Exam 4 Flashcards
(289 cards)
1
Q
where is precordial stethoscope placed
A
4th intercostal space and LEFT sternal border
2
Q
is Vt based on IDEAL body weight
A
yes (6-8ml/kg)
3
Q
low BLOOD O2
A
hypoxEMIA
4
Q
low TISSUE oxygen
A
hypoxia
5
Q
oxygen consumption
A
VO2
6
Q
oxygen delivery
A
DO2
(DO2 tissue is MORE important than DO2 lung)
7
Q
Low inspired oxygen (FiO2)
Hypoventilation
V/Q mismatch leading to shunt
Diffusion limitations
A
HYPOXEMIC hypoxia
8
Q
Not enough Hgb hypoxia
A
ANEMIC hypoxia
9
Q
Decreased release of O2
A
AFFINITY hypoxia
10
Q
Not enough cardiac output
A
CIRCULATORY hypoxia
11
Q
Cell won’t accept the delivery of the O2
A
HISTIOCYSTIC/O2 utilization hypoxia
12
Q
when are you more likely to illustrate cyanosis
A
with HIGH hgb
13
Q
does an increase in CO2 cause decrease in O2
A
YES
14
Q
If SpO2 is near 100% then increasing FiO2 will have ________ effect on DO2
A
little effect
15
Q
what are the wavelengths for pulse ox
A
660nm
940nm
16
Q
what cause false LOW pulse ox readings
A
Excessive motion
Blue nail polish
Anemia (low Hgb concentration)
SpO2 < 60%
Improper fitting probe
MetHgb similar to Hgb; if SaO2 (actual oxygen saturation) GREATER than > 85% then SpO2 will show low
17
Q
what causes dramatically LOW pulse ox
A
IV methylene blue dye
18
Q
what causes falsely HIGH pulse ox
A
Ambient fluorescent light
Carbon monoxide poisoning
MetHgb similar to Hgb; if SaO2 (actual oxygen saturation) LESS than < 85% then SpO2 will show high
19
Q
what is most accurate spo2 location
A
cheek
20
Q
decreased CO2
A
Hyperventilation: too much elimination
Hypotension
Decreased CO
R to L pulmonary shunt
Hypothyroidism
Hypothermia
Paralysis, motionless
21
Q
examples of obstructive issues
A
COPD, bronchospasm, asthma, cystic fibrosis
looks like a “sharks fin”
22
Q
what is the issue with capnography for non-intubated patients
A
no plateau phase, not accurate
23
Q
what is the measurement for STATIC lung compliance
A
plateau pressure (end inhalation prior to exhalation)
ALWAYS lower than peak pressure
MORE accurate than dynamic compliance
24
Q
STATIC lung compliance:
Indicates compliance ___________ resistance
A
Indicates compliance WITHOUT resistance
25
Measures lung compliance + airway resistance
DYNAMIC lung compliance
26
what is the measurement for DYNAMIC lung compliance
peak pressure
27
Pip -- plateau pressure =
resistance
28
increased PiP withOUT plateau pressure increase?
issues with the tube, secretions, foreign body
increased inspiratory gas flow rate
29
Effort INdependent
Most objective measurement of airway resistance for medium airways
Most sensitive indicator of obstructive disease
Normal: 4-5L/sec
Forced Expiratory Flow (FEF) between 25% and 75% of exhaled breath
30
Spirometry measures lung _________, __________, and _______
lung volumes, capacities, and flows
31
o Helps identify airway resistance
o Normal: at least 80% of vital capacity
Forced Expiratory Volume over one second (FEV1)
32
o Declines with age
o Normal: at least 80%
Forced Expiratory Volume/Forced Vital Capacity (FVC)
33
Forced expiratory volume 40%
obstructive
34
forced expiratory volume 90%
restrictive
35
forced expiratory volume 80%
normal
36
difficulty getting air OUT of the lungs
obstructive
37
difficulty getting air INTO the lungs
restrictive
38
Enlarged TLC, RV, FRC
Reduced ERV
obstructive
39
FEV1/FVC ratio preserved
Reduced TLC, FRC, RV, FVC & FEV1
restrictive
40
loop looks like upside down ice cream cone*
NORMAL (FLOW volume loop)
41
smaller, normal FLOW volume loop shape
restrictive
42
* Shape is caved in which indicates expiratory obstruction
* Lung volumes are larger
* Flows are reduced
* FLATTER, LESS ROUND shape as air flow is impeded
obstructive
43
Analyzing shapes and steepness
Indicator of lung compliance (distensibility)
Yields info regarding leaks, lung over-inflation and obstruction
PRESSURE volume loops
44
pressure volume loop:
during mechanical/positive pressure ventilation
COUNTER-clockwise
45
pressure volume loop:
during spontaneous ventilation
CLOCKWISE
46
pressure volume loop:
Higher pressure moves loop farther ______
RIGHT
47
pressure volume loop:
Flatter slope = ______________ compliance
DECREASED compliance
48
pressure volume loop:
Steeper slope = _____________ compliance
INCREASED compliance
49
flow volume loop:
moves in ______________ direction
clockwise
50
2 examples of fixed obstruction
tumor, tracheal stenosis
51
Expiration and inspiration constant
fixed obstruction
52
inspiration: airway narrows
expiration: opens
(milkshake!)
EXTRAthoracic
53
inspiration: opens airway
expiration: narrows
INTRAthoracic
54
example of restrictive disease
pulmonary fibrosis
55
electrolytes:
hyperreflexia
hypotension after induction
ataxia
seizures
HYPERnatremia
56
electrolytes:
decreased reflexes
seizures
lethargy
HYPOnatremia
57
electrolytes:
too rapid a correction leads to demyelination of pontine neurons*
associated with 3% hypertonic saline
central pontine myelinolysis
58
electrolytes:
prolonged PR interval
peaked T wave
HYPERkalemia
59
electrolytes:
Avoid HYPOventilation (acidosis)
for every 10-mmHg change in EtCO2 the ___+ changes 0.5 mEq
potassium
hyperkalemia dont hypoventilate!
60
electrolytes:
high U waves
flattened or inverted T waves
low ST segment
digoxin toxicity
HYPOkalemia
61
electrolytes:
avoid HYPERventilation (alkalosis) with ________________
HYPOkalemia
62
electrolytes:
DECREASED reflexes
lethargy
confusion
(breast cancer + hyperparathyroidism)
HYPERcalcemia
63
electrolytes:
INCREASED reflexes
tetany, twitching, tingling lips and fingers
laryngospasm
HYPOcalcemia
64
electrolytes:
associated with alkalosis, hypoparathyroid
HYPOcalcemia
(avoid hyperventilation)
65
electrolytes:
relaxes muscles
HYPERmagnesia + HYPOmagnesia
use nerve stimulator always!
66
electrolytes:
lethargy
(preeclampsia)
HYPERmagnesium
67
electrolytes:
Poor GI absorption, dialysis, ETOH
HYPOmagnesium
68
drugs that cause HYPOkalemia
-beta adrenergic agonists
-catecholamines (epi, norepi)
-insulin
-loop diuretics
-thiazide diuretics
-aminoglycosides
-mineralcorticoids (aldosterone)
-AT II
69
drugs that cause HYPERkalemia
-NSAIDS
-Sch
-digoxin
-ACE inhibitors
-beta blockers
-potassium sparing diuretics
-AT II blockers
70
SV / (divided by) end diastolic volume
EF
(normal is 55% or greater)
71
normal SVO2
70-80%
72
calcium = ___________ potential
threshold
73
potassium = _____________ potential
resting
74
what impacts SVO2 (4)
o Oxygen consumption (VO2)
o Hemoglobin level (Hgb)
o Cardiac Output (CO)
o Arterial oxygen saturation (starting) (SaO2)
75
SVO2 varies ___________ with VO2 (oxygen consumption)
inversely!
as VO2 increases, SVO2 decreases
(all the others are directly related)
76
decreased SvO2
* Increased VO2 (fever, hyperthermia)
* Decreased Hgb (anemia, hemolysis)
* Decreased SaO2
* Decreased CO (ex: MI, CHF, hypovolemic states)
77
increased SvO2
* Decreased VO2 (cyanide toxicity, carbon monoxide poisoning, hypothermia, sepsis)
* Increased Hgb (volume depleted)
* Increased SaO2
* Increased CO (burns, inotropic drugs)
78
CBF = ____--____ ml/100 gm/min = ISOELECTRIC EEG (internal cell)
15-20 ml/100 gm/min
79
CBF < ____ ml/100 gm/min = ↓ cell integrity =
<10 = irreversible injury
80
CBF < ____ ml/100 gm/min = __________ of EEG
< 25 = slowing
81
Cerebral perfusion pressure < ___ torr
<50 CPP= changes in EEG
82
cerebral perfusion pressure < ___ torr
<25 CPP = irreversible damage
83
torr =
pressure (associated with CPP)
84
anesthesia= _______________ changes
anesthesia= symmetrical
85
ischemia= ________ and ______________ changes
focal and Asymmetric
86
Fast activity, alert, eyes open, concentrating, anxious or busy thinking
beta
87
Normal, resting, relaxed, awake adults
alpha
88
Slow activity, considered abnormal in awake adults; subcortical lesions and encephalopathy
Normal in young children
theta
89
slowest, subcortical lesions and encephalopathy, hydrocephalus
Normal in babies
delta
90
SLOWEST frequency and highest amplitude
delta
91
FASTEST frequency and lowest amplitude
beta
92
accentuate frequency, then decrease it
Barbiturates and Benzodiazepines
93
slow frequency, increase amplitude (delta)
opioids
94
both frequency and amplitude are attenuated (slowed)
inhalation anesthetics
95
flat line EEG associated with anesthesia
indicative of decreased metabolic oxygen demands and neuroprotective qualities
(good thing!)
isoelectric state
96
Conscious recall or remembering exact events of previous experiences
explicit memory
97
Movement and ability to respond to commands without specific conscious recall of events (“awareness without recall”)
implicit (unconscious) memory
98
Also known as “recall”
consciousness (explicit memory) under general anesthesia with subsequent RECALL of the experienced events
awareness
99
Paralysis of un-anesthetized patients occurring when patients are given NMBs prior to anesthesia (out of sequence, mislabeling)
awake paralysis
100
surgeries with the highest risk of recall?
trauma >>> cardiac surgery >> c-section
101
to be a part of anesthesia awareness registry, you must experience _________ recall during general anesthesia
explicit
102
true or false
NO signs are reliable indicators of "light" anesthesia
true
103
what are the drugs that can mask signs of awareness during surgery
* 1st: NMBs
* Blockage of physiological responses
o Amphetamines
o Beta blockers
o Calcium channel blockers
* High levels of vitamin C
104
to have NO awareness during surgery:
volatile anesthetic at > ____ MAC
> .7
(.5-.7)
105
5 questions used to assess awareness event:
What was the last thing you remember before you went to sleep?
What is the first thing you remember after your operation?
Can you remember anything in between?
Can you remember if you had any dreams during your procedure?
What was the worst thing about your procedure?
106
Burst suppression: EEG _______ to random burst of electrical activity
EEG SLOWS to random burst of electrical activity
107
4 benefits of BIS monitoring
Reduction of PONV
Utilization of less drug to achieve a hypnotic state (save money)
Rapid emergence and recovery from general anesthesia (more efficient)
Improved quality of recovery, reduced PACU length of stay
108
when is BIS required*
TIVA (use of propofol)
109
when is BIS indicated
Hemodynamically sensitive patients (trauma, elderly, etc.)
ECT (monitoring of sub-clinical seizure activity)
TIVA (use of propofol)
110
BIS**
recall
>70
111
BIS**
general anesthesia
40-60
112
BIS**
burst suppression
20
113
BIS**
flat line EEG (good neuro protection + reduced demand for oxygen)
0
114
true or false
Do NOT rely on just a single monitor to test awareness
true
115
what can alter BIS value (7)
Hypothermia
shivering
warming blankets
head trauma
patient positioning
unipolar cautery
ketamine + nitrous (can INCREASE BIS value)
116
what does a Signal Quality Indicator (SQI) of 100 indicate
optimal, "perfect" signal, believe the BIS number
117
Electrical signals produced in response to various stimuli by the CNS
Neuronal pathway dysfunction can be identified
evoked potentials
118
Analysis of raw EEG data to derive a formula-driven numerical value indicative of LOC
BIS
119
Evoked potentials:
An INCREASE in latency: occurs _____ often (more time between spikes)
increase in latency = occurs LESS often
120
evoked potentials
described by (3)
latency
amplitude
site of stimulus
121
evoked potentials
Somatosensory (SSEP)
Afferent signaling = dorsal
Brainstem Auditory: clicking sounds send auditory nerve signal (CN #8)
122
evoked potentials
Motor (MEP)
Generally inaccurate, less utilized
Giving so much anesthetic to keep patient from moving without NMBs
Efferent signaling = ventral (corticospinal tracts)
123
evoked potentials
true or false
You CANNOT use NMBs with MEPs
true
it interferes with signal
124
four types of evoked potentials
Somatosensory
motor
auditory
visual
125
evoked potentials
IV anesthetics affect SSEP ______ than < inhaled anesthetics
IV anesthetics affect SSEP LESSSSSSS than inhaled
inhaled >> bigger impact than IV
126
Volatile anesthetics produce an _________ in SSEP latency and ___________ in amplitude (slow spikes, less tall)
increase in latency
decrease in amplitude
127
Etomidate and Ketamine __________ SSEP amplitude
increase amplitude
128
Nitrous ____________ SSEP amplitude
decreases amplitude
129
Reductions in blood flow ____________ SSEP
decrease
130
Opioids have ____ ________ on SSEP amplitude
no effect
131
cerebral oximetry looks at ____ __________, _________ blood flow
NON-pulsatile
venous blood flow
132
when should you attach a patient to cerebral oximetry
BEFORE giving oxygen (so you have a baseline)
133
cerebral oximetry
Regional sat < ____% or changes > ____% of baseline indicate possible reduction in cerebral oxygen
regional < 40%
>25% baseline
134
If cerebral oximetry goes down, increase the ETCO2 to >_____ mmHg by hypoventilating the patient**
>40
hypoventilation (acidosis)
causes cerebral vasodilation
135
Guedel’s Stages of Anesthesia
analyzes ____, ________, and __________ used for respiration
rate, rhythm, and muscles used
136
Guedel’s Stages of Anesthesia:
Analgesia and Disorientation (in pre-op holding)
stage 1
137
Guedel’s Stages of Anesthesia*
“Ether eye signs”: gaze becomes disconjugate
stage 2
138
Guedel’s Stages of Anesthesia*
Laryngospasm, HYPERreflexia,
delirium, agitation, excitement, irregular breathing, apnea, thrashing
stage 2
139
Guedel’s Stages of Anesthesia
Occurs during both induction + emergence (worst during EMERGENCE)
stage 2
140
Guedel’s Stages of Anesthesia:
EYELID reflex eliminated
Regular respirations + normal muscle tone
Plane 1, stage 3
141
Guedel’s Stages of Anesthesia:
LARYNGEAL reflex eliminated (no gag, intubate)
Volume reduced + rate increased
plane 2, stage 3 (ideal stage)
142
Guedel’s Stages of Anesthesia:
CARINAL reflex eliminated
onset of intercostal muscle paralysis
plane 3, stage 3 (ideal stage)
143
Guedel’s Stages of Anesthesia:
INTERCOSTAL paralysis complete (respirations eliminated)
plane 4, stage 3
144
Guedel’s Stages of Anesthesia:
Medullary paralysis (moribund)
Progressive cardiovascular collapse (way too deep)
stage 4
145
Guedel’s Stages of Anesthesia:
ideal stages
plane 2 and plane 3 (of stage 3)
146
Tissue stress is directly related to ____ and applied __________
Vt + pressure
147
anesthesia leads to
_____________ FRC, compliance, and muscle tone and
_____________ resistance
decreased FRC, compliance, muscle tone
increased resistance
148
Causes of Ventilator-Induced Injury:
Overdistention (volume) of alveoli
VOLUtrauma
149
Causes of Ventilator-Induced Injury:
Excessive pulmonary pressures
BAROtrauma
150
Causes of Ventilator-Induced Injury:
Repeated opening and collapse of atelectatic lung units (derecruitment)
ATELECtrauma
151
Causes of Ventilator-Induced Injury:
Inflammatory mediator release into alveoli and surrounding bronchiole spaces
(can be caused by the atelectrauma, volutrauma, barotrauma)
BIOtrauma
152
what is the range for mild/permissive hypercarbia (to protect the lungs)
pCO2 40-45 mmHg
153
Compliance is __________ at the ______________ of inspiration*
compliance is GREATER at the BEGINNING of inspiration
(think of a balloon)
154
Beginning of inspiration=_____ pressure=high compliance=_____ flow
low pressure=high flow
155
Vt / plateau pressure – PEEP**
compliance
156
Increased airway resistance contributes to a ____________ in dynamic compliance*
decrease in DYNAMIC compliance
157
Decreased COMPLIANCE = increased plateau pressure = increased _________ pressure*
driving pressure
158
Increased resistance = ____________ peak pressure*
increased PiP
159
Pplat (plateau pressure) – PEEP**
driving pressure
160
The LOWER the driving pressure, the ___________ the pulmonary compliance
(this is a good thing)
greater the compliance
161
increase in PEEP = ___________ in driving pressure
decrease in driving pressure!
162
increase in fresh gas flow = ____________ in Vt, MV, and PiPs
increase!
*unless using a ventilator compensator
163
Disconnect= immediately falls flat*
Small leak= gradually descends*
ascending/standing bellows
164
disconnect=still filled*
ascend during inspiration
descend during expiration
less safe
descending/hanging bellows
165
initial ventilator settings:
RR: ___-___ bpm
Vt: ___-___ ml/kg ideal body weight
PiP: < ____ cmH2O
Driving pressures: < ___ cmH2O
PEEP: ___-___ (2-3 from bellows weight)
FiO2: ___-___%
I:E Ratio: __:__
RR: 8-12 bpm
Vt: 6-8 ml/kg ideal body weight
PiP: < 30 cmH2O
Driving pressures: < 15 cmH2O
PEEP: 4-5 (2-3 from bellows weight)
FiO2: 40-50%
I:E Ratio: 1:2
166
what is the SAFEST way to increase MV
increase in RR
167
what is the most EFFICIENT way to increase MV
increase in Vt
168
Vt – _________ ____________ = what is delivered to the patient
Circuit Compliance
* Historically: around 100ml
* Present day: around 35-40ml
169
What is the PAO2 in a patient who is breathing room air and pCO2 is 80 mmHg?
* Lower (around 40-50 mmHg)
170
The “higher” the I:E ratio, the _____________ the inspiratory time=________ driving pressure**
the higher I:E, the GREATER the inspiratory time, the LOWER the driving pressure
171
Longer expiratory phase=____________ in ETCO2
reduction
172
Increase in respiratory rate=____________ pressure and flow
increase
173
Increase in inspiratory flow=___________ in I:E ratio
decrease
174
If you are using pressure control ventilation and compliance changes from low to high how will volume change?
volume will increase
175
ventilator modes:
Most common
Rate can change
Constant flow
PiP/pressure will vary
Barotrauma can occur
VOLUME controlled ventilation
176
ventilator modes:
Indication
Patients with no respiratory effort
Volume control
177
ventilator modes:
Indications
LMA, emphysema, neonates, children
Low lung compliance
Laparoscopy, pregnancy, children, ARDS, obesity
pressure control
178
ventilator modes:
Vt can vary
Varying/decelerating flow
Mandatory rate and inspiration time
Inspiratory times are longer
pressure control
179
ventilator modes:
Caution: changes in compliance or resistance can dramatically affect Vt delivery!
You can go from Vt 200ml to 1400ml very quickly with a chance in compliance
pressure control
180
ventilator modes:
decelerating flow waveform
pressure control
181
ventilator modes:
constant flow waveform
volume control
pressure control with volume guarantee
182
ventilator modes:
Best option!
Ventilator attempts to guarantee a set volume in PCV
Lung safety is improved
pressure control with VG
183
ventilator modes:
Pressure support (5-10 cmH20) will overcome the negative inspiratory pressure resistance due to ETT, circuit, filters, etc.
Only inspiratory pressure and breath trigger are set
RR is determined by patient
Amount of inspiratory flow can be programed for sensitivity:
* 200ml/min trigger for sicker patients
* 2000ml/min for patients that are doing well
pressure support ventilation
184
ventilator modes:
Indications
Spontaneous breathing support to increase comfort
Decreased work of breathing
pressure support ventilation
185
ventilator modes:
Synchronizes the patient's efforts with ventilator
Senses negative pressure inside the chest cavity created by diaphragm
Ventilator knows the patient initiated a patient driven breath
If patient does not inspire within trigger synchronization window waiting time, ventilator then will deliver a breath
synchronized intermittent mandatory ventilation (SIMV)
186
ventilator modes:
Patient breath does NOT compete with ventilator
“Backup” ventilation to maintain normocarbia
SIMV
187
Vt and flow are _________ dependent
volume
188
PiP, plateau pressure are __________ dependent
pressure
189
increase in auto-PEEP = __________ pressure and a ____________ volume
increased pressure, decreased volume
190
What artery is the SA node fed by?
Right coronary artery
(if affected, will lead to a heart block)
191
Can be from electrolytes or abnormality
Non-pacemaker cells
QRS and T look the same
ectopic site/foci
192
what is ventricular THRESHOLD potential
-70 mV
193
SODIUM ENTERS the cell to make it more positive; 30 mV
phase 0
194
potassium exits the cell
phase 1, phase 2, phase 3
195
calcium enters slowly, facilitating prolonged conduction;
potassium still exits the cell
phase 2
196
RESTING membrane potential: _____mV
-90
phase 4
197
what is DEPOLARIZATION ____ mV
30 mV
198
A picture between 2 electrodes
(one + and one -)
lead
199
Electricity flowing toward a positive lead is viewed as an __________ line
upward
200
leads:
Between the R arm, L arm, and L leg
BIPOLAR LIMB leads
201
leads:
Between a limb lead and a reference point (AV node)
unipolar AUGMENTED leads
202
leads:
Between a chest lead and a reference point (AV node)
unipolar PRECORDIAL leads
203
leads:
I, II, III
bipolar (limb)
204
leads:
o aVR (looks right)
o aVL (looks left)
o aVF (looks to the foot)
unipolar (AUGMENTED)
205
leads:
V1, V2, V3, V4, V5, V6
unipolar (PRECORDIAL)
206
Einthoven's Triangle*
right arm is always ____
negative --
207
Einthoven's Triangle*
left arm is both ___ and ___
+ and -
208
Einthoven's Triangle*
left leg is always ____
+
209
looks from right arm to left arm
lead I
210
looks from right arm to left leg
lead II
211
looks from left arm to left leg
lead III
212
modified chest leads uses lead ____
lead III
213
What lead is the most commonly monitored*
lead II
214
Looks for:
Presence and location of MI, axis deviation, chamber enlargement
DIAGNOSTIC monitoring
215
Explains HR, regularity, rhythm, conduction patterns
ROUTINE monitoring
216
4th ICS, RIGHT sternal border
V1
217
4th ICS, LEFT sternal border
V2
218
5th ICS, mid-clavicular line
V4
219
5th ICS, mid-axillary line
V6
220
Small box: ____ seconds
.04 seconds
221
large box: ___ seconds
.2
222
Small box: ___ mV (__ mm)
.1 mV = 1 mm
223
large box: ___ mV (__ mm)
.5 mV = 5 mm
224
2 large boxes: __ mV (___ mm)
1 mV= 10 mm
225
EKG:
standard calibration is ____ mm or ___ mV
10 mm or 1 mV (2 large boxes)
226
EKG
More sensitivity allows greater reception, but may __________ artifact
increase artifact (so be careful)
227
EKG
filter mode
sharp
228
EKG
monitor mode
blurry/fuzzy
229
what are the 5 parts of interpretation
rate
regularity
p waves
PR interval
QRS complex
230
PR interval should be less than ____ seconds
< .2 seconds (1 big box)
231
QRS complex should be less than ___ seconds (less than ___ small boxes)
< .12
< 3 small boxes
232
p wave ____--____ seconds
< ____ mm in height
.06-.1 seconds
<2.5 mm in height
233
EKG
Intervals=______ throughout all leads
Picture/tracing=____________ for the leads
intervals=same
picture/tracing=different
234
Dysrhythmias originate in the SA node
sinus
235
sinus tachy is 100 to _____ bpm
150
236
Dysrhythmias originate in the ATRIA
atrial/SUPRAventricular rhythms
237
Dysrhythmias originate in the AV node
junctional
238
Inherent/junctional/junctional escape rate
____--____ bpm
40-60
239
Accelerated junctional ___--___ bpm
60-100
240
junctional tachy >____
>100
241
SVT >____
>150
242
ALL ventricular rhythms have a _____ complex QRS
wide complex
243
what is another name for idioventricular rhythm
ventricular escape rhythm
agonal rhythm
244
___ or more beats = "run of VT"
>3 or more
245
idioventricular/ventricular escape/agonal
is ________ rhythm with ____ P waves
regular rhythm
NO p waves
246
true or false
with bigeminy PVCs, rate by 60-100, but mechanical rate can be 30-50
true
247
which heart block has a irregular R-R interval
2nd degree type 1 (wenkebach)
(p-p is still constant, but PR interval changes!)
248
which heart block has regular p-p, regular pr interval, regular QRS
but multiple p waves per QRS complex?
2nd degree type 2 (classical)
249
which heart block has a variable PR interval, regular p-p, regular r-r
third degree/complete
250
pacers:
position I
chamber paced (what the action is)
251
pacers:
position II
chamber sensed
252
pacers:
position III
response
253
pacers:
position IV
modulation (speeding up or slowing down)
254
pacers:
position V
antitachyarrhythmia functions
255
true or false
ventricular paced is ALWAYS a wide complex
true
256
how can you tell the difference between hyperkalemia and an MI
it will be in all leads
look at patient age
257
which lead can cause false ST elevation
red
258
RIGHT axis deviation = ____________ movement
clockwise
259
LEFT axis deviation = _______________ movement
counterclockwise
260
axis deviation:
Infarct: deviates ______
AWAY
Electricity does not like dead tissue!
261
axis deviation:
Hypertrophy: deviates ___________ the muscle
TOWARD
262
axis deviation:
obesity and pregnancy
LEFT shift
263
axis deviation:
Thin/OSA
RIGHT shift
264
true or false
Bundle branch block always have a WIDE complex QRS
true
265
Bundle branch block:
R-R is found in V1 or V2
RIGHT
"right=up"
266
Bundle branch block:
Deep Q wave is in V1 or V2
R-R is found in V5 or V6
LEFT
"left=down"
267
Bundle branch block:
can be confused with an MI
LEFT BBB
It may give a false positive for Q wave/infarction, and may also give a false positive on ST change
268
EKG:
REVERSIBLE category
ischemia
269
EKG:
tissue compromise
injury
270
EKG:
irreversible, tissue death
infarction
271
EKG:
tall/peaked T waves
or
inverted/symmetrical T waves
ST depression
ischemia
272
EKG:
ST elevation (with troponin release)
injury
273
EKG:
Q wave formation
(>.04 seconds, >1/3 height of the R wave)
infarction
274
what is a pathological Q wave
>___ seconds
>___ height of R wave
>.04 seconds
>1/3 height of R wave
275
Sub-ENDOcardial = Non-Q wave MI
– Less than 1/2 of endocardial wall infarcted
– T wave changes peaked/inverted
– ST depression/elevation, no Q wave
276
what is another term for subendocardial/non-q wave MI
NSTEMI
277
transmural = sub-EPI cardial = Q wave MI
– More than 1/2 of wall infarcted
– T wave inversion
– ST elevation
– Q wave
278
what is another term for transmural = sub-EPI cardial = Q wave MI
STEMI
279
true or false
for diagnostics, there must be an ST elevation in 2 or more leads
true
280
what is the overall best lead for detecting ISCHEMIA*
V5
281
what is the best combo for leads*
Lead V4 + V5: best combo (but usually not allowed)
so use: Lead II + V5!!!!
282
what is the best lead for detecting atrial dysrhythmias
lead II
283
what leads is hypertrophy detected in
all V leads
284
atrial hypertrophy:
NOTCHED (mcdonalds hump) p wave
BIPHASIC p wave
WIDENED p wave
LEFT atrial hypertrophy
285
atrial hypertrophy:
afib and MITRAL regurgitation
LEFT atrial hypertrophy
286
atrial hypertrophy:
TALL/PEAKED p wave
RIGHT atrial hypertrophy
287
atrial hypertrophy:
OSA and tricuspid regurgitation
RIGHT atrial hypertrophy
288
left ventricular hypertrophy:
S wave (in V1 or V2)
+
R wave (in V5 or V6)
=
>____ mm
*look for OVERLAP throughout the V leads*
>35 mm
289
what is an easy way to determine a long QT interval
if it is greater than HALF the distance of an R-R
