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34 Cards in this Set
- Front
- Back
This Action Potential Phase 0 begins with electrical stimulation
-Interior of cell becomes more + (fast sodium channel) -contraction of heart (SYST OLE) |
Depolarization
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Return of cell to resting potential
Relaxation of heart (DIASTOLE) |
Repolarization
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An amplified representation of how action potentials are grouped together to form a pattern or wave
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EKG
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Conduction Pathway of Heart
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1) SA node - "the beat" "the boss" 60-100bpm
2) AV node - "gatekeeper" "doorman" 40-60bpm (if SA node fails) 3) AV bundle "bundle of His" 4) Bundle branches 5) Pekinje fibers *3,4,5) 20-40bpm if SA and AV nodes fail |
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Blood Pathway through the heart
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Deoxygenated blood:
-in through superior vena cava -R atria --tricuspid valve -R ventricle --pulmonic valve -pulmonary artery -Lungs Oxygenated blood: --pulmonic veins -L atrium --mitral valve -L ventricle --aortic valve -Aorta ---Body |
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EKG Waveform
-starts with SA node and travels through the Atrium **Atrial Depolarization **Atrial Contraction |
P Wave
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EKG waveform:
**Ventricular Depolarization **Ventricular Contraction (systole follows) |
QRS Complex
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EKG waveform:
**Ventricular Repolarization **Ventricular Relaxation (diastole follows) |
T Wave
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Normal value of PR Interval of EKG:
Start of P wave to start of QRS complex "atrial kick" |
0.12 - 0.20 secs
*if greater than = problem in AV node |
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Normal value of QRS Interval:
Electrical conduction through ventricular pathways |
0.06 - 0.12 secs
*if greater than = hyperkalemia or problem with bundle branch system |
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How do you calculate HR on EKG strip
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if reg rhythm:
300 / large squares between QRS complexes if not reg: # of R waves in 6 sec strip (30 blocks) X 10 |
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EKG Rhythm often seen as a normal variation in athletes, during sleep, or vagal maneuver:
Rate 40-59bpm P Wave Sinus QRS Normal Conduction Normal Rhythm Regular |
Sinus Bradycardia
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Treatment for sinus bradycardia
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Treat underlying cause
Meds: Atropine - anticholinergic, increase HR and dries up Artificial pacing if patient is hemodynamically compromised **Pacing Always Ends Danger Pacemeker Atropine Epinephrine Dopamine |
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Rhythm with:
Rate 101-160bpm P Wave Sinus QRS Normal Conduction Normal Rhythm Regular |
Sinus Tachycardia
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Causes of Sinus Tachycardia Rhythm
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Increase in epinephrine, dopamine (Catecholamines)
CHF Hypoxia PE increase in Temp Stress Pain Decreased fluids |
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Treatment for Sinus Tachycardia
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Treat underlying cause
*Remember increased HR will then lower SV and lower CO to compensate (CO = HR X SV) |
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Rhythm with:
Rate 400 - 650bpm P Wave None ** QRS Normal Conduction Increased Rhythm Irregularly irregular |
Atrial Fibrillation
- May occur paroxysmally but often becomes chronic - usually associated with COPD, CHF or other heart disease |
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Treatment for Atrial Fibrillation
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Meds:
Digoxin, diltiazem (cardizem - calcium channel blocker), other antidysrhythmic meds to control AV conduction rate Cardioversion - stop rhythm if symptomatic and anticoagulate **if symptomatic must anticoagulate patient |
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If AFIB > 48hrs treat with
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Cardioversion
**anticoagulate first with heparin drip |
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Rhythm with:
Rate Normal or increased P Wave Different morphology than sinus due to originates from extopic pacemaker QRS Normal Conduction Normal Rhythm These occur early in cycle and usually do not have a complete compensatory pause |
Premature atrial contractions
*occur normally in non-diseased heart but if occur frequently may lead to atrial dysrhythmias ***PAC's don't mean much usually |
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Rhythm with:
Rate Variable P Wave usually obscured by QRS or T wave of PVC QRS < 0.12 secs (Bizarre morphology) Conduction Impulse originates below the branching portion of the bundle of His Rhythm Irregular - may occur in singles, couples or triplets; or bigeminy, trigeminy or quadrigeminy |
Premature ventricular contractions
-can occur in healthy hearts or in diseased hearts from drug toxicities (digitalis) ***Don't look like normal EKG |
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Treatment for Premature Ventricular Contractions (PVC's)
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Meds:
Lidocaine Pronestyl Amiodarone **only if: -associated with acute MI -occurs as couplets, bigeminy, trigeminy -multifocal -frequency >6/min |
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Rhythm with:
Rate 100-220bpm P wave Obscured QRS wide + bizarre morphology Conduction originates below branches of bundle of His as with PVC's Rhythm 3 or more ventricular beats in a row (regular or irregular) |
Ventricular Tachycardia
(V-Tach) only ventricle contracting *diseased hearts with CAD, Acute MI, digitalis toxicity, CHF **often patient symptomatic ***impaired to no cardiac output |
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Treatment for V-Tach
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Symptomatic?
No - Lidocaine bolus + drip Yes - Pulse? Yes: cardioversion + drugs No: treat as V-Fib --defibrillation, CPR, drugs |
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V-Tach with No Pulse Treatment
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Shock, Shock, Shock!!!!!!!
SCREAM Shock CPR Rhythm check Epinephrine Antirhythmic Meds: lidocaine, amniodarone |
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Rhythm with:
Rate None P wave None QRS None Conduction None Rhythm None |
*Flatline
Asystole/Ventricular Stand Still Treat with CPR, 100% Oxygen, IV, intubate, transcutaneous pacing, epinephrine (1mg IV push Q3-5 mins) |
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Rhythm with:
Rate Unattainable P Wave Obscured QRS Not apparent Conduction Chaotic electrical activity Rhythm Chaotic *absence of cardiac output *occurs with serious heart disease (Acute MI) |
Ventricular Fibrillation (V-Fib)
Treat with: Immediate defibrillation and ACLS protocols Identify and treat cause |
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When something causes a disruption in EKG monitoring
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Artifact
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Produced as impulse from SA and AV junction - caused by Atrial contraction
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P Wave
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Time between atrial depolarization and start of ventricular conduction (depolarization)
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P-R interval
Normal = 0.12 - 0.20 secs |
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Conduction of impulse through the bundle of His to perkinje fibers causing contraction of ventricles
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QRS complex
Normal = 0.06 - 0.12 secs |
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The heart's resting period after ventricles contract
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S-T Segment
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Ventricular Repolarization
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T Wave
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5 Steps to assess EKG Strip
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1) is there a "P" for every QRST?
2) is rhythm regular? ^----^----^ (msr spaces from r to r) 3) HR (# of Rs in 30 blocks X10 = HR) 4) PR (measure miniblocks) 5) QRS (before Q drops to S) |