents time take for entire electrical depolarization and repolarization of the ventricles.
0.44 or less
If > 0.44 we have to treat the underlying cause with drubgs, electrolyte imbalance, or changes in H.R.

Question 5

If the T wave is spiked (think electrolyte)

Answer 5

Hyperkalemia

Question 6

If the T wave is flat

Answer 6

Hypokalemia

Question 7

What does the 12 lead ECG show?

Answer 7

Structural changes, conduction disturbances, ischemia, infarction, electrolyte imbalance, and drug toxicity

Question 8

Where do you place the 5 lead ECG?

Answer 8

R and L 7th ICS
V Lead on the right side of the sternum 3rd ICS
R and L 2nd ICS.

Question 9

How can you determine a persons HR from an ECG?

Answer 9

count the number of QRS complexes in 1 minute..

Question 10

Six Sec. Strip Method

Answer 10

If the conduction has regular rate and rhythm then you can count the number of QRS complexes in 6 sec and mult. by 10.

Question 11

What does the P wave represent?

Answer 11

Atrial contraction (depolarization).

Question 12

What is the small block method?

Answer 12

Count # of small squares between one R-R interval, divide by 1500

Question 13

What is the big block method?

Answer 13

Count # of large square between one R-R Interval, divide by 300

Question 14

What is the First degree heart block?

Answer 14

When the PR interval is larger than .20. No sinus rhythm, the AV node has taken over

Question 15

What is a Bundle Branch Block?

Answer 15

When the QRS Complex is larger than .12. The conduction is only traveling through the bundle branch.

Question 16

U Wave

Answer 16

Often over looked and is associated with electrolyte imbalance, heart disease, and HTN. Seen in hypokalmeia

Question 17

How many bpm does the SA node provide

Answer 17

60-100

Question 18

How many bpm does the AV node provide

Answer 18

40-60

Question 19

How many bpm does the purkinje fibers provide

Answer 19

20-40

Question 20

What are the three speed for junctional?

Answer 20

1) Junctional bradycardia-bpm are less than 40-60
2) Accelerated Junctional- bpm are greater than 60
3) Junctional Tachycardia-bpm are greater than 100

Question 21

What three morphologies are in place for Junctional

Answer 21

1) When SA node is sick, P the wave is inverted
2) When SA node is knocked out. P wave is gone
3) the P wave is after the T wave

Question 22

Stable vs. Unstable dysrhythmias?

Answer 22

Stable=Asymptomcatic or mild symptoms
Unstable= Decreased perfusion/CO. (too fast, too slow)
-Pulseless
-Dizziness
-Syncope
-Hypotension
-Chest pain
-Shortness of breath

Question 23

Syncope

Answer 23

Fainting

Question 24

Head-up-tilt-test

Answer 24

Induce orthostatic hypotension (decrease BP, increase HR)

Question 25

What are the different diagnostic Tests we can use for dsrythmias?

Answer 25

``` Cont. ECG monitoring Transesophageal echocardiogram Electrophysiologic Study Holter monitoring Event monitoring (loop) Excercise treadmill testing ```

Question 26

What medications are used for dysrhythmias and why?

Answer 26

Atropine - bradycardia Adenosine - tachycardia Epinephrine- Cardiac arrest Amiodarone- VFibb and VTach

Question 27

What do you flush medications with?

Answer 27

20 mLs of NS to circulate

Question 28

Explain how you would administer Adenosine?

Answer 28

First you would fast push 6 mg = 1st dose | Then you can push 12 mg = 2nd dose

Question 29

When would you encourage vagal stimulation?

Answer 29

To slow down the heart = tachycardia

Question 30

Where do you NEVER want conduction to spike?

Answer 30

On the T wave b/c it can cause ventricular tachycardia

Question 31

What are the two malfunction that can occur with Pacemaker monitoring?

Answer 31

Failure to sense-Pacemaker isnt meeting the conduction pattern. Not spiking at the right place. Failure to capture- Pacemaker isnt carrying out conduction after it spikes.

Question 32

What are some main teaching points for a pacemarker>

Answer 32

- Avoid large magnets and electromagnetic fields - Dont use a cell phone on the same side as the device or place over the device - May set off metal detectors - Monitor pulse daily - Wear med alert braclet

Question 33

What are some complication after CPR

Answer 33

-Sternum and rib fractures -Liver and spleen lacerations Pneumothorax -Cardiac tamponade

Question 34

Defibrillation is used for

Answer 34

Is used only for pulseless VT and VF. - nonsynchronized - no QRS

Question 35

Cardioversion is used for

Answer 35

Used for Afib, Aflutter, SVT - synchronized - QRS

Question 36

How do you use a defibrillator?

Answer 36

``` Pick appropriate energy level -Monophasic 360 -biphasic 200 Turn of synch switch Apply conductive mater Charge fibrillator yell clear Deliver charge ```

Question 37

How do you used a cardioversion

Answer 37

Synchronzied circuit delievers a countershock to occur on the R wave of the QRS Complex. - Pick appropriate energy lever (50-100) - If non emergent sedate pt - Turn on synch switch - apply conductive matter - Charge cardioversion - yell clear - Deliever charge

Question 38

When would a pt recieved and ICD (Implanted Cardioverter Defibrillator)?

Answer 38

If they survive SCD (Sudden Cardiac Death)

Question 39

Important facts about ICD's

Answer 39

- Deliever 25J shock - Can have a combo (Pacemaker included) - If it fires more than once call EMS

Question 40

What is Radiofrequency Catheter Ablation Therapy

Answer 40

- Electrical energy used to burn ectopic areas - SVT's - used for atrial dysrhytmias

Question 41

What do you do after ROSC (Return of spontaneous ciruclation)

Answer 41

therapeutic hypothermia

Question 42

Sinus means...

Answer 42

Impulse came from the SA node.

Question 43

What is Normal Sinus Rhythm

Answer 43

-Reg. PQRST cycles -Rate b/w 60-100 P wave before each QRS complex -Narrow QRS complex (0.12) -All complexes look the same

Question 44

Sinus Bradycardia

Answer 44

- We have reg PQRST cycles - Rate is slowed to less than 60 bpm - P wave before QRS - Narrow QRS - All complexes look the same. TX: 1) Oxygen 2) Atropine 3) Pacemaker

Question 45

Sinus Tachycardia

Answer 45

CB: Exercise, fever, pain, hypovolemia, meds - Reg PQRST cycles - Rate is too fast b/w 101-200 bpm - P wave before each QRS complex - Narrow QRS - All Complexes look the same Tx: Treat the underlying cause

Question 46

Sinus Arrhythmia

Answer 46

Normal phenomenon of mile acceleration with inspiration and slowing of the heart rate with expiration No Tx - Irregurlar PQRST cycles (Q waves dont match up) - Rate slightly abnormal - P wave before each QRS Complex - Narrow QRS - All complexs look the same

Question 47

Premature Atrial Complex (PAC)

Answer 47

Abnormal electrical shock that is picked up by the AV node cuaseing the rest of the heart to fire. - Regular PQRST - Rate is normal with one interval that dosent belong - P wave before each QRS complex - Narrow QRS - All complexs look the same CB: Emotional stress, fatigue, caffeine, tobacco, alcohol, meds tx: Decrease sources of stimulation Isolated occurances are normal

Question 48

Tachydsyrhythmias

Answer 48

HR > 100 bpm | Decrease supply/ Increases Demand

Question 49

Dysrhythmias

Answer 49

``` Atrial!! -Aflutter -Afib -SVT (Cardioversion/ Synchronized) ```

Question 50

What do you treat dysrhythmias with?

Answer 50

Adensoin

Question 51

What are 4 types of Atrail Dysrhythmias?

Answer 51

1) PACs' 2) SVT 3) Atrial Flutter 4) Atrial fibrillation (most common)