EKG

Question 1

ability of cardiac cells to generate their own impulse

Answer 1

automaticity

Question 2

how “ready” cells are

Answer 2

excitability

Question 3

conduction of cardiac cell info from one cell to the next

Answer 3

conductivity

Question 4

squeeze of cardiac muscle in response to impulse

Answer 4

contractility

Question 5

electrical conduction of this node is 60-100bpm

Answer 5

SA node

Question 6

electrical conduction of this node is 40-60bpm

Answer 6

AV node

Question 7

electrical conduction of this is 20-40bpm

Answer 7

purkinje fibers

Question 8

important ions to consider with the heart:

Answer 8

potassium, sodium, calcium, magnesium

Question 9

lead 1 on a 12-lead shows

Answer 9

atrial disturbances

Question 10

lead 2 on a 12-lead shows

Answer 10

ventricular disturbances

Question 11

a 6 second strip of an EKG is how many large boxes?

Answer 11

30

Question 12

1 small square on an EKG is

Answer 12

0.04seconds

Question 13

how do you do a 6 second count?

Answer 13

multiple the # QRS complexes found over 6sec by 10 to get HR/minute

Question 14

if ST segment goes below baseline, this means _______ is happening

Answer 14

ischemia

Question 15

if ST segment is way up above baseline there is a

Answer 15

potential blockage (MI)

Question 16

if no P wave, there is a(n) _______ problem

Answer 16

atrial

Question 17

if no QRS complex, there is a(n) ________ problem

Answer 17

ventricular

Question 18

what is the treatment for symptomatic sinus bradycardia?

Answer 18

vagal stimulation, supplemental O2/IV fluids, atropine, pacing

Question 19

atropine dosing

Answer 19

if pt <90kg give 0.5mg, if >90kg give 1mg for a total of up to 3mg

Question 20

treatment of symptomatic sinus tachycardia

Answer 20

digoxin, beta-blockers, diuretics (treat the cause)

Question 21

HR elevated (150-250)

Answer 21

supraventricular tachycardia

Question 22

treatment of SVT includes

Answer 22

vagal stimulation, adenosine, cardioversion

Question 23

long-term risk of untreated afib

Answer 23

stroke

Question 24

blood does what in atrial fibrillation?

Answer 24

pools –> coagultes

Question 25

what medications treat afib?

Answer 25

anticoagulants & antidysrhythmics

Question 26

what do P waves look like in atrial flutter?

Answer 26

saw tooth

Question 27

- lack of communication between top to bottom of heart --> electrical impulse completely blocked b/t atria and ventricles - HR typically between 20-40 - P to P regular, R to R regular, just not matching up

Answer 27

3rd degree heart block

Question 28

3rd degree heart block can progress to

Answer 28

asystole

Question 29

treatment of 3rd degree heart block involves:

Answer 29

medications (atropine/epi), temporary pacing wires, permanent pacemaker

Question 30

if a patient with 3rd degree heart block goes unconscious, what action must be taken?

Answer 30

initiate CPR

Question 31

3 beats of this turns into Vtach

Answer 31

PVC (premature ventricular contraction)

Question 32

- P wave absent - widened QRS - can look completely normal except that one or 2 beats --> ventricle contracts out of turn

Answer 32

premature ventricular contraction (PVC)

Question 33

T/F: in a. beat of PVC, perfusion is occurring

Answer 33

F

Question 34

- many PVCs together - may be intermittent or sustained - may or may not have pulse

Answer 34

ventricular tachycardia

Question 35

- type of vtach - wont have pulse most time

Answer 35

torsades

Question 36

what medication can you give thats unique to torsades?

Answer 36

magnesium sulfate

Question 37

- no intervals, never a pulse - ventricles quivering - looks irregular

Answer 37

ventricular fibrillation

Question 38

this rhythm can turn into vfib

Answer 38

SVT

Question 39

T/F: if you're coded, you will get intubated

Answer 39

T

Question 40

- final attempts to make an electrical impulse - rate 20-30, few beats here and there

Answer 40

agonal

Question 41

flatline

Answer 41

asystole

Question 42

causes asystole

Answer 42

hypovolemia, hypoxia, acidosis, hypothermia, hypo/erkalemia, OD, trauma, thrombosis, tension pneumothorax, cardiac tamponade

Question 43

can you shock aystole

Answer 43

NO

Question 44

what medications are indicated for asystole?

Answer 44

epi, bicarb, dextrose, calcium --> no amioderone

Question 45

- can look like a normal rhythm on monitor but pt will have no pulse - electrical activity still present

Answer 45

PEA (pulseless electrical activity)

Question 46

digoxin is used to treat

Answer 46

SVT, sinus tachycardia

Question 47

indications for pacemaker placement:

Answer 47

3rd degree heart block, symptomatic bradycardia, asystole

Question 48

used to maintain HR in emergency situations or until permanent pacemaker can be implanted

Answer 48

temporary pacemakers (transvenous & transcutaneous)

Question 49

this pacemaking marker is before the P wave

Answer 49

atrial paced

Question 50

pacing spike will be before inverted QRS

Answer 50

ventricular paced

Question 51

most common permanent pacemaker, "dual chambered"; before every P wave & QRS complex

Answer 51

sequential paced

Question 52

T/F: failure to capture will look like pacing markers with nothing after them

Answer 52

T

Question 53

used for history of lethal dysrhythmias; programmed to deliver electrical impulses when it senses the HR becoming rapid, may increase voltage & shock again if first shock doesn't convert rhythm

Answer 53

implantable cardioverter defibrillator (ICD)

Question 54

pacemaker/ICD teachings/considerations

Answer 54

- don't shower 24h following procedure - no baths x2wks - wear affected arm in sling - dont raise arm above site x2wks - no lifting >10lbs x2wks - no MRI ever - no contact sports ever - always carry medical alert card