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The activity on an EKG represents _____ of the myocardium.
electrical activity
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When the myocardium is stimulated the muscle _____.
contracts
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In the resting state the myocardial cells are _____.
polarized
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In the resting state the interior of the myocardial cells are _____ charged.
negatively
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During depolarization the interior of the cell becomes _____ charged and the muscles _____.
positively, contract
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The dominant pacemaker site in the heart is the _____.
SA node
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The SA node is able to pace the heart through the process of _____.
automaticity
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The P wave represents the depolarization of the _____.
atria
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Ventricular repolarization occurs during the _____.
T wave
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A big box on EKG paper has _____ small sqaures inside.
5
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The time frame represented by one big box is
0.20 seconds
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The leads placed on the right and left arm are called _____.
limb leads
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Lead one shoots from _____.
left to right, straight across
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Measurements on ekg paper are calibrated in _____.
millimeters
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Deflections on the ekg paper are actually a measurement of _____.
voltage
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How will an EKG tell you if you have a high potasium level?
spiked T wave
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Normal Axis
- Lead 1: up
- Lead 2: up
- Lead 3: up
- Note:
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Physiological Left Axis
- Lead 1: up
- Lead 2: up or up down
- Lead 3: down
- Note:
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Pathological Left Axis
- Lead 1: up
- Lead 2: down
- Lead 3: down
- Note: anterior hemiblock
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Right Axis
- Lead 1: down
- Lead 2: up
- Lead 3: up
- Note: posterior hemiblock
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Extreme Right Axis
- Lead 1: down
- Lead 2: down
- Lead 3: down
- Note: ventricular in orion?
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Normal Sinus Rhythm
- Rate: 60 to 100 (atrial = ventricular)
- Rhythm: R-R intervals constant; regular
- P Wave: uniform. 1 P Wave in front of every QRS
- PRI: 0.12 - 0.20 seconds & constant
- QRS: < 0.12 seconds
- S-T Segment: neither elevated or depressed
- T Waves: usually slightly rounded and asymmetrical: T wave is less than 1/2 the height of the QRS
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Sinus Arrhythmia
- Rate: usually 60 to 100, can be slower (atrial = ventricular)
- Rhythm: R-R intervals vary; slightly irregular
- P Wave: uniform. 1 P Wave in front of every QRS
- PRI: 0.12 - 0.20 seconds & constant
- QRS: < 0.12 seconds
- S-T Segment: neither elevated or depressed
- T Waves: usually slightly rounded and asymmetrical: T wave is less than 1/2 the height of the QRS
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Wandering Atrial Pacemaker
- Rate: usually 60 to 100, can be slower (atrial = ventricular)
- Rhythm: R-R intervals vary as the pacemaker site changes; can be slightly irregular
- P Wave: morphology of P waves changes as the pacemaker site changes. 1 P wave in front of every QRS complex. some P waves may be difficult to see, depending on the pacemaker site.
- PRI: PRI measurement will vary slightly as the pacemaker site changed. should be 0.12 - 0.20 seconds. some may be < 0.12.
- QRS: < 0.12 seconds
- S-T Segment: neither elevated or depressed
- T Waves: usually slightly rounded and asymmetrical: T wave is less than 1/2 the height of the QRS
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CBC Rule of 5's
- Red Blood Count (RBC) = 5
- Hemoglobin (HBg) = 15
- Hematocrit (Hematocrit) = 45
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H&H
- ...............HBg....................
- WBC >------------<Platlets
- ................Hct.....................
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Hemoglobin
- Amount of hemoglobin in a standardized sample of uncoagulated blood.
- Evaluates:
- 1. anemia
- 2. blood loss
- 3. volume replacement
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Hematocrit
- The percentage of red blood cells in circulation.
- Evaluates:
- 1. anemia
- 2. hydration
- 3. fluid balances/loss/replacement
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Red Blood Count
Number of red blood cells per microliter.
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Erythropoietin (EPO)
hormone produced by the kidneys that promotes the formation of red blood cells in the bone marrow
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White Blood Count (WBC)
- determines the number of leukocytes per microliter
- Normal Values 4,000 to 10,000 cells/mcl
- Evaluates:
- 1. infection
- 2. inflammatory response
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Precordial Leads
- V1 - right of sternum, 4th intercostal space
- V2 - left of sternum, 4th intercostal space
- V3 - 5th rib, between V2 & V4
- V4 - 5th intercostal space, midclavicular
- V5 - 5th intercostal space, anterior axillary
- V6 - 5th intercostal space, midaxillary
- V4R - 5th intercostal space, midclavicular Right Side
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You want to give PANCURONIUM when and why? What is the pedi dose (with route)?
Also know as Pavulon, a nondepolaring neuromuscular blocker. It is used to facilitate endotracheal intubation. The pedi dose is the same as the adult dose, 0.04 to 0.1 mg/kg IV.
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Transcutaneous Cardiac Pacing
- Use if pharma has no effect & pt is hypotensive of hypoperfusing. Consider an analgesic prior or during.
- 1. initiate IV, O2 & ECG
- 2. place pt suppine
- 3. confirm symptomatic bradycardia & confirm medical direction order for TCP
- 4. apply pacing electrodes
- 5. connect electrodes
- 6. set desired heart rate on pacemaker (typically 60/60)
- [adhock]
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Symptomatic Bradycardia Drugs
- 1) ATROPINE 0.50 mg IV q 3-5 min, max 3mg
- 2) DOPAMINE 5-20 mcg/kg/min
- 3) EPINIPHRINE 2-10 mcg/min
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Tachycardia: Narrow Complex Drugs
- 1) ADENOSINE 6/12/12 rapid w/ flush
- other considerations...
- 1) AMIODARONE 150 mg slow IV (15mg/min)
- 2) PROCAINAMIDE 20-30 mg/min/IV
- 3) DILTIAZEM 0.25 mg/kg slow IV or VERAPAMIL 2.5 mg slow IV if NO WPW/Hypotension
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Hs (Hs & Ts)
- 1) hypovolemia
- 2) hypoxia
- 3) hydrogen ion
- 4) hyper/hypo-kalemia
- 5) hypothermia
- 6) hypo/hyper-glycemia
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Ts (Hs & Ts)
- 1) tablets/toxins
- 2) cardiac tamponade
- 3) tension pneumo
- 4) tamponade (AMI)
- 5) thromboembolism
- 6) trauma
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3rd Degree Heart Block
- 1) RATE: atrial normal, ventrical Brady
- 2) RHYTHM: Regular P-P and R-R since firing independently
- 3) P WAVE: more P than QRS
- 4) PRI: varies. no association P to QRS
- 5) S-T: neither elevated or depressed
- 6) T WAVE: normal - usually slightly rounded & assymetrical; < 1/2 the height of the QRS
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Depolarization of the ventricles is represented on the EKG strip by the...
T wave.
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Normal QRS Complex
< .012 seconds
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Normal PRI
between 0.12 & 0.20 seconds & constant
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AVR, AVL & AVF are known as ________ leads.
augmented or unipolar
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AVL looks at...
high lateral wall.
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What are the coronary ateries for each lead?
All of the leads are supplied by the LCA except for those that look at the Inferior wall ( 2, 3 & AVF) & they are supplied by the RCA.
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How can you tell if you have a Trycyclic OD?
AVR will will have large R waves.
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some Neurotransmitters
- 1. GABA
- 2. Dopamine
- 3. Norepinephrine
- 4. Epinephrine
- 5. Histamine
- 6. Serotonin
- 7. Acetylcholine
- 8. Adenosine
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How can you identify Pericarditis on an EKG?
ST elevation will be present in almost every lead
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