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How big are the small squares? Large squares?
- small squares: 1 mm
- large squares: 5 mm
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What do we measure in an EKG?
- amplitude (height)
- duration (length)
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What are we looking for when we are looking at an EKG?
- heart rate
- heart rhythm
- consistency
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What are we looking for when we are analyzing the heart rate?
- normal
- bradycardia
- tachycardia
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How do we analyze the heart rate on an EKG?
count how many R waves occur in 6 seconds then multiply by 10 to get beats per minute
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If our speed is set at 25 mm/sec then how many squares are there in 6 seconds?
150 small or 30 large
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If our speed is set at 50 mm/sec, then how many squares are there in 6 seconds?
300 small or 60 large
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What are we looking for with heart rhythm on an EKG?
regular or irregular
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What should a reqular heart rhythm look like on an EKG?
- one P for each QRS, and one QRS for each P
- all complexes shoul occur at the same intervals
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What kind of consistency do we look at in an EKG?
- do all P waves look like each other
- do all QRS complexes look like each other
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What are the different artifacts we see on an EKG?
- sixty - cycle interference
- wandering baseline
- motion artifacts - muscle tremors
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What is the 60 cycle interference?
electrical interference pattern that occurs when electrical equipment is not properly grounded
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How do we prevent 60 cycle interferences?
- use properly grounded powercord
- make sure clips are clean, securely attached to cable, and properly attached to patient
- unplug other appliances on the circuit
- turn off fluorescent lights
- hold patient's legs properly - not touching each other
- make sure cables are not touching the table, or the person holding the patient
- cover the table with a towel or rubber mat
- move to another room
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What does 60 cycle interference look like on an EKG?
regular saw-tooth effect
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What is a wandering baseline?
respiratory artifact caused by changes in resistance between electrode and patient
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What causes a wandering baseline?
the patient panting or deep breathing
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What is the muscle tremors artifact? And what causes it?
- rapid, irregular, erratic tracings
- movement of the patient
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What are different normal EKG rhythms?
- sinus rhythm
- respiratory sinus arrhythmia
- wandering pacemaker
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What does a sinus rhythm look like on an EKG?
- P wave for every QRS, and QRS for every P wave
- regular rhythm
- normal rate
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What animal is a respiratory sinus arrhythmia normal in?
dog
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What causes a respiratory sinus arrhythmia?
caused by changes in vagal tone during respiration
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What does a respiratory sinus arrhythmia sound/look like?
- as animal inhales, heart rate increases
- as animal exhales, heart rate decreases
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What does a wandering pacemaker look like?
P waves varies - different sized and shapes
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What causes a wandering pacemaker?
caused by pacemaker site shifting within the SA node
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What are some common problems detectable on an EKG?
- PVCs
- escape beats
- atrial fibrillation
- ventricular fibrillation
- cardiac arrest
- heart enlargement
- potassium disturbances
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What does PVC stands for?
- premature ventricular contractions
- or VPC - ventricular premature contractions
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What does a PVC look like?
wide, bizarre ventricular beat
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What causes a PVC?
- coming a little too soon in the rhythm
- not associated with a P wave
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What can a PVC mean?
too deep in anesthesia
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What is an escape beat?
ventricular beat coming too late
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When does an escape beat occur?
- after a brief pause in the regular rhythm
- may occur if the SA node fails to depolarize
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When an escape beat originates in the AV node, what does the EKG look like?
looks like a relatively normal QRS complex
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If an escape beat originates in the ventricles, what does the EKG look like?
wide, bizarre QRS - looks like a PVC, but late
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What is atrial fibrillation?
rapid, uncontrolled atrial activity
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What does atrial fibrillation look like on an EKG?
- P waves are not detectable on EKG
- relatively normal QRS complexes occur at a rapid rate
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Why do the QRS complexes occur rapidly during atrial fibrillation?
because the AV node is continuously being bombarded by impulses from the atria
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What is the outcome of an atrial fibrillation?
decreased cardiac output
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What does ventricular fibrillation look like on an EKG?
- no coordinated pattern present
- jagged, irregular baseline undulations
- P waves, QRS complexes, and T waves are absent
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What do we usually have to do to a patient with ventricular fibrillation?
CPR
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What does cardiac arrest look like on an EKG?
straight line with some bizarre electrical activity
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What does the patient look like in cardiac arrest?
- unconscious
- cyanotic
- respiratory arrest or agonal breaths
- fixed dilated pupils
- no detectable pulse or heartbeat
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Which lead can we see a heart enlargement?
lead ll
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What does a right atrial enlargement look like on an EKG?
P waves are taller than normal, spiked
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What does a left atrial enlargement look like on an EKG?
P waves wider than normal, may be notched
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What does a left ventricular enlargement look like?
R waves are taller than normal, S-T coving
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What does a right ventricular enlargement look like?
axis shift, multiple vague criteria
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What are the different potassium disturbanced detectable on an EKG?
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What does hyperkalemia look like on an EKG?
tall peaked T waves, flattened P waves
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What can be associated with hyperkalemia?
- Addison's disease
- decreased renal excretion
- metabolic acidosis
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What does hypokalemia look like on an EKG?
small biphasic T waves
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What can be assoicated with hypokalemia?
- GI or urinary loss of potassium
- excessive diuresis
- possible metabolic alkalosis
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