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Phase 2 - Block 2

Phase 2 - Block 2 (cardiology)

horizontal small square measures .04 seconds
horizontal large square measures .20 seconds
vertical small square measures 1 mm
vertical large square measures 5 mm
horizontal axis measures time
vertical axis measures voltage in mm (mV)
Patient should be supine except for COPD or physical deformities
Precordial leads V1-V6
V1, V2 placement lateral to sternum at 4th intercostal space
V3 placement centered between V2 and V4
V4 placement mid-clavicular, 4th intercostal space
V5 placement anterior mid-axillary, 5th intercostal space
V6 placement mid-axillary, 5th intercostal space
Types of artifact somatic tremor
Electrical interference 60 cycle - saw toothed pattern/obscures underlying rhythm
P-R interval normal interval .12 - .20 seconds
P-R represents atrial depolarization
QRS normal interval .04 - .10 seconds
QRS represents ventricular depolarization
U-waves taller than ____ are abnormal 1.5mm
Inverted U-waves typically a sign of ischemic disease
Atrial rate is determined by measuring distance between P waves
Ventricular rate is determined by measuring distance between R waves
Triplicate method R wave on heavy line, next is 300, 150, 100,75, 60, 50.... bpm
6 second method count the number of complexes in a 6 second period (30 large blocks) and multiply by 10 or 3 second period (15 large blocks and multiply by 20)
5 steps to interpret EKGs rate, rhythm, p-wave, PR interval, QRS duration
Treat sinus bradycardia isoproterenol, atropine, pacemaker
Treat sinus tachycardia isoproterenol, atropine, pacemaker
Wandering pacemaker variation of P wave (3 or more)
Sick sinus syndrome several abnormalities; high incidence of lethal arrhythmia
Supraventricular arrhythmia premature atrial contractions (PAC), premature p-waves with different morphology
Treat supraventricular arrhythmia digitalis, beta-blocker, calcium antagonists
Treat A-Flutter (saw tooth) synchronized cardioversion, digitalis, verapamil, beta-blockers
Treat A-Fib anti-coagulant, digitalis, beta-blockers, calcium antagonists, synchronized cardioversion
Treat SVT digitalis, lidocaine, beta-blockers, carotid sinus massage, valslva maneuvers, immerse pt's face in ice water
Treat AV Junctional Escape atropine
Treat WPW cardioversion, digitalis, beta blockers, surgery
Treat Junctional withhold drugs, atropine, pacemakers
Treat AV Block isoproterenol, atropine, pacemaker
Treat PVCs Isoproterenol, atropine, lidocaine, beta blockers
Treat V-tach without hemodynamic decompensation lidocaine, procainamide
Treat V-tach with hemodynamic collapse cardiovert, precordial thump, ventricular pacing
Torsades de Pointes isoproterenol, pacing, anti-arrhythmics
V-fib and V-flutter defibrillation, CPR, lidocaine, procainamide, bretylium, therapy
CPK enzyme elevates in 1-3 hours peaks in 24 hours normal in 3 - 4 days
SGOT enzyme elevates several hours after peaks in 1.5 - 3 days normal in 4-5 days
LDH enzyme elevates 48 hours peaks 4-7 days normal in 2 weeks
Triponin I elevates 4-6 hours peaks 12-16 hours
Created by: hspointon