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SPC Cardio Assess

SPC Cardiopulmonary Assessment Unit 3 & 4

PA film description (standard) Pt standing, xray from back to chest, film against chest
AP film description (portable) Pt lying in bed, xray from chest to back, film under back
Lateral film description Pt sideways, film against R or L lateral chest wall, used to assess LL lesions
Lateral Decubitus film description Pt lies w/ film against affected side, used to assess pleural effusion
Apical Lordotic film description Film against pt's upper back, xray @ 45deg angle from lower anterior chest, used to assess middle & upper lobe lesions
What are the 4 radiographic densities? Air, Fluid, Fat, Bone
What is Radiolucent? Black areas on xray, low density, ie. air
What is Radiopaque? White or grey areas on xray, high density, i.e. fluid, fat, bone
What could a tracheal shift indicate? Pneumothorax
What to look for in the Hilar region? PA engorgement = Cor Pulmonale, Adenopathy = Lymph Node changes
Cardiac silhouette description Heart ratio < 50% size of chest area, R diaphragm 2cm higher than L, C/P Angles (Sulcus) lost w/ pleural effusion
Clavicle position used for: Pt positioning, the vertebrae s/b between the medial ends of the clavicles
Posterior ribs used to: Assess lung volume
Anterior ribs used to: Assess lung volume
At end-inspiration the diaphragm is: Between the 9th - 11th posterior ribs, between the 4th - 6th anterior ribs,
Lower lung volume shows: Whiter lung fields, larger heart shadow
Atelectasis xray description Lobar, tracheal shift toward affected area, hemidiaphragm elevation, narrowed posterior rib spaces, volume loss
Pneumothorax xray description Black hemithorax, lung mass toward Hilum, tracheal shift away from affected area
COPD xray description Narrow tear/pear shaped heart, prominent PAs, low & flat diaphragms, wide posterior rib spaces, horizontal posterior ribs, radiolucent lung fields
Interstitial Disease xray description "Cobbwebs", Honeycombing, diffuse nodules 2-4cm diameter
Cardiogenic Pulmonary Edema (CHF) xray desription Increased heart ratio > 50%, Kerly B lines - prominent in R lung base, blunted C/P Angles - notably on R side, dense fluffy lung field opacities that project out from the Hilar areas that look like a 'batwing' or 'butterfly'
Consolidation xray description Aleolar opacification (white areas), patent air-filled bronchi contrasted against opaque lung tissue
ECG paper runs at what? 25mm/sec or 25 small squares
What axis is the Time interval on? Horizontal
Small Square is = to 0.04 sec
Large Square is = to 0.20 sec
What axis is Voltage on? Vertical
1 millivolt is = to 10 small squares or 2 large squares
What is a Bipolar Lead? Two opposite polarity leads (+ and -)
What is a Unipolar Lead? A positive lead on a limb
What is Positive Deflection? An upward spike, current flow is toward the + electrode
What is Negative Deflection? A downward spike, current flow is away from the + electrode
What is Lead Axis? Refers to the average direction of current flow in the heart
Mean Cardiac Vector Relates both current direction & intensity/magnitude, where current flow is most intense - current flow follows tissue mass
Bipolar Lead I - R arm, + L arm, aka as Limb Leads
Bipolar Lead II - R arm, + L leg
QRS is prominent when Current flow parallels normal depolarization
Bipolar Leads III - L arm, + L leg
Unipolar Leads are also known as Augmented Leads, must be amplified
Unipolar aVr located + R arm
Unipolar aVl located + L arm
Unipolar aVf located + L foot
Precordial Leads V1 & V2 Located at 4th intercostal space next to sternum, view the R ventricle
Precordial Leads V3 - V6 Located at 5th intercostal space just medial of midclavicular line to midaxillary line
Precordial Leads View the heart in a horizontal plane, known as the Chest Leads
Precordial Leads V3 & V4 view The interventricular septum
Precordial Leads V5 & V6 view The left ventricle
What Leads locate the mean cardiac vector? Lead I & aVf
What are the 3 Bipolar Leads called? I, II, III
What are the 3 Unipolar Leads called? aVr, aVl, aVf (a = augmented due to amplication, v = voltage, r = right arm, l = left arm, f = left foot (leg))
What are the 6 Chest or Precordial Leads called? V1, V2, V3, V4, V5, & V6
The normal ECG has how many leads where? Six limb leads examining the heart in the vertical plane and six chest leads examining the heart in the horizontal plane
Normal duration of the P-R interval 0.12 - 0.20 secs or 3 - 5 small blocks/1 large square, >.20 secs = 1deg heart block
Normal duration of the QRS complex 0.06 - 0.10 secs or 1.5 - 2.5 small blocks, >0.12secs = bundle branch block
Normal duration of the Q-T interval 0.36 - 0.44 sec or 9 - 11 small blocks
Normal heart rate Count the large blocks between two consecutive R waves, divide 300 by that number = HR
Axis Deviation occurs When the MCV shifts out of the normal quadrant
Axis Deviation is due to Muscle mass changes (hypertrophy), polarity shift (bundle branch block), tissue dies (infarction), position changes (obesity)
Right axis deviation causes Cor Pulmonale, L ventricular Infarction, Acute pulmonary embolism
Left axis deviation causes R ventricular infarction, L ventricular hypertrophy, obesity
What is the Isoelectric Baseline? Flat line just before the P wave or right after the T wave, used as a zero voltage reference point
What is an ECG segment? Time line between two waves
What is an ECG interval? A wave plus the time to the next wave
Normal S-T interval End of the QRS complex, isoelectric = no electric activity
Elevated or Depressed S-T segment MI, L bundle branch block, pericarditis
Sinus Tachycardia P wave present, RR interval regular, rate > 100/min, will look normal but condensed
Sinus Tachycardia causes Hypoxemia, Xanthines (caffeine), Beta 1 adrenergics
Ventricular Tachycardia No P waves, wide/bizarre QRS complexes >0.12 secs, RR interval is regular, rate 150-250/min
Ventricular Tachycardia tx Lidocaine, synchronized cardioversion, untreated goes to V-Fib
Ventricular Fibrillation Ventricles showing minimal activity - QRS wave rarely over 1 mV, looks like crazy squiggly lines
Ventricular Fibrillation tx Defibrillation (shock)
Atrial Flutter "Sawtooth" P waves, normal QRS complexes, atrial rate 200-300/min, normal ventricular rate, normal RR interval, common w/ pulmonary disease
Atrial Fibrillation No true P waves, atrial rate 350-600/min, ventricular rate normal to > 100/min, irregular RR rate
Atrial Fibrillation tx Synchronized cardioversion
Premature Ventricular Complex Ectopic beat from ventricle, wide/bizarre QRS complexes >0.12sec, disrupted RR interval, common cause-myocardial sichemia
Premature Ventricular Complex tx Lidocaine
Couplet Two PVC's in a row
Salvo Three or more PVC's in a row, more than 30secs = V.Tach,
Salvo tx Lidocaine, synchronized cardioversion
Bigeminy Pattern of two heart beats, commonly involves PVC
Trigeminy Pattern of three heart beats, commonly involves PVC, every 3rd beat is a PVC followed by 2 normal heart beats
AV Blocks An impulse transmission problem between the atria & ventricles, caused by damage to the nodal pathway from ischemia or infarction, degree increases as damage progresses
First Degree Heart Block Normal P wave, P-R interval > 0.20sec, QRS complex normal, RR normal, P-QRS interval normal
First Degree Heart Block tx None
Second Degree Heart Block (Mobitz Type I) P-R interval increases until no P wave, RR interval normal
Second Degree Heart Block (Mobitz Type II) Multiple P waves between normal P-QRS-T patterns, fairly regular pattern
Second Degree Heart Block (Mobitz Type II) tx Atropine, Isoproterenol, pacemaker
Third Degree Heart Block Complete A-V dissociation, P unrelated to QRS, QRS wide/bizarre, regular RR interval, ventricular rate < 60/min
Third Degree Heart Block tx Pacemaker
Created by: vgflgirl
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