ECG

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Author:
flucas
ID:
301641
Filename:
ECG
Updated:
2015-04-27 18:41:13
Tags:
ECG electrophysiology
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Description:
ECG basics
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  1. normal PR interval:
    0.12-0.20 seconds = 3 - 5 small boxes = less than 1 big box
  2. normal QRS interval
    less than 0.12 seconds = less than 3 small boxes
  3. What basic cardiac conduction dysfunction can cause a prolonged PR interval?
    • conduction block
    • e.g. AV block
  4. What basic cardiac conduction dysfunction can cause a shortened PR interval?
    • "short circuit": bypass AV node with aberrant pathway between atria and ventricles
    • e.g. WPW
  5. What is the basic cardiac conduction dysfunction that causes a prolonged QRS?
    • ventricular rhythm = rhythm originates in ventricles and not AV/His/Purkinje system
    • e.g. His-Purkinje block
    • e.g. aberrant pathway: WPW
  6. What are the "shockable" and "non-shockable" ACLS cardiac arrest rhythms?
    • shockable: VF and pulseless VT
    • non-shockable: asystole and PEA
  7. What are the cardiac arrest rhythms?
    PULSELESS rhythms: VF, pulseless VT, PEA, asystole
  8. What is the 1st ACLS IV/IO drug for cardiac arrest rhythms?
    • adult: 1mg epinephrine
    • kid: 0.01mg/kg epinephrine
  9. What are the antiarrhythmic drugs for VFib?
    • Amiodarone 300mg (kid = 5mg/kg)
    • Magnesium 2g
    • Lignocaine 1.5mg/kg
  10. What antiarrhythmic drug do you use for VT?
    • monomorphic VT: Amiodarone 300mg (kid = 5mg/kg)
    • polymorphic VT (Torsades de Pointes) = Magnesium 2mg
  11. Do you "shock" all people with VT?
    No: must be ARREST rhythm with PULSELESS VT
  12. What cardiac rhythms make up PEA?
    • any cardiac rhythm except VFib, VT, and asystole
    • = any rhythm that does not cause perfusion/pulse
  13. What are the most common causes of PEA?
    • 5 H's and 5 T's:
    • Hypoxia
    • Hypovolemia
    • Hypothermia
    • Hypo/hyper-kalemia
    • Hypoglycemia
    • Hydrogen ions (acidosis)
    • Toxins
    • Tension Pneumothorax
    • Tamponade (cardiac)
    • Thrombosis (coronary)
    • Thrombosis (pulmonary)
    • Trauma
  14. What are Supraventricular Tachycardias?
    • = tachycardia with narrow QRS = originates in atrial nodes
    • AFib
    • A flutter
    • re-entry SVT (AV re-entry tachycardia)
    • junctional tachycardia
    • multifocal atrial tachycardia
    • sinus tachycardia
  15. What is the max conductance of the AV node?
    ~200 beat/min
  16. What are common AV node blocking agents? What are they used for?
    • = beta blockers, CCB, digoxin (adenosine, vagal manuevers)
    • used for rate control with AFib
    • DO NOT USE with WPW/accessory pathway arrhythmias
  17. What are the vagal maneuvers and what are they used for?
    • used to treat SVT; increases AV node blockage
    • = carotid sinus massage (10-15s)
    • = valsalva maneuver (10s)
    • = icepack to face (20-30s)
  18. What population do you want to avoid using adenosine? Why?
    • asthmatics
    • adenosine can cause bronchoconstriction
  19. How do you use adenosine?
    • used for transient AV node blockage¬†
    • used to try to terminate re-entry circuit
    • short half life (5-10s)
    • must use rapidly with bolus through large bore IV and immediately flushed with 20-30mL NS
  20. What are typical features of re-entry SVT in kids compared to sinus tachycardia?
    • faster rate (>220 in infants; >180 in kids)
    • does not vary with level of activity
    • has no P-waves
    • has no prodrome of illness

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