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How big are the small squares? Large squares?
- small squares: 1 mm
- large squares: 5 mm
What do we measure in an EKG?
- amplitude (height)
- duration (length)
What are we looking for when we are looking at an EKG?
- heart rate
- heart rhythm
What are we looking for when we are analyzing the heart rate?
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
If our speed is set at 25 mm/sec then how many squares are there in 6 seconds?
150 small or 30 large
If our speed is set at 50 mm/sec, then how many squares are there in 6 seconds?
300 small or 60 large
What are we looking for with heart rhythm on an EKG?
regular or irregular
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
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
What are the different artifacts we see on an EKG?
- sixty - cycle interference
- wandering baseline
- motion artifacts - muscle tremors
What is the 60 cycle interference?
electrical interference pattern that occurs when electrical equipment is not properly grounded
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
What does 60 cycle interference look like on an EKG?
regular saw-tooth effect
What is a wandering baseline?
respiratory artifact caused by changes in resistance between electrode and patient
What causes a wandering baseline?
the patient panting or deep breathing
What is the muscle tremors artifact? And what causes it?
- rapid, irregular, erratic tracings
- movement of the patient
What are different normal EKG rhythms?
- sinus rhythm
- respiratory sinus arrhythmia
- wandering pacemaker
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
What animal is a respiratory sinus arrhythmia normal in?
What causes a respiratory sinus arrhythmia?
caused by changes in vagal tone during respiration
What does a respiratory sinus arrhythmia sound/look like?
- as animal inhales, heart rate increases
- as animal exhales, heart rate decreases
What does a wandering pacemaker look like?
P waves varies - different sized and shapes
What causes a wandering pacemaker?
caused by pacemaker site shifting within the SA node
What are some common problems detectable on an EKG?
- escape beats
- atrial fibrillation
- ventricular fibrillation
- cardiac arrest
- heart enlargement
- potassium disturbances
What does PVC stands for?
- premature ventricular contractions
- or VPC - ventricular premature contractions
What does a PVC look like?
wide, bizarre ventricular beat
What causes a PVC?
- coming a little too soon in the rhythm
- not associated with a P wave
What can a PVC mean?
too deep in anesthesia
What is an escape beat?
ventricular beat coming too late
When does an escape beat occur?
- after a brief pause in the regular rhythm
- may occur if the SA node fails to depolarize
When an escape beat originates in the AV node, what does the EKG look like?
looks like a relatively normal QRS complex
If an escape beat originates in the ventricles, what does the EKG look like?
wide, bizarre QRS - looks like a PVC, but late
What is atrial fibrillation?
rapid, uncontrolled atrial activity
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
Why do the QRS complexes occur rapidly during atrial fibrillation?
because the AV node is continuously being bombarded by impulses from the atria
What is the outcome of an atrial fibrillation?
decreased cardiac output
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
What do we usually have to do to a patient with ventricular fibrillation?
What does cardiac arrest look like on an EKG?
straight line with some bizarre electrical activity
What does the patient look like in cardiac arrest?
- respiratory arrest or agonal breaths
- fixed dilated pupils
- no detectable pulse or heartbeat
Which lead can we see a heart enlargement?
What does a right atrial enlargement look like on an EKG?
P waves are taller than normal, spiked
What does a left atrial enlargement look like on an EKG?
P waves wider than normal, may be notched
What does a left ventricular enlargement look like?
R waves are taller than normal, S-T coving
What does a right ventricular enlargement look like?
axis shift, multiple vague criteria
What are the different potassium disturbanced detectable on an EKG?
What does hyperkalemia look like on an EKG?
tall peaked T waves, flattened P waves
What can be associated with hyperkalemia?
- Addison's disease
- decreased renal excretion
- metabolic acidosis
What does hypokalemia look like on an EKG?
small biphasic T waves
What can be assoicated with hypokalemia?
- GI or urinary loss of potassium
- excessive diuresis
- possible metabolic alkalosis