Electrocardiography 2

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Electrocardiography 2
2012-09-23 21:05:18
Clinical Practice ll

Clinical Practice ll
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  1. How big are the small squares?  Large squares?
    • small squares:  1 mm
    • large squares:  5 mm
  2. What do we measure in an EKG?
    • amplitude (height)
    • duration (length)
  3. What are we looking for when we are looking at an EKG?
    • heart rate
    • heart rhythm
    • consistency
  4. What are we looking for when we are analyzing the heart rate?
    • normal
    • bradycardia
    • tachycardia
  5. 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
  6. If our speed is set at 25 mm/sec then how many squares are there in 6 seconds?
    150 small or 30 large
  7. If our speed is set at 50 mm/sec, then how many squares are there in 6 seconds?
    300 small or 60 large
  8. What are we looking for with heart rhythm on an EKG?
    regular or irregular
  9. 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
  10. 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
  11. What are the different artifacts we see on an EKG?
    • sixty - cycle interference
    • wandering baseline
    • motion artifacts - muscle tremors
  12. What is the 60 cycle interference?
    electrical interference pattern that occurs when electrical equipment is not properly grounded
  13. 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 
  14. What does 60 cycle interference look like on an EKG?
    regular saw-tooth effect
  15. What is a wandering baseline?
    respiratory artifact caused by changes in resistance between electrode and patient
  16. What causes a wandering baseline?
    the patient panting or deep breathing
  17. What is the muscle tremors artifact?  And what causes it?
    • rapid, irregular, erratic tracings
    • movement of the patient
  18. What are different normal EKG rhythms?
    • sinus rhythm
    • respiratory sinus arrhythmia
    • wandering pacemaker
  19. 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
  20. What animal is a respiratory sinus arrhythmia normal in?
  21. What causes a respiratory sinus arrhythmia?
    caused by changes in vagal tone during respiration
  22. What does a respiratory sinus arrhythmia sound/look like?
    • as animal inhales, heart rate increases
    • as animal exhales, heart rate decreases
  23. What does a wandering pacemaker look like?
    P waves varies - different sized and shapes
  24. What causes a wandering pacemaker?
    caused by pacemaker site shifting within the SA node
  25. What are some common problems detectable on an EKG?
    • PVCs
    • escape beats
    • atrial fibrillation
    • ventricular fibrillation
    • cardiac arrest
    • heart enlargement
    • potassium disturbances
  26. What does PVC stands for?
    • premature ventricular contractions
    • or VPC - ventricular premature contractions
  27. What does a PVC look like?
    wide, bizarre ventricular beat
  28. What causes a PVC?
    • coming a little too soon in the rhythm
    • not associated with a P wave
  29. What can a PVC mean?
    too deep in anesthesia
  30. What is an escape beat?
    ventricular beat coming too late
  31. When does an escape beat occur?
    • after a brief pause in the regular rhythm
    • may occur if the SA node fails to depolarize
  32. When an escape beat originates in the AV node, what does the EKG look like?
    looks like a relatively normal QRS complex
  33. If an escape beat originates in the ventricles, what does the EKG look like?
    wide, bizarre QRS - looks like a PVC, but late
  34. What is atrial fibrillation?
    rapid, uncontrolled atrial activity
  35. 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
  36. Why do the QRS complexes occur rapidly during atrial fibrillation?
    because the AV node is continuously being bombarded by impulses from the atria
  37. What is the outcome of an atrial fibrillation?
    decreased cardiac output
  38. 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
  39. What do we usually have to do to a patient with ventricular fibrillation?
  40. What does cardiac arrest look like on an EKG?
    straight line with some bizarre electrical activity
  41. What does the patient look like in cardiac arrest?
    • unconscious
    • cyanotic
    • respiratory arrest or agonal breaths
    • fixed dilated pupils
    • no detectable pulse or heartbeat
  42. Which lead can we see a heart enlargement?
    lead ll
  43. What does a right atrial enlargement look like on an EKG?
    P waves are taller than normal, spiked
  44. What does a left atrial enlargement look like on an EKG?
    P waves wider than normal, may be notched
  45. What does a left ventricular enlargement look like?
    R waves are taller than normal, S-T coving
  46. What does a right ventricular enlargement look like?
    axis shift, multiple vague criteria
  47. What are the different potassium disturbanced detectable on an EKG?
    • hyperkalemia
    • hypokalemia
  48. What does hyperkalemia look like on an EKG?
    tall peaked T waves, flattened P waves
  49. What can be associated with hyperkalemia?
    • Addison's disease
    • decreased renal excretion
    • metabolic acidosis
  50. What does hypokalemia look like on an EKG?
    small biphasic T waves
  51. What can be assoicated with hypokalemia?
    • GI or urinary loss of potassium
    • excessive diuresis
    • possible metabolic alkalosis