EKG

  1. What are chronotropes
    drugs that impact impulse 

    • (+)hr ex. epinephrine
    • (-) hr ex. digoxin
  2. P wave represents the
    length
    If the problem is in the P wave the problem is in the atria 

    should be less than 0.11
  3. QRS represents 

    length
    QRS= ventricular depolarization ( stimulation) 

    should be less than 0.12 sec
  4. T represents
    ventricular repolarization ( relax)
  5. U represents
    the repolarization of Purkinje fibers

    • - hypokalemia
    • -HTN
  6. PR represents

    and the normal time
    time needed for the SA node to be stimulated ( atrial depolarization) and the conduction to AV node before ventricular depolarization 

    .12-.20 ( if its longer = heart block) 

    really should be called PQ
  7. ST represents
    ventricular repolarization 

    2+ blocks above= MI
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    Normal Sinus Rhythm 

    - keep assessing
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    NSR but 60bpm

    Give atropene ( to speed up the hr) 

    0.5-1mg q3-5min 3mg total
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    rate 100-150bpm

    might lose a P wave 

    • cause: anxiety, fear, bleeding 
    • treatment: metoprolol ( beta blocker)
  11. What to do for dysrhythmias?
    O- MI

    oxygen, monitor, IV
  12. When to defib? what to make sure of?
    • Defib the Vfib and pulseless V-tach 
    • - in an emergency ( no pulse)

    start at 120J ( biphase)

    - Not in sync mode
  13. What is cardioversion?
    Sync with QRS
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    Sinus arrhythmia 

    Normal except the PP, and RR intervals are irregular 

    if no hemodynamics are effects = dont treat
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    Premature atrial contractions 

    • Rhythm=irregular the P can be early 
    • ( atria beats 2x before the ventricle picks up the contraction) 

    Need full minute strip 

    if its less than 6PAC/min dont treat
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    Atrial fibrillation

    • ALWAYS irregular ( NO PR) 
    • -atria is asynchronous with ventricle --> blood pools ( stroke risk) 

    Atrial rate 300-600

    acute:

    • - Ca+ channel blocker diltiazem 
    •      - push 10-20mg 
    •      -drip 5-10 mg/hr

    • - Check TEE is (-) then cardiovert 
    • - give digoxin while waiting 

    chronic: give warfarin and monitor INR
  17. A flutter
    Atrial Flutter

    • P waves: saw tooth
    • No PR

    • 1) Md do vagal maneuver
    • 2) adenosine ( slows AV node) 
    •       - will cause asystole 
    • give 6mg, 12mg, 12mg then 20ml saline flush
  18. PVC
    Premature ventricular contraction 

    Extra impulse in the ventricle 

    cause: dig toxicity(2+), nicotine, caffeine

    More than 6PVC/min= get MD, on the T wave side 

    • amiodarone
    • 150mg/10 min
    • 1mg/min 6hr
    • 0.5 mg/min 18 hr 

    monitor lungs, bp, thyroid
  19. Bigeminy

    trigeminy
    Bigeminy: every other beat is a PVC ---> emergency about to go to v tach 

    Trigeminy: every 3rd beat 

    - give lidocaine if amiodarone is not available
  20. Couplet + triplet
    Couplet + triplet 

    • 2PVC in a row = couplet
    • 3 PVC in a row = v tach--> triplet 

    Emergency give amiodarone
  21. Unifocal ,multifocal
    unifocal : PVC 1 area of vent


    multifocal PVC 2 area of the ventricle
  22. Junctional
    Junctional Rhythm 

    • AV node takes over as the pacemaker 
    • - Absent/ inverted P wave 

    • Give atropene 
    • 0.5-1mg q3-5min 3mg total 

    If atropene doesnt work do defib
  23. SVT
    • Supraventricular Tachycardia 
    • Sudden 150-200 bpm 

    • Narrow complex 
    • - No P wave, PR not measurable 

    cause: underlying rhythm afib, aflutter 

    Treat:

    check hemodynamics if unstable cardiovert 

    stable: vagal , adenosine 6,12,12 , betablocker
  24. Vtach
    Vtach 

    • wide complex >.12 sec 
    • P waves buried 100-200

    1) check carotid, femoral 

    • Vtach + pulse, hemodynamically stable
    • - amiodarone
    • load 150 mg over 10 min
    • 1mg/min 6hrs
    • .5mg/min

    • Lidocaine 1-1.5mg/kg IV 2-3min
    •                1-2mg/min 

    toxicity SAMS ( slurred speech, seizure, muscle twitch) 

    • Hemodynamically unstable 
    • - cardiovert or defib?--look up
    • -Epi q3-5min 1mg IVP
    • -amiodarone
    • 150mg over 10min 1mg/min 6 hr, .5/min 18hr 

    Check for reversible causes
  25. Drugs that can go down an ET tube if there is no IV access
    NAVEL

    • Narcan
    • Atropine
    • Vasopressin
    • Epinephrine
    • Lidocaine
  26. H's + T's
    • Hypovolemia
    • Hypoxia
    • Hydrogen
    • Hypothermia
    • Hypokalemia
    • Hyperkalemia ( 10U insulin, sodium bicarb, D50W)

    • Tension pneumothorax- need compress 2nd mid
    • Tamponade- pericardiocentesis
    • Toxins
    • Thrombosis pulmonary/coronary
  27. Ventricular Fibrillation
    • V fib
    • - pulseless 
    • - CO=0 

    • Defibrilate q2min
    • -Epi q3-5min 1 mg 
    • -Amiodarone - load 150mg/10min                                     1mg/min 6hr                                              .5mg/min 18hr 

    Look for Hs, Ts
  28. Asystole
    Asystole 

    CPR NOT Defib

    • Epi: 1mg IVP q3-5min
    • Must confirm asystole in 2+ leads= death

    Reversible causes H's+T's
  29. no pulse
    PEA 

    • Mimics NSR but no pulse ( hearts not pumping but the electrical work is) 
    • CPR
    • epi 1mg IVP q3-5min 
    • NO atropine

    H's + T's ( usually hypovolemia)
  30. Torsades
    Torsades de Pointes 

    Mg deficiency --< give 1-2g Mg IVP
  31. ROSC
    ROSC

    Pulse is back post CPR

    • low bp: Ise 1-2L of lactage ringers, or NS
    • if it doesnt work start vasopressor
  32. Idioventricular or Ventricular escape rhythm
    idioventricular or ventricular escape rhythm 

    • impulse starts below the AV node 
    • vent 20-40 
    • 40+ = accelerated junctional rhythm 

    Treat

    • CPR
    • Epi 1mg q3-5min
    • NO atropine
  33. v standstill
    Ventricular standstill 

    atria is firing but no ventricle response 


    CPR  no pulse + Epi
  34. 1st degree
    • 1st degree AV Block 
    • PR prolonged 

    atropene .5-1mg
  35. 2nd degree AV Block, Wenckebach, Mobitz Type 1
    • 2nd degree AV Block, Wenckebach, Mobitz Type 1 
    • irregular
    • More P than QRS
    • progressive PR it widens until its drops

    - atropene
  36. 2nd Degree AV block Mobitz type 2
    2nd Degree AV block Mobitz type 2 

    more P> QRS , QRS=abnormal 


    • about to get pacemaker 
    • no atropene
  37. 3rd degree AV block , complete heart block
    3rd degree AV block , complete heart block 


    must get pacemaker
  38. Whats failure to capture?
    fired at the right time

    hearts not responding
  39. Failure to sense
    fired spikes at the wrong time
  40. 3 stages of shock
    1) Compensatory : HR goes up, BP norm 

    - cool skin 

    2) Progressive: Bp goes down, organs suffer 

    • 3) Irreversible 
    • bp down, hr up MOD= 2+ org fail
Author
skuper4
ID
341441
Card Set
EKG
Description
EKG rhythm and what to do
Updated