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Cardio Units 3-4
spc
| Question | Answer |
|---|---|
| PA film (standard) | pt is standing, xray beam from back to chest, shot back to front |
| Ap film (portable) | pt lying in bed, xray beam through anterior chest to back, shot front to back |
| Lateral film? | Pt sideways, film against R or L lateral chest wall, used to assess lower lobe lesions and cancer |
| Lateral Decubitus film description? | Pt lies w/ film against affected side, used to assess pleural effusion, check for fluid movement |
| Apical Lordotic film description? | Film against pt's upper back, xray @ 45deg angle from lower anterior chest, caudal angle, 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, air (pneumothorax, bullae, pneumatoceles, parenchyma) |
| What is Radiopaque? | White or grey areas on xray, high density, fluid, fat, bone |
| Fluid is? | light gray on xray, blood vessels, fissure fluid, pleural fluid(white) |
| Fat and bone are? | white on xray, heart, breast, adipose, ribs |
| What could a tracheal shift indicate? | pneumothorax |
| The trachea shifts towards problems within the lungs and? | away from problems outs of the lungs |
| What to look for in the Hilar region? | PA engorgement = Cor Pulmonale, Adenopathy = Lymph Node changes |
| Cardiac silhouette description | Heart ratio should be< 50% size of chest area, Right diaphragm 2cm higher than Left, C/P Angles (Sulcus) will be lost with pleural effusion |
| Clavicle position used for: | Pt positioning, the vertebrae should be between the medial ends of the clavicles |
| Posterior and anterior ribs are used too? | asses lung volume |
| An over exposed film? | lungs fields black without vascularity, vertebrae easily seen through cardiac shadow |
| An under exposed film? | lungs fields white |
| 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 |
| If there is white where there should be black on an xray, this is called? | consolidation |
| Hyperinflation (copd) xray? | Narrow tear/pear shaped heart, prominent PAs, low & flat diaphragms, wide posterior rib spaces, horizontal posterior ribs, radiolucent lung fields, small or narrow heart shadow |
| A miliary pattern in the apicies? | Tuberculosis |
| Interstitial Disease xray description | "Cobbwebs", Honeycombing, miliary pattern, diffuse nodules 2-4cm diameter |
| A ground glass appearance? | ARDS |
| Cardiogenic Pulmonary Edema (CHF) xray desription? | Increased heart ratio > 50%, Kerly B lines - prominent in R lung base, lymph vessels full of fluid. 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 |
| What is peribronchial cuffing? | thick bronchial wall from sputum |
| Blunting of the costophrenic angles and a menicus sign are noted with? | pleural effusion |
| An ECG is measuring electrical impluses within the heart, and echo measures? | the mechanics. can have good ECG with bad mechanics |
| What axis is the time interval on? | horizontal, voltage(amplitude) is vertical |
| ECG paper runs at? | 25mm/sec or s5 small squares |
| Small square is? | 0.04 sec |
| Large square is? | 0.20 sec |
| 1 milivolt is equal to? | 10 small squares ir 2 large squares |
| To determine a pulse rate from at ECG? | Divide 300 by the number are large squares between two r segments |
| What is the line on the ECG that determines there is no electrical activity called? | the isoelectric line |
| What is a stemi? | an elevated or depressed ST segment. ST elevated MI, not getting enough O2 to the heart causing ischemia |
| What is a bipolar lead? | two opposite polarity leade (+ and -) |
| What is a unipolar lead? | a positive lead on a limb |
| The hearts natural electrical signal always travels? | down and to the left, if the signal is heading towards a lead it will chart above the isoelectric line. if traveling away, it will be below. |
| 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? | 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 ( shift to stronger part of the heart) |
| 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 |
| 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 ischemia |
| 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 P wave does not send signal to the ventricles, missing qrs, 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 |
| The chest leads are also called? | precordial leads |
| PEA stands for? | pulse less electrical activity |
| During the P wave the atria are firing, the QRS? | ventricles are firing and the atria are repolarizing, during the T wave the ventricles repolarize |
Created by:
juialynn92
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