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EKG Waveforms

What is a normal PR interval? 0.12-0.20 seconds
What is a normal QRS? 0.06-0.10 seconds
What happens during P waves? Atrial depolarization
What happens during QRS waves? Ventricular depolarization
What happens during T waves? Ventricular repolarization
Characteristics of normal sinus rhythm (NSR) * Rate: 60-100bpm * Rhythm: regular * 1P:1QRS * PR interval 0.12-0.20sec * QRS 0.06-0.10sec
Characteristics of sinus tachycardia. * same as NSR, with HR >100bpm.
Characteristics of sinus bradycardia * same as NSR< with HR <60bpm * do not treat unless patient is symptomatic. Treat with atropine 0.5mg or pacemaker therapy.
Characteristics of premature atrial contractions (PACs) * Rhythm is normal until interrupted by early beats from the atria, which makes the rhythm irregular * Usually requires no treatment; advise client to reduce ETOH and caffeine intake, reduce stress, and stop smoking (if applicable).
Atrial tachycardia (supraventricular tachycardia, or SVT) * Rate: 100-280bpm (~150-200bpm) * PR: unmeasurable * generally T-on-P waves * vagal maneuvers, adenosine, verapamil
Atrial flutter * Atrial rate 240-360bpm; ventricular usually <150bpm * P:QRS may be 2:1, 4:1, 6:1 or variable * PR unmeasurable * characteristic F (sawtooth) waves
Atrial fibrillation * Atrial rate 300-600bpm; ventricular 100-180bpm * Rhythm: irregularly irregular * P:QRS is variable * PR unmeasurable * f (fibrillatory) waves
How is A-fib/A-flutter treated? ABCDE - adenosine, beta blockers, CCBs, digoxin, electrocardioversion. If <48h duration, safe to cardiovert. If >48h, must anticoagulate first before cardioversion, unless hemodynamically unstable.
Junctional rhythm characteristics An inverted P wave either 1. before or 2. after the QRS. Can also have hidden P waves.
Junctional rhythm (junctional escape rhythm) * 40-60bpm * If P wave is present, PR is generally <0.10sec. * Treat if symptomatic.
Accelerated junctional rhythm * 60-100bpm
Junctional tachycardia * >100bpm
Premature ventricular contractions (PVCs) * Rate: variable * Rhythm: irregular, with PVC interrupting underlying rhythm followed by a compensatory pause. * P:QRS: no P before PVC * PR: absent with PVC. * QRS is wide, bizarre, >0.12sec.
How are PVCs treated? Treat is experiencing symptoms - IV lidocaine, procainamide, quinidine, propanolol. Avoid stimulant use. A RUN OF 3 OR MORE PVCS = RUN OF VTACH.
Ventricular tachycardia (VT or VTach) * Rate: 100-250bpm * Rhythm: regular * P waves usually not identifiable * PR not measured * wide, bizarre QRS, >0.12sec
How is VT treated? Treat if VT is sustained or client is experiencing symptoms - amiodorone or lidocaine. If pt is unconcious or unstable, immediate defib is required.
Ventricular fibrillation (VF or VFib) * rate: too rapid to count * rhythm: grossly irregular * no P waves, no PR * pt has *NO* CO! Call a code blue, DEFIB THE VFIB!
1st Degree AV Block * Rate usually 60-100bpm * Rhythm: regular * PR interval >0.20sec * Generally no treatment required.
2nd degree AV block type 1, Mobitz I or Wenckebach * Rate 60-100bpm * Rhythm atrial regular, ventricular irregular * PR interval progressively lengthens; absence of QRS at times * monitor; atropine or isproterenol if pt is symptomatic.
2nd degree AV block type 11, Mobitz II * atrial 60-100bpm, ventricular <60bpm * atrial regular, ventricular irregular * P:QRS typically 2:1, may vary * Atropine or isoproterenol; pacemaker
3rd degree AV block (complete heart block) * atrial 60-100bpm, ventricular 15-60bpm * atrial & ventricular regular * NO RELATIONSHIP BETWEEN P & QRS! * PR not measured. * QRS 0.06-0.10 if junctional escape rhythm, >0.12 if ventricular escape rhythm * immediate pacemaker therapy.
Bundle Branch Block (BBB) * delayed conduction through the bundle of His (ventricles) * Need 12-lead EKG to determine if R or LBBB * widened QRS, >0.12sec. Generally has a "rabbit ears" appearance.
Difference between junctional rhythm w/ BBB and afib w/ BBB * Junctional: no P waves, but REGULAR * Afib: no P waves, but IRREGULAR
Bigeminal PVCs PVCs that occur every other beat.
Unifocal PVCs Look exactly the same - probably came from the same site in the ventricles.
Trigeminal PVCs Every third beat
Quadrigeminal PVCs Every fourth beat
Couplet PVCs Paired
Multifocal PVCs When PVCs look different.
R-on-T Phenomenon When a PVC has occurred during the vulnerable period of ventricular repolarization (on/near peak of T wave). May precipitate into VT or VF!
monomorphic VT when QRS complexes are identical
polymorphic VT when QRS complexes look different
Treatment of stable monomorphic VT with a pulse * amiodorone 150mg IV bolus/10min, followed by 1mg/min infusion over 6hrs then 0.5mg/min over 18hrs. * lidocaine 1-1.5mg/kg IV bolus, then 0.5-0.75mg/kg IV q5-10min. Maintenance: 1-4mg/min. * AL drugs - ^
torsades de pointes * polymorphic VT * pt becomes hemodynamically unstable very quickly
treating torsades de pointes * remove/correct the causative factors. * Mg loading dose 1-2g/10mL dextrose 5% in water over 5min followed by maintenance infusion of 0.5-1g/hour.
ventricular standstill * P waves w/o QRS complexes or an isoelectric line. May occur d/t acidosis, hypoxia, hyperkalemia, hypothermia or drug OD.
atrial kick accounts for ___ of CO. 30%
Closure of the AV valves constitutes which heart sound? S1. AV = mitral and tricuspid
Closure of the pulmonic valves constitutes which heart sound? S2. PV = semilunar valves. aortic and pulmonic
P wave * atrial depolarization * smooth and rounded * 1P:1QRS * + in lead II * abnormally tall, peaked P = enlargement of R atrium
PR interval * represents the time from the onset of atrial depolarization to the time of ventricular depolarzation * 0.12-0.20sec
QRS complex * ventricular depolarization * 0.06-0.10sec
ST segment * represents end of ventricular depolarization and the beginning of ventricular repolarization * Normally isoelectric * elevation = ominous, MI * depression = myocardial ischemia * scooped out appearance w/ digitalis
T wave * ventricular repolarization
1 small box on EKG paper = ____sec 0.04
5 small boxes on EKG paper = ____sec 0.20
2 black lines = _____sec. a typical strip is _____sec. 3, 6.
Created by: 39115207
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