UNIT 1 - ECG interpretation & Treatment

Question 1

RA Electrode Placement

Answer 1

Right forearm or wrist

Question 2

LA Electrode Placement

Answer 2

Left forearm or wrist

Question 3

LL Electrode Placement

Answer 3

Left lower leg, proximal to ankle

Question 4

RL Electrode Placement

Answer 4

Right lower leg, proximal to ankle

Question 5

V1 Electrode Placement

Answer 5

4th intercostal space, right sternal edge

Question 6

V2 Electrode Placement

Answer 6

4th intercostal space, left sternal edge

Question 7

V3 Electrode Placement

Answer 7

Midway between V2 and V4

Question 8

V4 Electrode Placement

Answer 8

5th intercostal space, mid-clavicular line

Question 9

V5 Electrode Placement

Answer 9

Anterior axillary line

Question 10

V6 Electrode Placement

Answer 10

Mid-axillary line

Question 11

The H causes of cardiac arrest

Answer 11

Hypovolemia
Hypoxia
Hypothermia
Hypo/hyperkalemia
Hypoglycemia
H+ acidosis

Question 12

The T causes of cardiac arrest

Answer 12

Tension pneumothorax
Tamponade
Toxins
Trauma
Thrombosis

Question 13

A patient comes into the emergency room with shortness of breath and epigastric pain. The doctor is querying an MI, what enzymes would be tested?

Answer 13

Creatine-Kinase (Ck-MB)
Troponin T

Question 14

How long do heart enzymes increase after pain of an MI has started?

Answer 14

3 - 6 hours

Question 15

How long do heart enzymes remain elevated for?

Answer 15

14 - 21 days

Question 16

How long does Troponin I levels rise after an Acute MI?

Answer 16

7 - 14 hours

Question 17

What is the treatment for STEMI?

Answer 17

Aspirin 300 mg
O2 therapy
IV Nitroglycerin
Streptokinase
Tissue-type plasminogen activator (t-PA)

Question 18

Josh’s ECG shows electrical activity but when feeling for a pulse, none is absent. What is your next course of action?

Answer 18

Commence CPR
Treat H’s and T’s
Give Epinephrine 1 mg

Patient has pulseless electrical activity

Question 19

Your patient experiences a flat line (code blue/asystole), what is your next course of action?

Answer 19

Commence CPR
1 mg Epinephrine
Treat H’s and T’s

Question 20

On your patient’s ECG, there is an irregular rhythm, atrial rate 400 bpm, ventricular rate 160 - 180 bpm and absent P wave. What is this rhythm and what is your next course of action>

Answer 20

A fib

Use a biphasic defibrillator for electrical conversion or use chemical conversions such as Amiodarone, procainamide or diltiazem.

Provide Heparin to prevent atrial thrombus

Question 21

Brian has a HR 100-250 bpm and expresses that they are experiencing feelings of impending death. His ECG shows absent P waves and QRS complex > 0.12 seconds. What is this rhythm and what is your next course of action?

Answer 21

V tach

Amiodarone 150 mg IV slow bolus over 10 minutes

Repeat 150 mg IV (over 10 minutes) every 10 - 15 minutes.

Question 22

What do you do for pulseless VT?

Answer 22

Defibrillation 200
Chest compressions
1 mg Epinephrine q 5 mins
Amiodarone 300mg IV push

Question 23

What is an alternate infusion of Amiodarone for VT?

Answer 23

360 mg over 6 hours then 540 mg over the remaining 18 hours.

1mg/min over 6 hours - 0.5 mg/min

Question 24

The ECG of Katyln reveals regular narrow QRS complexes with a HR 150 - 250 bpm. What is this rhythm and what do you give?

Answer 24

PSVT
Adenosine 6 - 12 mg IV

Question 25

This rhythm has a regular r-r interval, HR 125 bpm and a PR interval 0.16 sec. What is this?

Answer 25

Sinus Tachycardia

Question 26

Lian is experiencing SOB, altered LOC, pulmonary edema and her ECG shows a PR interval <0.2. What is this rhythm?

Answer 26

Sinus Bradycardia

Question 27

Explain the protocol for a client experiencing symptomatic bradycardia?

Answer 27

Assess signs & symptoms. IDENTIFY & TREAT UNDERLYING CAUSES Maintain patent airway Administer O2 Cardiac monitoring to identify rhythm, monitor BP and SPO2 IV access Assess 12 lead ECG If it is present and causes hypotension, altered LOC, signs of shock, chest pain and acute CHF then administer atropine 1mg bolus then q 3 - 5 minutes to 3mg max dose

Question 28

If atropine doesn't work for bradyarrhythmia, what can you do?

Answer 28

Dopamine 2 - 50mcg/kg per min Epinephrine 2 - 10 mcg per min Transcutaneous pacing

Question 29

How do you ventilate a patient with bradycardia?

Answer 29

Start @ 10 - 12 breaths/min until partial pressure of end tidal CO2 is 35 - 40 mmHg

Question 30

Normal PR interval

Answer 30

0.12 - 0.20 sec

Question 31

Normal QRS complex

Answer 31

0.06 - 0.12

Question 32

Big box method

Answer 32

Number of big boxes between two R waves then divide it into 300

Question 33

Atrial contraction/depolarization

Answer 33

P wave

Question 34

Time it takes for the impulse to spread from the atria to the ventricles

Answer 34

PR interval

Question 35

Ventricular contraction/depolarization

Answer 35

QRS complex

Question 36

Electrical systole

Answer 36

QT interval

Question 37

Ventricular depolarization is complete and repolarization about to begin.

Answer 37

ST segment

Question 38

Repolarization of the ventricles

Answer 38

T wave

Question 39

How does the conduction of the heart go?

Answer 39

Sinoatrial node (60 - 100 bpm) -> Atrioventricular node (40 - 60 bpm)-> Bundle of His (40 - 60 bpm)-> Left and right bundle branch (20 - 40 bpm) -> Perkinjie fibers (20 - 40 bpm)