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Flashcards in EKG Deck (25)
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1

what is the difference between 3 lead, 5 lead, and 12 lead EKGs?

  • 3 & 5 lead: continuous pictures of the heart
    • 5 lead: telemetry-->5 wires
    • 3 lead: bedside-->3 wires
  • 12 lead: snapshot in time
    • 10 wires
    • not continuous

2

what is the time interval from one dark line to another dark line on a strip?

what is the time interval for each individual box on a strip?

  • 0.2 seconds
  • 0.04 sec (so 5 of these little boxes for each large box from dark line to dark line)

3

PR Interval

  • beginning of P wave to beginning of QRS wave
    • should be <0.2 seconds
    • if longer than 0.2 seconds, this is first degree AV block

4

ST segment

  • from end of QRS complex to end of T wave
  • if elevated: STEMI-->infarction
  • if depressed: ischemia-->not getting the O2 you need

5

what are the questions to ask when looking at a cardiac rhythm strip

  • are there QRS's?
  • is there a "p" wave?
  • is there a "p" wave for every QRS?
    • do the p's walkout? are they regular?
    • do the QRS's walkout? are they regular?
  • what is the ventricular rate? (how many QRS's times 10)
  • measure PR interval. Is it normal? (less than 0.2 seconds)

6

what is this rhythm?

  • normal sinus rhythm
    • has P's, QRS's, and a P for every QRS
      • the P's and the QRS's walk out
      • rate is normal
  • sinus node fires 60-100 bpm (or 50-90 bpm in some sources)
  • follows normal conduction pattern

7

what is this rhythm?

  • sinus bradycardia:
    • has P's, has QRS's, has a P for every QRS
    • P's and QRS's walk out
    • rate is slow
  • sinus node fires at a rate <60 bpm
  • normal rhythm in aerobically trained athletes and during sleep
  • only need to treat if symptomatic w/ weakness, syncope, low HR/BP
    • tx: atropine, pacemaker

8

what is this rhythm?

  • sinus tachycardia:
    • has P's, has QRS's, has a P for every QRS
    • P's and QRS's walk out
    • rate is fast
  • discharge rate from sinus node is increased and is >100 bpm
  • could be normal if currently active, in pain, has anxiety
    • tx: treat underlying problem, use vagal maneuvers
  • if HR gets too high: can use adenosine, beta blockers, CCBs

9

what is this rhythm?

  • atrial fibrillation
    • has QRS's, but has NO P WAVES!
    • QRS's DO NOT walk out, they are irregular
    • ventricular rate can be WNL
      • but atrial rate can be as high as 350-400
  • patho: total disorganization of atria b/c P wave is where electrical impulse starts (at SA node), so in this case, the atria are sending impulses at lots of irregular times
    • pt has no atrial kick, so b/c no oomph from atria to get ventricles contracting, the ejection fraction is low
  • tx: 
    • control HR w/ digoxin
    • warfarin to prevent DVT long term
    • amiodarone use to convert pt back to normal sinus

10

what is this rhythm?

  • atrial flutter:
    • has QRS's
    • QRS's walk out (but sometimes they don't)
    • sawtooth pattern
  • patho: atria are being more consistent, but ventricle not contracting for every atrial signal
    • usually caused by something else such as an MI, pneumonia, ascites
  • tx is the same as a fib, but this is more episodic and you don't usually live with this, b/c when fix underlying dz process, then flip back to sinus rhythm
    • tx: 
      • digoxin: to slow HR
      • warfarin: DVT prophylaxis
      • amiodarone: to convert back to normal sinus

11

what is this rhythm?

  • sinus tachycardia with premature atrial contractions (PACs)
    • PAC: just a beat
    • QRS's and P's are present
      • P wave for every QRS
      • P's and QRS's DO NOT walk out
      • rate can be WNL
  • atria contracts prematurely, so shows as a P wave, then ventricles contract and QRS happens, then returns to normal rhythm
  • caused by caffeine, alcohol, tobacco, fatigue, stress, electrolyte imbalances
  • tx: tx underlying cause (ie remove caffeine)

12

what is this rhythm?

sinus bradycardia w/ multifocal PVCs

13

what is this rhythm?

normal sinus rhythm with unifocal PVCs

14

what is this rhythm?

  • normal sinus rhythm with bigeminal PVCs
    • bigeminal means every other beat is a PVC

15

what is this rhythm?

  • normal sinus rhythm with triplet PVCs
    • triplet: 3 PVCs in a row
      • look like v tach b/c not getting the cardiac output
    • couplet: another variation which means 2 PVCs in a row

16

premature ventricular contractions (PVCs)

  • contraction originating in ectopic focus of the ventricles
  • premature occurrence of a wide and distorted QRS complex
    • no P wave before a large, wacky QRS
  • cardiac output is decreased from what is should be b/c don't leave time for ventricles to fill
    • especially if couplet/triplet
  • the more diseased the heart is, the greater likelihood of PVCs
  • tx: tx the cause
    • amiodarone 
    • lidocaine

17

pacemaker

  • used to pace heart when the normal conduction pathway is damaged or diseased
  • mostly used when pt has severe, symptomatic bradycardia 
  • if pt has a pacemaker ventricular wire: pacer spike before QRS
  • if pt has a pacemaker atrial wire: pacer spike before P wave

18

implantable cardioverter defibrillator (ICD)

  • this is a pacemaker that is also able to shock the patient if they go into v tach or v fib
    • all ICDs have pacemakers, but not all pacemakers have ICDs
    • will not shock pt in asystole
  • via subclavian vein to endocardium

19

what is this rhythm?

  • first degree AV block
    • P's and QRS's present
      • P for every QRS
      • P and QRS walk out
      • PR is prolonged more than 0.2 seconds or 5 little blocks
  • cause: check medications b/c medications like beta blockers can cause this by prolonging the PR interval and slowing the HR
  • tx: continue to monitor if asymptomatic

20

ventricular tachycardia

  • run of 3-4 PVCs, no p waves
  • can be stable or unstable, sustained or unsustained
    • sustained: stay in v tach
    • unsustained: go in and out of v tach
  • considered life threatening: b/c of decreased cardiac output and the possibility of deterioration into v fib
  • if pt has a pulse, tx like tachycardia, but quickly b/c pt can go into v tach w/o a pulse or v fib
    • so give adenosine or IVP beta blocker
  • if pt is w/o a pulse, start CPR and call a code

21

what is this rhythm?

ventricular tachycardia

22

what is this rhythm?

  • ventricular fibrillation
    • no pulse, no cardiac output
  • tx: CPR with defibrillation

23

what is this rhythm?

  • asystole
    • represents total absence of ventricular electrical activity
    • no ventricular contraction, so no cardiac output, occurring b/c depolarization does not occur
  • tx: check pt, and if no response from pt, start CPR
    • should not shock this rhythm until some type of electrical activity

24

pulseless electrical activity (PEA)

  • looks like normal sinus rhythm
    • QRS and P are present
    • everything walks out
    • there is a P for every QRS
      • pt does not have a pulse, but the only way to tell is through assessment!
  • electrical system is working, but the heart is not contracting, so there is no pulse and no cardiac output!
    • occurs most often in a very diseased heart
  • most common thing that triggers PEA is a change in rate (like 80 to 40)
  • will eventually become asystole, so immediately call code and start CPR

25

what to do if you see STEMI on a 12 lead EKG?

  • immediately put O2 on patient and draw troponins and CK-MB