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Where to put EKG pads
- Smoke over Fire (LEFT)
- Clouds over Grass (RIGHT)
- Brown anywhere
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Heart Block indicates a problem with the ____
AV node
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Least Serious Degree of Heart Block
1st degree
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Slightly Injured/Ischemic AV node, Longer PR interval, Anything >.20
First degree heart block
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When do you treat first degree heart block
when there are s/s of decreased cardiac output (bradycardia) but otherwise leave untreated
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EKG changes in 1st Degree Heart block
Upright P wave followed by QRS complex, PRI greater than .20 seconds (constantly)
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1st type of Second Degree Heart Block
Wenckebach
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EKG changes for Wenckebach (1st type of 2nd degree Heart Block)
Upright, some P waves not followed by QRS, PRI progressively lengthens until a P wave is not conducted anymore
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Second Type of 2nd Degree Heart Block
"Classical"... "Mobitz II"
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Any time you see an extra P wave, measure :
EVERY PR INTERVAL
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When the AV node is injured, it does not let every impulse get through...sometimes it takes 2 P waves (or more) before QRS is created
Mobitz II (2nd degree)
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How will you tell Mobitz II or Classical Second Degree Heart Block apart from others
- Every PR interval is exactly the same
- Too many P waves without QRS complex
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A patient with Classical Second Degree Heart Block with Prolonged PRI is likely to have what kind of HR
Bradycardic (40s)
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Like a cement wall, NOTHING goes from atria to ventricles (2 pacemaker sites)
Complete Heart Block
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EKG characteristics of a complete heart block
Rate of 60-100, more P waves than QRS, no relationship between P waves and QRS, QRS >.12 if ventricular, <.12 if junctional
*Every PR interval you measure will be different
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PR Intervals for types of Heart Blocks
1st- Greater than .20 seconds constant
Wen- Increas. longer until one P is blocked
2nd- Constant on conducted beats, can be > .20 sec
3rd- PRI not constant no relation of Ps to QRSs (Ps march through)
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Rate/Rhythm of Heart Blocks
- 1st- Usually Regular
- Wen- Irregular
- 2nd- Usually Regular
- 3rd- Regular
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Conduction in Heart Blocks
- 1st- One P for every QRS
- Wen- More than one P for some QRSs
- 2nd- More than one P for every QRS
- 3rd- More Ps than QRS
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