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Flashcards in EKG Deck (77)
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1

Sinus tachycardia

-Rate is over 100; just a fast rate (may be 120-150 but NOT as high as 160)
-Regular rhythm

2

Sinus bradycardia

-Rate is less than 60; SLOW rate (if getting into 30s, start to suspect an AV block, usually wont be THAT low)
-Regular rhythm

3

Sinus vs. Junctional

Sinus- has a P wave
Junctional- absence of a P wave

4

Atrial flutter

-Flutter waves (F waves)
-Saw tooth pattern
-Rapid succession of identical back to back atrial depolarization waves

5

Atrial flutter treatment

Tx same as afib
Definitive treatment is catheter ablation

6

Rule for measuring Atrial flutter on EKG

300/150/75 rule
300- 1:1 (For every QRS- you have 1 P wave)
**150- 2:1 block**
75- 3:1 block

7

HR of _______ tells you its atrial flutter (count it out by QRS complex)

150

If you see HR of 150, you HAVE to consider atrial flutter

8

Atrial fibrillation

*NO P WAVES*
-Irregularly irregular (classic!!!)
-Chaotic erratic baseline
-No p waves prior to qrs
-Irregularly spaced qrs complexes

9

Causes of A-fib

-HTN
-CAD (coronary artery disease)
-rheumatic heart disease
-*binge etoh (holiday heart)*
-valvular heart disease
-*hyperthyroid*
-Atrial stasis
-CVA
-thromboemobolism

10

Treatment (rate control vs rhythm control)

RATE CONTROL: B blockers, digoxin, Ca ch blockers, anticoagulation (coumadin, pradaxa)

RHYTHM CONTRO: class IC, III or cardioversion (electrical or pharmaceutical, last option)

11

A fib with RVR (rapid ventricular response)

-seen in older patients, worry that ventricles aren't filling
-Looks like A Fib but with very irregular AVF, V1, V2, V3
-Atria aren’t filling properly (no time bc of high HR), ventricles can’t fill either, BP drops severely, hypotension

12

What can't be used to treat A Fib with RVR?

**B blocker or Ca channel blocker- can’t use this bc it will drop BP even further**

13

During A Fib with RVR lateral leads will show

ST depression (esp older patients, with high HR)

-Reason: heart is getting ischemic, low cardiac output; O2 delivery to heart is getting sacrificed; this is a RATE related change (rate related ischemia, NOT necrosis or MI, but ischemia)

14

Pericarditis

*Most common EKG change- DIFFUSE ST SEGMENT ELEVATION*
(ALL ST segments will be elevated; Must see this on an anatomical lead)
-->LOOK FOR bump immediately following QRS

**PR DEPRESSION IS ALSO SEEN**
(also look for big dip right BEFORE QRS complex)

15

Pericarditis is seen primarily in

younger people
-Inflammation of lining of heart

16

SVT (Supraventricular tachycardia)

-HR more that 160, 170 but can be as high as 210-220
-Complaint is *palpitations*, light headedness, chest pain, etc.

17

SVT shows what EKG changes

-Rate related ischemia (ST depression is seen)
**Look for dip immediately AFTER QRS complex**

-HR will be more than 160-170 (or higher)
-REGULAR rhythm

18

If rhythm is regular (P-->QRS-->T) but rate is very fast, think ____

SVT

19

For SVT treatment, may need to give

Adenosine (very unpleasant to give, heart stops, see flat line on EKG, but then you'll see P wave, then QRS and HR will resume)

Can try asking patient to bear down or carotid massage one side of neck at a time before giving adenosine

20

Giving Adenosine during SVT will cause

the rate related ischemia to stop

(if adenosine doesn't work may beed to shock patient)

21

Hyperkalemia

-peaked T waves
-look for another small peak/triangle right after QRS

22

Most important treatment for Hyperkalemia

CALCIUM

(doesn’t lower K level, doesn’t do ANYTHING to K level, don't want to worry about this first, must first stabilize the cardiac membrane; ***Calcium- cardiac membrane stabilization***)

23

Treatment order for Hyperkalemia

1. Calcium (stabilize membrane)
2. IV Insulin (to lower K) and Dextrose (need to counteract insulin to prevent hypoglycemia)
3. Albuterol and Bicarb- both lower K

24

Kayexalate

is a drug but it isn’t good; give orally, causes diarrhea; doesn’t lower K very much, gives you intestinal necrosis and ischemia = BAD!!

25

What will also show peaked T waves?

early MI
(but usually it's hyperkalemia!)

26

Where to look for severe/uncontrolled hyperkalemia

V1, V2, V3 will show HUGE peaked T waves

27

EKG changes seen when hyperkalemia goes untreated

*QRS widens (widened QRS is always BAD)
*Peaked T waves
*Prolonged PR interval
*Near sinusoidal pattern - see sine waves; patient has seconds left to live --> GIVE CALCIUM!!!!!!! (see immediate changes, will narrow/close QRS, etc.)

28

If none if your drugs are working to lower K, must ______

use dialysis

29

Causes of hyperkalemia

Patients taking K but not going to dialysis, eating K in their diet, non-compliant with dialysis, must figure out problem and prevent it or they will keep coming back

30

V tach EKG changes

-all leads are irregular
-AV dissociation