ER cardiology

Question 1

Osborne Waves

Answer 1

Hypothermia

Question 2

5 Steps for ECG

Answer 2

Rate, Rhythm, Axis, Hypertrophy, Infarction

Question 3

What to look for Rhythm

Answer 3

p before every QRS, QRS after every P, P and QRS intervals

Question 4

Irregular rhythms

Answer 4

Sinus arrhythmia, Wandering pacemaker, multifocal atrial tachycardia, atrial fibrillation,

Question 5

Escape Rhythms

Answer 5

atrial escape rhythm, Junctional escape rhythm, ventricular escape rhythm

Question 6

Tachyarrhythmias

Answer 6

Atrial flutter(sawtooth pattern), atrial fibrillation, ventricular flutter, Ventricular fibrillation

Question 7

1st degree AV block

Answer 7

prolonged PR interval >0.2 seconds

Question 8

2nd degree AV block

Answer 8

Mobitz/Wenkebach . PR lengthens with a dropped QRS

Question 9

2nd degree AV block Mobitz II

Answer 9

some P waves do not produce a QRS

Question 10

3rd degree AV block

Answer 10

complete heart block. no P waves produce a QRS

Question 11

Right BBB

Answer 11

R, R’ in V1 or V2

Question 12

Left BBB

Answer 12

R, R’ in V5 or V6

Question 13

What to look for in Axis

Answer 13

QRS + or - in leads 1 and aVF, is axis norma?

Question 14

Normal Axis deviation

Answer 14

QRS upright in Lead 1 and in aVF

Question 15

inferior MI

Answer 15

leads II, III, aVF, right coronary artery

Question 16

anterior, anteroseptal MI

Answer 16

leads V1-V4, left anterior descending artery

Question 17

lateral MI

Answer 17

v5-v6, 1, aVL, left circumflex artery

Question 18

posterior MI

Answer 18

ST depression in V1, V2, left circumflex or right coronary artery

Question 19

Anterior leads

Answer 19

V3, V4

Question 20

Septal leads

Answer 20

V1, V2

Question 21

inferior leads

Answer 21

II, III, aVF

Question 22

Lateral leads

Answer 22

I, aVL, V5, V6

Question 23

life threatening DDX

Answer 23

ACS, aortic dissection, PE, pneumonthorax, pericardial tamponade, Mediastinitis

Question 24

Non-life threatening DDX

Answer 24

pleurisy, CHF, pneumonia, angina pectoris, pericarditis, endocarditis, PUD, GERD, panic disorder

Question 25

Sick sinus syndrome ECG

Answer 25

alternating tachy/brady

Question 26

SSS TX

Answer 26

pacemaker

Question 27

SVT TX

Answer 27

Unstable- cardiovert. Stable- vagal manuever or carotid massage. Drugs- adenosine 6mg IV, diltiazem or CCB, BB

Question 28

Torsades TX

Answer 28

Magnesium sulfate

Question 29

Ventricular fibrillation TX

Answer 29

defibrillation 360J monophasic, 120-200J Biphasic

Question 30

Asystole/PEA algorithm

Answer 30

CPR 2 min, IV access/epi, continue CPR until shockable rhythm

Question 31

VF/VTach

Answer 31

CPR 2 min, IV access/epi, continue CPR, amiodarone (300mg, then 150mg) if epi doesnt work

Question 32

adult tachycardia w/ pulse algorithm

Answer 32

1) maintain airway, oxygen, cardiac monitor 2) unstable- synchronized cardioversion. consider adenosine 2) stable with wide QRS- adenosine or antiarrhythmic 3) vagal maneuvers, adenosine, BB/CCB

Question 33

Adult Bradycardia w/ Pulse

Answer 33

1) identify and treat underlying cause maintain airway, oxygen, monitor 2) unstable- atropine (.5 mg bolus to a max of 3 mg), dopamine or epinephrine 3) stable- monitor

Question 34

Post cardiac arrest care

Answer 34

1) maintain oxygen | 2) treat hypotension

Question 35

Wandering Pacemaker

Answer 35

Maintains rate but P waves change

Question 36

Multifocal Artrial Tachycardia

Answer 36

P wave changes shape and rate is >100bpm

Question 37

Atrial Fibrillation

Answer 37

chaotic atrial spikes, no discernable P waves

Question 38

Atrial Escape

Answer 38

skips a beat and then resumes sinus pacing

Question 39

Junctional escape rhythm

Answer 39

skips a beat and a P wave then resumes pacing 40-60bpm with no P waves

Question 40

Ventricular Escape rhythm

Answer 40

Skipped beat and 20-40 rate resumes with no P waves and wide QRS

Question 41

Junctional Escape beat

Answer 41

sinus pause then a beat with no P wave

Question 42

Ventricular Escape beat

Answer 42

sinus pause then a beat with no P wave and wide QRS

Question 43

Premature junctional contractions

Answer 43

premature beat with no P wave or inverted P wave

Question 44

Premature Ventricular contraction

Answer 44

premature beat with wide QRS

Question 45

Paroxysmal atrial tachycardia

Answer 45

regular rhythm that suddenly becomes much faster, P waves will be normal if they are not buried in the T wave

Question 46

Paroxysmal Junctional Tachycardia

Answer 46

often looks the same as SVT but no discernible P waves ever

Question 47

atrial flutter

Answer 47

saw tooth pattern

Question 48

atrial fibrillation

Answer 48

irregularly irregular chaotic atrial firing

Question 49

ventricular fibrillation

Answer 49

Smooth sine waves

Question 50

Ventricular fibrillation

Answer 50

totally erratic

Question 51

Heart Block poem

Answer 51

if the R is far from P then you have a first degree Longer, longer, longer drop! Then you have a Wenkebach If some P's just don't get through, then you have a mobitz II If P and Q just don't agree, then you have a third degree

Question 52

RBBB

Answer 52

RR' in V1-V2

Question 53

LBBB

Answer 53

bunny ears in V5-V6

Question 54

Right axis deviation

Answer 54

QRS upright in lead aVF and inverted in Lead 1

Question 55

Left axis deviation

Answer 55

QRS upright in lead I and inverted in aVF

Question 56

Extreme RAD

Answer 56

QRS inverted in both lead I and avf

Question 57

Right atrial hypertrophy

Answer 57

large diphasic P wae with tall initial componentq

Question 58

Left atrial hypertrophy

Answer 58

Large diphasic P wave with a wide terminal component

Question 59

ST elevation

Answer 59

injury

Question 60

T wave inversion

Answer 60

Ischemia

Question 61

Atropine

Answer 61

Bradycardia

Question 62

Adenosine

Answer 62

6mg supraventricular tachycardia

Question 63

diltiazem

Answer 63

atrial flutter

Question 64

Ventricular arrhythmias

Answer 64

Amiodarone