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Cardio Units 3-4


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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