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PAAM
PAAM EXAM Review
| Prompt | Response |
|---|---|
| The upper airway extends from the _________ and _________ to the ___________. | Mouth and Nose to the Larynx. |
| The upper airway includes the _____________, ___________ and _________. | nasal cavity, oral cavity, and pharynx. (nasopharynx, oropharynx, and laryngopharynx). |
| The lower airway begins below the __________ and includes the __________, __________, ____________, and __________. | larynx and includes the trachea, bronchi, bronchioles, and alveoli. |
| Tracheal Bifurcation: | The trachea bifurcates (splits into the right and left mainstem bronchi at the carina |
| Gas Exchange: occurs at the _________, which are the functional units of the lungs. Exchange happens across the ___________. | Alveoli, Alveolar-capillary Membrane |
| Visceral vs. Parietal Pleura: The ___________ is the inner layer that directly envelops the lungs and lacks nerve endings. | Visceral pleura |
| Visceral vs. Parietal Pleura: The _____________ is the outer layer that lines the thoracic cavity and does contain nerve fibers, making it sensitive to pain. | Parietal pleura |
| Adult vs. Pediatric Airway: Children have a smaller_______ and a relatively larger __________, which increases the risk of _____________. | Jaw, Tongue, Airway Obstruction. |
| Adult vs. Pediatric Airway: The pediatric epiglottis is __________, _________, and often described as "________-_______". | floppier, rounder, "omega-shaped" |
| Adult vs. Pediatric Airway: The narrowest point in a pediatric airway (under age 10) is the____________, whereas in adults, it is the ________________. | cricoid cartilage, vocal cords (glottis) |
| Adult vs. Pediatric Airway: Children have a more __________, and ____________ larynx and a ________, ________ occiput. | superior and anterior, larger, rounder |
| Laryngeal Landmarks: Structures visualized during direct visual intubation include the ____________, ___________, ___________, and the________. (the depression between the base of the tongue and epiglottis). | epiglottis, vocal cords, arytenoid cartilage, and the vallecula. |
| Ventilation vs. Respiration: Ventilation is the _____________. | is the mechanical, physical movement of air into and out of the body. |
| Ventilation vs. Respiration: Respiration is the ____________. | physiological exchange of gases (O2 and CO2) between the atmosphere, blood, and cells. |
| Internal vs. External Respiration: External (pulmonary) respiration is the _________________. | exchange of gases between the alveoli and the pulmonary capillaries. |
| Internal vs. External Respiration: Internal (cellular) respiration is the _________________ | exchange of gases between the red blood cells and the body's tissues at the cellular level. |
| Normal Volumes: The average Tidal Volume (VT) in a healthy adult is approximately __________ mL . Dead Space—the air that does not participate in gas exchange—is approximately ________ mL. | 500 mL, 150 mL. |
| Calculations: Alveolar Volume: ___________ - __________ . | Tidal Volume - Dead Space |
| Calculations: Minute Volume: ____________ X ____________. | Tidal Volume X Respiratory Rate |
| Calculations: Alveolar Minute Volume (____________ -____________) X _______________. | (Tidal Volume - Dead Space) X Respiratory Rate. |
| Respiratory Physiology and Drives: The primary stimulus to breathe is the _______________ Drive, controlled by central ______________ that respond to an increase in arterial CO2 levels | Hypercarbic Drive, chemoreceptors in the medulla |
| Respiratory Physiology and Drives: The ______________ drive is a secondary/backup system where breathing is triggered by low oxygen O2 levels in the blood. | Hypoxic drive, |
| CO2 Transport: CO2 is primarily transported as ________________. (CO2 transport is typically: 70% as bicarbonate, 23% bound to hemoglobin, and 7% dissolved in plasma) | Bicarbonate Ion |
| Oxygen Dissociation Curve: Right shift (Bohr Effect) occurs | Occurs in high-stress states like acidosis or hyperthermia, causing hemoglobin to release O2 more easily to tissues. |
| Oxygen Dissociation Curve: Left shift (Haldane Effect) | Occurs in states like alkalosis or hypothermia, causing hemoglobin to hold onto O2 more tightly |
| Protective Reflex: _______________ Reflex stops over-ventilation; it is triggered by _________________ receptors that signal the brain to terminate inhalation when the lungs are full. | Hering-Breuer Reflex, pulmonary stretch receptors |
| V/Q Mismatch: A "V" (Ventilation) mismatch occurs when air ____________________ (e.g., asthma, COPD, pneumonia, or brain injury). A "Q" (Perfusion) mismatch occurs when ________________________ (e.g., hypovolemia or blood clot). | cannot reach the alveoli, blood flow to the alveoli is blocked |
| Oxygen regulators use a ______:______ pin sizing system to ensure the correct gas is connected | 2:5 pin |
| A ______________ fitting is used to connect a regulator to a ventilator, typically delivering _____ psi. | DISS (Diameter Index Safety System), 50 PSI |
| Rales: | Bubbling sounds indicating fluid in the alveoli. |
| Rhonchi: | Rattling/drum-like sounds caused by mucus in larger airways. |
| Wheezing: | Whistling sounds caused by bronchoconstriction. |
| Stertor: | Snoring sounds. |
| Stridor: | High-pitched sound indicating upper airway obstruction or swelling. |
| Cheyne-Stokes: | Progressively deeper, faster breathing followed by periods of shallow breathing and apnea. |
| Kussmaul’s Respirations: | Deep, gasping respirations often seen in diabetic ketoacidosis. |
| Biot’s Respirations (Ataxic): | Irregular, unpredictable breathing with no clear pattern. |
| Supplemental Oxygen Delivery (Typical FiO2): Nasal Cannula: | 1-6 Lpm delivering ~24-44% FiO2. |
| Supplemental Oxygen Delivery (Typical FiO2): Non-Rebreather (NRB) Mask: | 10-15 Lpm delivering ~90%+ FiO2. |
| Supplemental Oxygen Delivery (Typical FiO2): BVM (with reservoir): | 15 Lpm delivering nearly 100% FiO2. |
| Supplemental Oxygen Delivery (Typical FiO2): Pocket Mask: | 15 Lpm delivering ~50% FiO2. |
| OPA (Oropharyngeal Airway): Indication: Measurement: Placement: | Unconscious patient with no gag reflex. Corner of the mouth to the earlobe or angle of the jaw. Inserted upside down and rotated 180 degrees in adults; in pediatrics, it is often inserted right-side up with a tongue depressor to avoid palate trauma. |
| NPA (Nasopharyngeal Airway): Indication: Measurement: Placement: | Patient with a gag reflex or clenched teeth. Suspected head trauma or mid-face fractures (potential for cranial entry). Tip of the nose to the earlobe. |
| Types of Catheters: __________ (also known as Yankauer or tonsil tip), which are used ___________ , and ___________ (whistle tip or French), which are flexible and used for ___________. | Rigid catheters, for the oropharynx to remove large volumes of fluid or debris, Soft catheters, the nasopharynx or down an ET tube. |
| ___________ catheter, is designed for the SALAD technique (suction assisted laryngoscopy and airway decontamination) and is better for "chunkier" fluids like vomit. | DuCanto catheter |
| Suction Times: Adult: Child: Infant (up to 1 year old): ET or Trach Tube: | 15 seconds 10 seconds 5 seconds 5–10 seconds |
| Difficult Airway Assessment (LEMONS) | Look externally, Evaluate the 3-3-2 rule, Mallampati score, Obstructions, Neck mobility, Saturations. |
| Mallampati Scores: This system classifies the view of the oropharynx to predict intubation difficulty: Grade 1: Grade 2: | Grade 1: Soft palate, uvula, and entire tonsillar fossa clearly visible. Grade 2: Soft palate and uvula visible; upper half of tonsil fossa visible. |
| Mallampati Scores: This system classifies the view of the oropharynx to predict intubation difficulty: Grade 3: Grade 4: | Grade 3: Soft and hard palate visible; only the base of the uvula is visible. Grade 4: Only the hard palate is visible. |
| The 3-3-2 Rule: This assesses anatomic limitations to visualizing the larynx using the patient's fingers: 3-_-_ | 3 fingers: The patient should be able to fit three of their own fingers vertically in their open mouth. |
| The 3-3-2 Rule: This assesses anatomic limitations to visualizing the larynx using the patient's fingers: _-3-_ | 3 fingers: Distance from the tip of the chin (mentum) to the hyoid bone. (larynx). |
| The 3-3-2 Rule: This assesses anatomic limitations to visualizing the larynx using the patient's fingers: _-_2 | 2 fingers: Distance from the hyoid bone to the top of the thyroid cartilage |
| POGO: | This stands for Percentage of Glottic Opening. It is a scale from 0 to 100 used to score the percentage of the glottis (vocal cords) that can be visualized during laryngoscopy. |
| CPAP: | Continuous Positive Airway Pressure adds positive pressure throughout the respiratory cycle, which helps push fluid out of the alveoli and back into the vascular system in CHF patients, or keeps airways open in asthma/COPD patients. |
| ET Blades: Tip placement Macintosh (Curved): Miller (Straight): | The tip is placed in the vallecula to indirectly lift the epiglottis. The tip is used to directly lift the epiglottis. |
| Stylet: Used to ________ | Used to add rigidity and shape to the ET tube for easier insertion. |
| Murphy Eye: is the ___________ | The name of the distal lateral hole that provides an alternate pathway for airflow. |
| Bougie: Used when ____________ | Used when the glottic opening is difficult to visualize; the distal curved tip is called a Coudé tip |
| Pediatric Sizing: Formula: For a school-age child_______, & premature infants _________ | (Age/4) + 4 for uncuffed a 5.5–6.5 ET tube is typically used, require a 2.5–3.0. |
| Pediatric Weight: Formula | (Age x 3) +7 Handtevy System and Broselow tape |
| pH and Acid-Base: Normal pH is __________. Respiratory acidosis is caused by hypoventilation __________, while metabolic acidosis can be caused by conditions like ______________. | 7.35–7.45. (retaining CO2). DKA or lactic acid buildup |
| Gas Laws: Boyle’s Law: | Pressure and volume are inversely related (applies to changes in altitude in HEMS). |
| Gas Laws: Henry’s Law: | Amount of gas dissolved in a liquid is proportional to its partial pressure. |
| Gas Laws: Charles’s Law: | Volume and temperature are directly proportional. |
| Gas Laws: Dalton’s Law: | Total pressure is the sum of partial pressures of all gases in the mixture. |
| Gas Laws: Boyle’s Law: Pressure and volume are _________ related | inversely |
| Gas Laws: Henry’s Law: Amount of gas dissolved in a liquid is _________ to its partial pressure. | proportional |
| Gas Laws: Charles’s Law: Volume and temperature are ____________ proportional. | directly |
| Gas Laws: Dalton’s Law: Total pressure is the ____________ of all gases in the mixture. | sum of partial pressures |
| Scene Operations and Rescue: Action Circle: | the circular area that extends outward from the vehicles involved in the collision. It must be kept clear of all non-essential personnel and equipment. Radius 50 feet. |
| Scene Operations and Rescue: Circle Survey: | The purpose of performing a "circle survey" (or 360-degree walk-around) is to give rescuers a 360-degree view of the scene. |
| Scene Operations and Rescue: Water Rescue Order: Reach, Throw, Row, Go | Water rescues should be conducted in the following specific order to prioritize rescuer safety: Reach (with a long pole), Throw (a flotation device), Row (using a boat), and Go (water entry as a last resort). |
| Scene Operations and Rescue: Confined Space Dangers: | Rescues in confined spaces involve fatal possibilities including oxygen deficiency, toxic or explosive chemicals, cave-ins, machinery entrapment, electricity, and structural collapse. |
| Scene Operations and Rescue: Vehicle Fire Parking Distance: | The rescue vehicle should be parked no closer than 100 feet from the fire. |
| Communication: Therapeutic Communication: Active Communication: | Communication using a calm tone and empathy to build rapport include Reflection, Empathy, Clarification, and Interpretation (or facilitation). |
| Interpersonal Zones | Intimate Zone (0–1.5 feet): Personal Space (1.5–4 feet): Social Space (4–12 feet): Public Space (12 feet or more): |
| The 50/70 Rule: | Regarding eye contact, this rule suggests maintaining eye contact 50% of the time while speaking and 70% of the time while listening to show attentiveness and sincerity. |
| Active Listening: This is an active skill requiring complete focus and consists of several feedback techniques: | Silence, Reflection, Facilitation, Empathy, Clarification, Confrontation, Interpretation, Asking about feelings, Explanation, and Summarization. |
| Assessment Mnemonics: SAMPLE History: | Signs/Symptoms, Allergies, Medications, Pertinent past history, Last oral intake, and Events leading up to the illness. |
| Assessment Mnemonics: OPQRST-ASPN: Used to evaluate the history of the present illness: | Onset, Provocation, Quality, Radiation, Severity, Time, and Associated Signs/Pertinent Negatives. |
| Assessment Mnemonics: AEIOU-TIPS: This mnemonic is used to assess causes of altered mental status: | Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychosis, and Stroke. |
| Assessment Mnemonics: DCAP-BLS-TIC: Used during the physical exam to identify | Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Lacerations, Swelling, Tenderness, Instability, and Crepitus. |
| Differential Diagnosis: | This is a list of potential diagnoses developed through clinical reasoning to help modify the assessment and formulate a treatment plan. |
| Assessment Techniques: The four techniques used, in order, are____________ | Inspection, Palpation, Percussion, and Auscultation. |
| Percussion Types: Clinicians use percussion to identify _________________ often to assess the diaphragm's position or lung consolidation. Standard techniques include________, ___________, __________. | resonance (air) or dullness (fluid/solid), (direct, indirect, and blunt percussion) |
| Clinical Odors: Fruity breath can indicate | Diabetic Ketoacidosis (DKA). |
| Clinical Odors: Bitter almonds can indicate | Cyanide poisoning. |
| Clinical Odors: General bad breath can indicate | Dental issues or throat infection. |
| Clinical Odors: Urine/Ammonia can indicate | Associated with kidney failure or uremia |
| Clinical Odors: Fishy vaginal odor can indicate | Infection (Bacterial vaginosis). |
| Clinical Odors: Fecal breath can indicate | Major bowel obstruction. |
| Pulse Deficit: The difference between the __________ pulse and a ________ pulse, indicating that some heart contractions are not reaching the periphery. | apical pulse, peripheral pulse |
| Cardiac Output (CO)= | Heart Rate X Stroke Volume. |
| Blood Pressure (BP)= | Cardiac Output X Systemic Vascular Resistance. |
| MAP (Mean Arterial Pressure)= | (Systolic + (2 X Diastolic)) / 3 |
| Korotkoff Sounds: There are five phases of sounds heard during BP measurement: | (1) Snapping/Tapping (Systolic), (2) Swooshing, (3) Tapping, (4) Thumping/Muffling, and (5) Silence (Diastolic). |
| Glucose Levels: Normal: Approximately __________ Hypoglycemic: Generally considered below ___________ Hyperglycemic: Generally considered above _____________ | 80–120 mg/dL. 60 mg/dL. 140 mg/dL. |
| Glasgow Coma Scale (GCS): This system uses three categories to assess consciousness: | Eye Opening (4), Verbal Response (5), and Motor Response (6). |
| Skin Color Identification: Pallor: | A pale color suggesting decreased blood flow or anemia, often seen in shock or hypothermia. |
| Skin Color Identification: Cyanosis: | A bluish tint indicating decreased oxygenation of the tissues (central or peripheral). |
| Skin Color Identification: Jaundice: | A yellow coloring typically appearing first in the sclera, associated with liver disease. |
| Skin Color Identification: Erythema: | A redness that can indicate allergic reactions, vasodilation, or inflammation. |
| Skin Color Identification: Petechiae: | Tiny, reddish-purple spots (less than 0.5 cm) caused by capillary bleeding. |
| Skin Color Identification: Purpura: | Reddish-purple blotches (greater than 0.5 cm). |
| Skin Color Identification: Mottling: | Patchy skin discoloration often associated with poor peripheral perfusion or shock. |
| Skin Color Identification: Ecchymosis: | A blue-black bruise resulting from trauma or bleeding disorders. |
| Skin Turgor: This is a test for skin elasticity and hydration. Test | Test: Pick up a fold of skin over a bony prominence and release it; it should immediately return to its original state. |
| Skin Turgor: Tenting: | If the skin stays pinched (poor turgor), it indicates dehydration. |
| Pupil Assessment: Unequal Pupils: Known as ___________ | Anisocoria |
| Pupil Assessment: Alerts to: | New inequality can alert you to brain pathology, stroke, or pressure on the oculomotor nerve (CN-III) |
| Pupil Assessment: Pinpoint Pupils: Known as ___________. | Miosis. |
| Pupil Assessment: Dilated Pupils: Known as __________. | Mydriasis. |
| Pupil Assessment: Ecchymosis Around Eyes: Known as ________ _______, which is a clinical sign of a _____________. | Raccoon eyes, basilar skull fracture |
| The Ear: Three Parts: ___________, _________, and ______ ear. | External, middle, and inner ear. |
| The Ear: Middle Ear: Three Ossicles__________, ___________, and __________. | Three Ossicles: The Malleus (hammer), Incus (anvil), and Stapes (stirrup). |
| Ecchymosis Behind Ears: Known as ____________, which also indicates a ______________ | Battle's sign, basilar skull fracture |
| Otoscope: Used to visually inspect the external ear canal and the tympanic membrane known as_________ | eardrum |
| Kussmaul’s Sign: It indicates that the heart is having difficulty filling, often seen in cardiac tamponade or restrictive lung disease | An increase in jugular venous distention (JVD) during inhalation. |
| Pressure Approximation: Pressure in the jugular veins approximates ________ _________ pressure | right atrial pressure |
| Goal of Secondary Assessment: | To conduct a focused physical examination to investigate body systems (cardiovascular, respiratory, etc.) suspected to be involved in the patient's primary problem. |
| Subcutaneous Emphysema & It signifies | A crackling sensation under the skin caused by air trapping. It alerts you to a leak in the respiratory tract or a potential tension pneumothorax. |
| Carotid Bruit & It signifies | A rumbling or vibrating noise heard during auscultation of the carotid artery. It signifies turbulent blood flow caused by narrowing or atherosclerosis. |
| Heart Sounds: Normal Sounds: | S1 (the "lub") and S2 (the "dub"). |
| Heart Sounds: Diastole: | The Tricuspid and Mitral valves are open. |
| Heart Sounds: Systole: | The Aortic and Pulmonic valves are open. |
| Erb’s Point Location: Located at the ______ Intercostal Space (ICS), just ______ of the sternum. | 3rd, left |
| Abdominal Assessment: Scaphoid Abdomen: A _____________ or _______________ abdomen. It is often a sign of severe __________ or ____________. | A concave or sunken-in abdomen. It is often a sign of severe malnutrition or dehydration. |
| Abdominal Assessment: Pulsating Mass: indicates an _____________. | An obvious pulsating mass in the abdomen indicates an Abdominal Aortic Aneurysm (AAA). |
| Abdominal Assessment: Ascites: The medical term for the _______________ across a patient's abdomen. | accumulation of fluid |
| Abdominal Assessment: Bleeding Signs: Cullen’s Sign: ______________ indicates ____________ bleeding. | Bruising/discoloration over the umbilicus; indicates intra-abdominal bleeding. |
| Abdominal Assessment: Bleeding Signs: Grey Turner’s Sign: ________________; indicates ___________ bleeding. | Bruising/discoloration over the flanks; indicates intra-abdominal bleeding. |
| Hematemesis is defined as | Vomiting bright red blood |
| Hemoptysis is defined as | Coughing up blood (respiratory) |
| Hematochezia is defined as | Bright red blood in stool |
| Melena is defined as | Dark, sticky, foul-smelling stool |
| Types of Abdominal Pain: Visceral: It originates in the walls of ___________, ____________, _____________. | Vague, poorly localized, dull, or crampy. It originates in the walls of hollow organs (e.g., gallbladder), capsules of solid organs (e.g., liver), or the visceral peritoneum. |
| Somatic: ________ and ___________ to a specific region. It travels along definite neural routes to the spinal column and is often caused by _______________ or _________________. | Somatic: Sharp and localized to a specific region. It travels along definite neural routes to the spinal column and is often caused by bacterial or chemical irritation. |
| Referred: Pain felt in ____________________________ | Referred: Pain felt in a region other than where it originates (e.g., pain from a dissecting abdominal aortic aneurysm felt between the shoulder blades). |
| Kehr’s Sign: __________ pain associated with __________ pain. _________ shoulder tip pain often indicates a ______________, while ________ shoulder tip pain is associated with ____________. | Shoulder tip pain associated with abdominal pain. Left shoulder tip pain often indicates a ruptured spleen, while right shoulder tip pain is associated with cholecystitis. |
| Positive Murphy’s Sign: A clinical indicator used to assess for suspected ____________ or ______________. | A clinical indicator used to assess for suspected gallbladder or liver disease. |
| McBurney’s Point: Location: Significance: | Located in the Right Lower Quadrant (RLQ), approximately two-thirds of the way from the umbilicus to the Anterior Superior Iliac Spine (ASIS). Rebound tenderness or pain at this point (McBurney’s sign) is a classic indicator of appendicitis. |
| Pitting Edema Scale: +1: +2: +3: +4: | +1 is a 2mm indentation, +2 is 4mm, +3 is 6mm, and +4 is an 8mm indentation that remains for a prolonged time |
| Pulse Scale: 0: +1: +2: +3: | 0 = Absent, +1 = Weak/Thready, +2 = Normal, +3 = Bounding |
| Spinal Curvatures: Lordosis: | An exaggerated lumbar concavity (also known as "swayback"). |
| Spinal Curvatures: Scoliosis: | A lateral curvature of the spine. |
| Spinal Curvatures: Kyphosis: | An exaggerated thoracic convexity (also known as "hunchback"). |
| Cranial Nerves CN I (Olfactory): | Smell. CN I (Olfactory) |
| Cranial Nerves CN II (Optic): | Vision and light sensing for the pupillary reflex. CN II (Optic) |
| Cranial Nerves CN III (Oculomotor): | Controls pupil size, lens shape, and most eye movements. CN III (Oculomotor) |
| Cranial Nerves: CN IV (Trochlear): | Moves the eye downward and inward. CN IV (Trochlear) |
| Cranial Nerves: CN V (Trigeminal): | Facial sensation and chewing. CN V (Trigeminal) |
| Cranial Nerves: CN VI (Abducens): | Moves the eye laterally CN VI (Abducens) |
| Cranial Nerves: CN VII (Facial): | Facial expression and taste (anterior 2/3 of tongue). CN VII (Facial) |
| Cranial Nerves: CN VIII (Vestibulocochlear): | Hearing and balance. CN VIII (Vestibulocochlear) |
| Cranial Nerves: CN IX (Glossopharyngeal): | Swallowing, taste (posterior 1/3), and posterior pharynx sensation. CN IX (Glossopharyngeal) |
| Cranial Nerves: CN X (Vagus): | The "wandering nerve"; provides parasympathetic innervation to the heart, lungs, and most abdominal organs; also involved in swallowing and speech. CN X (Vagus) |
| Cranial Nerves: CN XI (Accessory): | Ability to shrug the shoulders. CN XI (Accessory) |
| Cranial Nerves: CN XII (Hypoglossal): | Tongue movement. CN XII (Hypoglossal) |
| Parasympathetic Carriers: | Cranial nerves III, VII, IX, and X carry parasympathetic fibers. |
| Pacemakers and Firing Rates: SA Node: | 60–100 bpm (Primary) |
| Pacemakers and Firing Rates: AV Node/Junction: | 40–60 bpm |
| Pacemakers and Firing Rates: Ventricles (Purkinje fibers): | 20–40 bpm |
| Conduction to Left Atrium: The electrical stimulus travels from the SA node to the left atrium via _____________. | The electrical stimulus travels from the SA node to the left atrium via Bachmann's Bundle. |
| Potentials: Autorhythmic cells depolarize primarily via ____________ influx. | Potentials: Autorhythmic cells depolarize primarily via calcium influx. |
| Potentials: Contractile cells depolarize via rapid__________ influx, exhibit a plateau phase due to _________, and repolarize via __________ efflux. | Contractile cells depolarize via rapid sodium influx, exhibit a plateau phase due to calcium, and repolarize via |
| Einthoven’s Triangle (Bipolar Leads): Lead I: | Right Arm (-) to Left Arm (+). |
| Einthoven’s Triangle (Bipolar Leads): Lead II: | Right Arm (-) to Left Leg (+). |
| Einthoven’s Triangle (Bipolar Leads): Lead III: | Left Arm (-) to Left Leg (+). |
| Graph Paper: Speed: | 25 mm/sec. |
| Graph Paper: 1 small horizontal box: | 0.04 seconds. |
| Graph Paper: 1 small vertical box: | 0.1 mV (1 mm). |
| Waveforms: P wave: Atrial depolarization. Should be________ and _______. Normal PRI: ______-______ seconds. Max amplitude: < ____ mm (limb) and < ______ mm (chest). | Waveforms: o P wave: Atrial depolarization. Should be upright and rounded. Normal PRI: 0.12–0.20 seconds. Max amplitude: < 2.5 mm (limb) and < 1.5 mm (chest). |
| QRS Complex: Ventricular ________. Normal duration: < ________ seconds. | QRS Complex: Ventricular depolarization. Normal duration: < 0.12 seconds. |
| T wave: Ventricular _________. Max amplitude: < ____ mm (limb) and < _____ mm (chest). | T wave: Ventricular repolarization. Max amplitude: < 5 mm (limb) and < 10 mm (chest). |
| Hemoglobin States Oxyhemoglobin: | Hemoglobin bound to oxygen. |
| Hemoglobin States Carbaminohemoglobin: | Hemoglobin bound to carbon dioxide. |
| Hemoglobin States Carboxyhemoglobin: | Hemoglobin bound to carbon monoxide. |
| Hemoglobin States Methemoglobin: | A state where the iron in hemoglobin is oxidized preventing it from binding oxygen; it can be treated with Methylene Blue. |
| The action potential (the threshold at which depolarization is triggered) of the autorhythmic cell occurs at | -40mV |
| The ion that causes the cardiac contractile cell to repolarize is | Potassium. |
| When obtaining a 12 lead ECG, where do you place V5? | When obtaining a 12-lead ECG, the V5 electrode is placed at the fifth intercostal space (5th ICS) along the anterior axillary line |
| What is the intrinsic firing rate of the Purkinje System? | 20 to 40 beats per minute |
| The resting potential of the autorhythmic cell occurs at | -60mV |
| Carbon monoxide poisoning is usually fatal if the carboxyhemoglobin (COHb) level gets above | 60% |
| The ion that causes autorhythmic cells to depolarize is | Calcium |
| When obtaining a 12 lead ECG, where do you place V1? | the V1 electrode is placed at the fourth intercostal space (4th ICS), located just to the right of the sternum |
| A 12-lead ECG requires four limb electrodes and six precordial (chest) electrodes V1 - V2 | Precordial (Chest) Leads (V1–V6) V1: Fourth intercostal space (4th ICS), just to the right of the sternum (approx. 1 inch) V2: Fourth intercostal space (4th ICS), just to the left of the sternum |
| A 12-lead ECG requires four limb electrodes and six precordial (chest) electrodes V3- V5 | V3: Placed midway between leads V2 and V4 V4: Fifth intercostal space (5th ICS) at the midclavicular line V5: Fifth intercostal space (5th ICS) at the anterior axillary line |
| A 12-lead ECG requires four limb electrodes and six precordial (chest) electrodes V6 | V6: Fifth intercostal space (5th ICS) at the midaxillary line (horizontal to V4) |
| Supplemental Leads for 15-Lead ECG Right-Sided Leads (Right Ventricle) | V4R: Fifth intercostal space (5th ICS) at the right midclavicular line V5R: Right anterior axillary line, level with V4R V6R: Right midaxillary line, level with V5R |
| Supplemental Leads for 15-Lead ECG Posterior Leads (Posterior Wall) | V7: Posterior axillary line, lateral to V6. V8: Fifth intercostal space (5th ICS) at the mid-scapular line. V9: Level with V8 at the paravertebral line (midway between the scapula and the spine) |
| Autorhythmic Cells resting and action potential | Resting Membrane Potential (-60 mV) Action Potential Threshold (-40 mV) |
| Autorhythmic cells phases of repolarization and depolarization Phase 4: Spontaneous Depolarization (Prepotential) | Action: The cell membrane potential does not remain flat but instead exhibits a gradual upward slope from its lowest point of approximately -60 mV toward a threshold of -40 mV |
| Autorhythmic cells phases of repolarization and depolarization Phase 4: Spontaneous Depolarization (Prepotential) -Voltage | Voltage: The cycle begins at a "resting" point of approximately -60 mV and moves toward a threshold of -40 mV |
| Autorhythmic cells phases of repolarization and depolarization Phase 4: Spontaneous Depolarization (Prepotential) -Ion Movement | Ion Movement: This spontaneous rise is caused by a slow influx (inward leak) of Calcium and, to a lesser extent, Sodium |
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