Unit 4 Flashcards
1
Q
If ventricular contractions don’t have a pattern on a EKG, what do you need in order to discern
A
more strip, at least 15 sec worth
2
Q
What is the normal pathway of conduction through the heart
A
(atrial) SA to AV to BOH to Purkinjie (ventricle)
3
Q
Which electrolyte sets the resting membrane potential in the heart
A
K
4
Q
On a clock, list where lead 1, 2, 3 would be
A
1 is 9-3
2 is 11-5
3 is 1-7
5
Q
What does the term augmented lead mean
A
these leads fill in the gaps not picked up by leads 1, 2, 3
6
Q
Mantra for determining HR
A
300, 150, 100, 75, 60, 50, 40
7
Q
An anterior MI effects which artery
A
LAD
8
Q
An inferior MI effects which artery
A
RCA
9
Q
When looking at an EKG, what segment might indicate possible electrolyte imbalance
A
ST
10
Q
WHat does hypokalemia look like on an EKG
A
short descending T wave
11
Q
what does hyperkalemia look like on an EKG
A
tall, ascending ST
12
Q
Both hypo and hyperkalemia create a _____ ST segment
A
depolarizing
13
Q
What part of the heart is the first thing to depolarize (in regards to ventricular)
A
the septum
14
Q
Depolarization is due to
A
Na
15
Q
REpolarization is due to
A
Ca
16
Q
Depolarization is
A
contraction
17
Q
Repolarization is
A
relaxation
18
Q
Contraction or depolarization traveling towards a pos electrode looks like what
A
above the baseline (pos)
19
Q
Contraction or depolorization traveling AWAY from a pos electrode looks like
A
below the baseline
20
Q
Lead 1 electrode is located where (what limbs)
A
right arm towards pos left arm
21
Q
Lead 2 electrode is located where (what limbs)
A
right arm towards positive Left Leg
22
Q
lead 3 electrode is located where (what limbs)
A
Left arm to pos Left Leg (rule of L’s)
23
Q
list the 3 augmented leads
A
AVR, AV1, AVF
24
Q
AVR is located where
A
right arm
25
AV1 is located where
left arm
26
AVF is located where
left leg
27
what are the precordial chest leads
V1-V6
28
the precordial chest leads are looking at what part of the EKG
R segment
29
what is normal EKG speed for 1 small box
.04 sec
30
What is normal height of 1 box of an EKG reading
.1
31
What is it called when a section of an EKG is on the baseline (not above or not below)
isoelectric
32
P wave represents what
atrial DEpolarization
33
Ventricular Depolarization is what part of the EKG
QRS complex
34
What is the normal length of a QT segment
there is no normal
35
If a QT segment is prolonged, this is ____
really bad, there is a risk of arrythmia that could potentially lead to sudden death
36
True ventricular repolarization is what part of the EKG
T wave
37
the ST segment is usually (above baseline, below baseline or isoelectric)
isoelectric
38
What is J point
the point where ST segment begins (the pointy peak)
39
What is the rule about P/T waves
they should be going in the same direction
40
WHat is a U wave
not everyone has a U wave, this is the final phase of ventricular repolarization, U should be going in same direction as T
41
Normal HR Is
60-100
42
To calculate EXACT HR use what formula
1500/ number of small boxes
43
the atrial rate goes from ____ to ____
P wave to P wave
44
ventricular rate goes from ____ to ____
R to R
45
with brady cardia and tachycardia, how to determine whether or not you will tx them with PT
Brady, if under 50 don't tx and call physician, if they are asymptomatic and above 50 you should be ok
Tachy- are they symptomatic and have DOE
quick HR can cause decreased CO- so watch
46
with brady cardia and tachycardia, how to determine whether or not you will tx them with PT
Brady, if under 50 don't tx and call physician, if they are asymptomatic and above 50 you should be ok
Tachy- are they symptomatic and have DOE
47
Explain what PAC looks like on an EKG
a short RR then long RR
48
Explain the impulse or conduction with PAC
the impulse starts in the SA note, except for the one premature beat (this one starts from ectopic atrial focus)
49
When would you notify Dr. about PACs and not treat
when there are more than 9 in 1 min
50
Are PAC's an immediate threat
no, they are fairly common (From stress, caffiene)
51
When would you notify Dr. about PACs
when there are more than 9 in 1 min
52
Is atrial flutter an immediate threat
no, we can treat if their sx are under control (just assess pt)
53
P waves are F waves explains
atrial flutter
54
How many foci does atrial flutter have
1
55
Is atrial flutter an immediate threat
no, we can treat if their sx are under control
56
Explain conduction of Afib
it does not start in SA node
57
how many foci with Afib
multi
58
What do you look at with Afib (which part of EKG)
you can't count atrial rate, so you look at ventricular rate, if it's over 100 CO may be compromised
59
You have a P for every QRS, but you don't have a QRS for every P explains
PVC
60
3 main types of PVC
bigeminy, trigeminy, couplet
61
"wide mountain base" looks like a
PVC
62
Where does the conduction originate with a PVC
ventricals
63
What is one common cause of PVC
electrolyte imbalance
64
If there are more than ___ PVCs per min you should notify Dr.
6
65
What are other significant parameters to call Dr for PVCs
more than 6 per min, coupleting, bigiminy, multifocal
66
How might a pulse feel with a PVC
skip beat then strong beat
67
3 PVCs in a row is considered
VTAC (emergency)
68
sx of VTAC
hypotension, loc, weak pulse
69
VFIB is a
medical emergency
70
conditions we would not treat
bigeminy, trigeminy, vtac, vfib
71
pattern of a bigeminy
normal, bad, normal, bad
72
WHat are the 7 rules to determine whether an EKG is normal
1. Is HR 60-100
2. Do P waves all look alike
3. Is there a P wave for every QRS
4. Look at the PR interval, are there 3-5 little boxes
5. Does the QRS take less than 2 ½ little boxes
6. Is there a QRS for every P wave
7. Is T wave the same direction as the P wave
73
P segment represents
atrial contraction
74
WHat are the 5 rules to determine whether an EKG is normal
1) check HR (60-100)
2) is the PR interval less than 5 little boxes
3) are the P and T in the same direction
4) Is there a P for every QRS
5) Is there a QRS for every P
75
pattern of a trigeminy
normal, normal, bad
76
a bunch of little bumps followed by a normal QRS would be
atrial flutter
77
atrial flutter has how many foci
1
78
afib has how many foci
multi
79
with first degree AV block, the PR interval is
more than 5 boxes (its greater than .20 sec)
80
non invasive dx test that involves a transducer emitting a high freq
echo
81
which type of echo is best for obese pts, chest deformity or lung diseases
4TEE (transesophageal)
82
4 common issues echos are good to detect
thrombus, akenesis, valve fnct, EF
83
What is MUGA
a non invasive multi aquasition image that calculates the left vent EF by way of a stain to the RBCs
84
invasive dx procedure used with angiography and dye in the femoral or radial arteries
cardiac cath
85
cardiac caths are often used when what doesnt work (to determine what is going on)
after all efforts with nitroglycerine are used
86
What is PTCA
percutaneous transluminal coronary angioplasty
87
Types of coronary vessel surgical procedures (types of percu interventions)
PTCA
STENT
LASER
88
Which type of coronary vessel surgery involves a balloon and angioplasty
PTCA
89
Which type of coronary vessel surgery involves a wire left in place to keep vessel open
stent
90
which coronary vessel surgery clears out plaque
laser
91
CABG usually uses what vessels to repair
saph vein, left mammary or radial artery
92
3 ways CABG is performed
sternal, minimally invasive, off pump
93
pacemakers are implanted where
right vent or right atria
94
4 main uses for pacemakers
SA node malformity (SSS)
complete HB
transplant (cutting of the nerves)
CHF
95
4 main uses for pacemakers
SA node malformity (SSS)
complete HB
transplant (cutting of the nerves)
CHF
96
Will heat pad effect pace maker
no
97
What intensity scale/monitoring sx to use for pts with pace makers
RPE or something other than HR
98
acutely, what to prevent after pacemaker implant
90 degrees shoulder flexion for a week
99
What is the device called that is an implanted emergency defibrilator in a pt
ICD
100
****RESP FAILURE pH level
pH less than 7.25
101
***What is resp failure PO2 level
PO2 less than 60
102
***What is resp failure for PCO2
PCO2 greater than 50
103
Iron lung is what type of vent
neg pressure
104
pro of neg pressure vent
less risk of issues/pathologies caused by
105
Pos pressure vents can sometimes cause compression of the
vena cavas
106
what 2 main factors effect pos pressure vents
compliance and resistance in lungs
107
What is FiO2
the fraction of inspired O2 the pt gets from the ventilator
108
the higher the FiO2, the ____ the pt
sicker (the more they need the vent to do the work)
109
the higher the FiO2, the ____ the pt
sicker (the more they need the vent to do the work)
110
What is PEEP
pos end expiratory pressure
111
What is the use for PEEP in a vent
used to maintain an open airway
112
The higher the PEEP, the ____ the pt
sicker
113
Do we turn off vent alarms
no, not off or on
114
What are high pressure alarms on a vent indicative of
secretions in tube or coughing fits that restrict bronchials (all of this increases the need for work of the machine)
115
What are high pressure alarms on a vent indicative of
when PIP gets really high...usually from secretions in tube or coughing fits that restrict bronchials (all of this increases the need for work of the machine)
116
Low pressure alarm is usually due to
tube getting disconnected
117
Which type of alarm is an emergency
apnea
118
apnea alarm indicates (this one is loud an peircing)
sx failure, no air
119
to indicate good PFT, reserve should not be equal to
TV
120
to indicate good PFT, reserve should not be equal to
TV
121
CK is what
creatine phosphokinase
122
The higher the level of CK, the more ____ has occured
damage
123
CK levels rise how soon after MI
3 hours (first enzyme marker to elevate)
124
What is important to know about CK levels and the promptness of a person visiting the ER after MI sx
it rises quick, but it leaves sx quickly so get to ER quick to check levels
125
What is important to know about CK levels and the promptness of a person visiting the ER after MI sx
it rises quick, but it leaves sx quickly so get to ER quick to check levels
126
CK-MB and LDH1 are
isoenzymes
127
what are isoenzymes
enzymes not specific to the heart (may indicate organ issues)
128
What are the 3 specific types of CK
MM-muscle
MB-heart
BB-Brain
129
MB again (type of CK) is what
heart
130
CK returns to normal when
3 days
131
Is CK MB specific only to an MI
no, it can also elevate with atrial fibrillation and tachycardic arrhythmias, cardiac catheterization, during CPR or cardioversion, with cardiac contusion or multiple traumas, and in congestive heart failure or emboli
132
Is CK MB specific only to an MI
no, it can also elevate with atrial fibrillation and tachycardic arrhythmias, cardiac catheterization, during CPR or cardioversion, with cardiac contusion or multiple traumas, and in congestive heart failure or emboli
133
This muscle protein binds to tropomyosin
```
Troponin T (cTNT)
Troponin T has three different isoforms: one for slow-twitch fibers, one for fast-twitch fibers, and one for cardiac muscle
```
134
which cardiac marker should be the highest normally (in non pathology)
LDH 2 should always be highest of the isoenzymes present in bld for healthy people
135
If one has an MI, they have a "flipped LDH" what is this
If you have had an MI you will have a flipped LDH, this means that LDH1 is higher in value than LDH2.
136
If one has an MI, they have a "flipped LDH" what is this
If you have had an MI you will have a flipped LDH, this means that LDH1 is higher in value than LDH2.
137
CK value that is super high (indicates bad MI or trauma)
over 2000
138
normal Hgb values
14-16 men
| 12-15 women
139
normal Hgb values
14-16 men
| 12-15 women
140
what hgb level would you not do therapy
under 8
141
elevated WBC is usually indicative of
BACTERIAL infection
142
elevated WBC is usually indicative of
BACTERIAL infection
143
Decreased WBC is indicative of
VIRAL inf
144
normal platelet range
15,000-45,0000
145
platelets less than 5000
dont treat (they are on BR)
146
platelets less than 5000
dont treat (they are on BR)
147
What test is done to see how well blood clots
Prothrombin time (PT)
148
coumadin is monitored by way of
Prothrombin time
149
heparin is monitored by way of
PTT partial thromboplastin time
150
the heart contracts from ___ to ___
top right to bottom left
151
the heart contracts from ___ to ___
top right to bottom left
152
how many boxes should PR interval be
3-5 little boxes
153
how many boxes should PR interval be
3-5 little boxes
154
again, what are the steps to determine NSR
1. Is HR 60-100
2. Do P waves all look alike
3. Is there a P wave for every QRS
4. Look at the PR interval, are there 3-5 little boxes btwn
5. Does the QRS take less than 2 ½ little boxes
6. Is there a QRS for every P wave
7. Is T wave the same direction as the P wave
155
again, what are the steps to determine NSR
1. Is HR 60-100
2. Do P waves all look alike
3. Is there a P wave for every QRS
4. Look at the PR interval, are there 3-5 little boxes btwn
5. Does the QRS take less than 2 ½ little boxes
6. Is there a QRS for every P wave
7. Is T wave the same direction as the P wave
156
individual PVCs are not what
a big concern
157
individual PVCs are not what
a big concern
158
if you notice possible afib on a standard strip, what should you do (in addition to checking pt status)
get 15 sec strip to read
159
what might trick you to think afib
Afib can look like something similar called artifact. Artifact happens near a body part that is moving around so if you are raising R arm up and down you would just see artificant in Lead I and lead II (only see in an electrode over the moving part). With Afib you will see it in every lead
160
what might trick you to think afib
Afib can look like something similar called artifact. Artifact happens near a body part that is moving around so if you are raising R arm up and down you would just see artificant in Lead I and lead II (only see in an electrode over the moving part). With Afib you will see it in every lead
161
what type of scenario would you not tx a pt with afib
yesterday they were just fine, but today are showing afib on strip
162
what type of scenario would you not tx a pt with afib
yesterday they were just fine, but today are showing afib on strip
163
How AFIB can get serious quickly*****
atria never strongly contacts, so 30% of blood stays in the atrium, which makes pts much more likely to get a blood clot, which cold go to the ventricle and the to lungs or periphery which would be very bad.
If it becomes a pulmonary emboli- quick on set of SOB, heavy fatigue, chest pain
If it goes to the brain- stroke, look for facial droop, slurred speech, gait pattern changed, unilateral weakness, confusion.
If it goes to L coronary vessel- heart attack
If it goes to the leg- acute arterial claudication- dec pulse, unilateral leg pain, cold to touch
164
with a PVC, there is a qrs for every p, but not a ___ for every ____
p for every qrs
165
with a PVC, there is a qrs for every p, but not a ___ for every ____
p for every qrs
166
full thickness, damage is the entire section of the tissue is what type of MI
transmural
167
partial thickness, the damage is done from the inside out and some tissue is still healthy and ok is what type of MI
subendo
168
what constitutes an MI
at least 2 of the following:
sx (lasting more than 20 min)
enzyme changes
EKG changes in at least 2 leads
169
What is the best determining factor for patients with MI sx less than 3 hours (to dx MI)
ECG the one BEST discriminator in patients with onset of chest pain of 3 hours or less duration.
170
What is the best determining factor to dx pts with MI after 3 hours of sx
After 3 hours, creatine kinase MB mass the one BEST discriminator
171
very first sign of transmural MI
ST segment elevation
172
EKG change for transmural ischemia is seen where
T wave
173
Myocardial ischemia vs injury
ischemia heals, injury doesnt (but injury isn't as bad as full infarct as infarct = dead tissue)
174
EKG change for transmural INJURY is seen where
ST segment
175
Myocardial ischemia vs injury
ischemia heals, injury doesnt (but injury isn't as bad as full infarct as infarct = dead tissue = permanent)
176
In a post transmural MI they look for what on an EKG
they look for reciprocal changes – this causes ST segment depression
* as there are no leads directly over posterior part of heart, see reciprocal changes in leads opposite. Therefore, show ST depression and tall symmetrical T waves and large R wave progression.
177
anterior infarct clicks are found where
V2, V3 (V4 with greater damage)
178
septal infarct, clicks are found where
V1, V2
179
lateral infarct, clicks are found where
I, aVL, V5, V6
180
inferior infarct, clicks are found where
II, III, aVF
181
post infarct, clicks are found where
V1, V2, V3
182
post infarct, clicks are found where
V1, V2, V3
183
blood supply for ant and septal infarct
LAD
184
blood supply for lateral infarct
circumflex
185
blood supply for inf infarct
RCA
186
blood supply for post infarct
post descending
187
in addition to an MI, what could a depressed ST segment also mean
electrolyte issue, or digitalis toxicity
188
in addition to an MI, what could a depressed ST segment also mean
electrolyte issue, or digitalis toxicity
189
what electrolyte is related to resting membrane potential
K
190
Hypokalemia would look like what on an EKG
decreased T wave and ST segmentHy
191
Hyper kalemia would look like what on an EKG
increased, tall T wave
192
electrolyte involved in threshold potential
Ca
193
sx of hypocalcium
Parethesias around the mouth and in the digits
+ Chvostek sign
+Trousaue sign
194
What is chvostek sign
(tap the facial nerve just below the temple and the nose or lip twitches)
195
What is Trousaue sign
hyperflexia
| contraction of the hand and fingers with the arterial blood flow in the arm is occluded for 5 minutes).
196
main diff btwn assist control vent (ASV) and SIMV (synchronized intermittent mandatory)
ASV has a sensor that reads when the pt makes an effort breathing, and delivers a pre set amt when needed
SIMV has no sensor, just sends a preset amt regardless of effort or not
197
Which mode of vent is best to use when weaning a pt off a vent
SIMV
198
which mode of vent has a risk of hyperventilating
ASV
199
this "vent" is used for obstructive sleep apnea and it Applies continuous same positive pressure during inspiration and expiration to a spontaneously breathing patient
CPAP
200
DIff btwn bipap and cpap
cpap is a continuous amt of pressure regardless of inhalation or exhalation, bipap the pressure can change
201
One of the main jobs of a vent
to maintain open airway
202
normal pH
7.35-7.45
203
Normal PCO2
35-45
204
Normal HCO3
22-26
205
ratio of HCO3 to CO2 is
20:1
206
Buffers aid in acid base balance, they are chemicals present in both ___ and ____
plasma and RBCs
207
are buffers fast or slow
very fast (less than a sec)
208
is bicarb or non bicarb the primary buffer
bicarb
209
our body's response to not normal CO2 levels in blood
we will start to breath fast to blow it off, or hold our breath or breath slow if it's too low
210
what initiates our homeostasis for buffering (respiratory wise)
if the H+ levels (H is acid) are high, the respiratory sx will increase to breath of the CO2 (acid)
211
Which is a faster sx, buffering or respiratory
buffering, resp takes 1-3 min
212
3 main ways to maintain acid base balance
buffers, resp, kidneys (kidneys take hours to days)
213
PCO2 is only influenced by
respiratory changes
214
CO2 is only eliminated in what 2 ways
resp and urination
215
Kidneys control what (acid base balance)
bicarb levels
216
what is hypoventilation
too much CO2 (resp acidosis)
217
severe obstructive lung disease or overdose with sleep meds would lead to (resp acidosis or alk)
acidosis
218
explain what causes hyper ventilation
think of the ventilation term as exhaling (exhaling too much)
219
pH should be
7.4
220
metabolic or non resp parameters, have to do with
bicarb
221
think of HCO3 as
base
222
main cause of metabolic acidocis
diarrhea
223
main cause of metabolic alkalosis
vomitting (fluid loss) - when pple are sick and vomitting, they are ridding their body of acids making them more basic
224
compensatory hyperventilation occurs with (met acidosis or alk)
hypervent (breathing alot) with metabolic acidosi
225
compensatory hypoventilation occurs with metabolic
alk
226
if our CO2 is too high, but breathing off the CO2 isn't fixing the issue, what happens next in the body
Compensation-the body will then increase bicarb to try and balance out
227
explain compensation vs correction for acid base balance
correction- the component causing the imbalance is altered
compensation- the indirect component is altered to fix the direct issue
228
In her chart for acid/base probs, corrected numbers would always be
7.4
40 (CO2)
24 (HCO3)
and 20:1
229
again, bicarb is regulated
in kidney (directly or indirectly)
230
If a person has kidney disease, can an acid base prob be corrected
no, just compensated
231
IF it’s a resp problem the compensation will be _____ and if kidneys are problem then the compensation is ____
IF it’s a resp problem the compensation is kidney
| if kidneys are problem then resp is compensation
232
If pH is normal, and the 2 components are not, then it's
completely comp
233
if pH is abnormal but the starting comp value is normal it is
uncompensated
234
if pH is abnormal and the starting comp value is not normal it is
partially comp
235
if both acid and base values are high, look at
pH as the problem factor
236
IF BASE IS TOO HIGH (INITIAL HCO3) YOU NEED TO DO WHAT TO COMPENSATE
SINCE THE COMPENSATING FACTOR WILL BE THE OPP (RESP OR CO2) YOU NEED TO HYPOVENTILATE
237
IF STARTING HCO3 IS TOO LOW, YOU NEED TO DO WHAT TO COMPENSATE
HYPERVENT
238
TO INCREASE CO2 YOU ___ VENTILATE
HYPO
239
TO DECREASE CO2 YOU ---- VENTILATE
HYPER
240
so long story short, if it's a resp prob something will occur where
at kidneys
241
long story short, if it's a metabolic prob, something will occur
at lungs (hypo or hypervent)
242
volume of inspired air OR volume of expired air with each breath
TV
243
RV almost ___ with age
doubles (amt that is left after an expiration)
244
What is it called when normal TV is exceeded (inhale or exhale)
inspiratory reserve volume - TV plus more
| expiratory reserve volume - TV plus more
245
Does TLC change with aging
no
246
IC or inspiratory capacity is made of
IRV + TV (inspiratory reserve plus TV)
247
Amount of air remaining in the lungs after a normal full exhalation (exhalation version of IC)
functional residual capacity
248
What is VC (or vital capacity)
IRV + ERV + TV
249
What makes up TLC
RV +IRV +ERV+TV
250
The max that lungs can expand is
TLC
251
what happens during ex with lung volume
As exercise begins, tidal volume increases initially followed by an increase in breathing frequency.
252
What makes min ventilation
TV x freq
253
maximal total amount of air that can be forced out following a maximal inspiration.
FVC (forced vital capacity)
254
VC (amt that can be exhaled) and FVC won't be the same for what pts
emphysema
255
amt of air that can forcefully be exhaled in a matter of sec is
FEV
256
normal FEV1 is
75% (you should be able to blow out 75% of your air in 1 sec)
257
normal FEV3
90% (you should be able to blow out 90% of your air in 3 sec)
258
what 2 main things will increase with an obstructive lung disease
RV, TLC
259
how to find METS
VO2 max/3.5
260
pts should be able to do ___% of VO2 max for an 8 hour work day
40% (so take .40 times the predicted and this gives VO2 Max)
261
For FEV, you should be able to do ___ % of your predicted for your age
80-100%
262
posterior thoracatomy goes through what muscles
traps, rhomboids, lats
263
anterior thoracatomy goes throu
(pec major and serratus) not as common
264
most freq used method of approach for cardiac surg
sternal
265
what is a carotid endodarectomy
incision in to one of the carotids to check pressure to see level of blockage
266
if 4 things are listed regarding ABG, what are they and what order
pH/PaCO2/PaO2/HCO3
267
is cyanosis a reliable sign to check for resp distress
no, it could be other things
268
increased a-a gradient is what kind of pathology
lung
269
how to determine bradycardia or tachycardia
look at number of boxes (big box method)
270
is PAC an emergency
no, only if there are more than 9 in 1 min do you need to notify doc
271
transmural MI (1st sign)
ST elevation
272
subendo MI you see
ST depression
273
when else may you see ST depression
during ex (ischemia - will return t normal)
274
first degree from second rom 3rd HB
1st- every p will have a qrs and there will be a pattern
2nd - p's will be without qrs's and no pattern
3rd- p's and t's will start to blend into one bumpity bump
275
4 main ways to tackle plaque (surgically)
PTCA
Stent
arthroectomy
laser
276
pacemaker vs ICD (uses)
pacemaker-SSS, heart transplant, HB, CHF
| ICD-emergencies (VTAC, VFIB)
277
In order to qualify for a pressure support vent , the pt must
be able to have some efforts to breathe
278
modes of ventlators
```
ACV-assisted control vent
SIMV- Synchronized interm. mandatory
Pressure support
CPAP
BIPAP
```
