Special Procedures
What modifications would you do for a patient with Parkinsons?
What is the first thing you should do in any algorithm?
Identify and treat the underlying cause.
My rhythm is irregular and my rate is 91 bpm. My P waves are normal. QRS duration is 0.07s. PRI is 0.19s. What am i?
Sinus arrhythmia.
Name 3 things that can cause artifact
Poor skin prep, movement, electrical interference, patient is tense
Name 5 things that should be on a requisition
Patient name, patient DOB, physician signature, family physician, requesting physician, date of requisition (todays date), indication, medications,
What do you need to do to every ECG when there is a modification?
Comment your modifications so the physician is aware
Adenosine is the first line drug for SVT, but ONLY if the rhythm is what?
Regular and monomorphic.
My rhythm is regular and rate is 58 bpm. My P waves are normal. PRI is 0.22s. QRS duration is 0.08s. What am I?
Sinus bradycardia with a first degree AVB
Name 3 reasons a patient may cause somatic tremor artifact and how to correct it
Shivering: get them a blanket. Anxious: ensure they understand there are no risks with the test and speak softly. Curiosity: explain what you are doing and everything happening. Restless: ensure patient is comfortable, get pillow.
What is the difference in the hookups for a right sided ECG and a patient with dextrocardia?
Right-sided hookup leaves the limb leads unchanged, dextrocardia involves switching your limb leads as well.
Your patient is on the mental health floor with psychosis. Explain your process of doing the ECG with this patient.
Ensure you are not alone. Observe their behavior. If you deem unsafe, come back another time (unless STAT). Explain the test thoroughly, speaking clear and in a non-threatening voice
What is the main medication given for Bradycardia? If that is unsuccessful, what other 2 medications could you try?
Atropine is first line. If that is unsuccessful, try Dopamine or Epinephrine infusions.
My rhythm is regular and my rate is 67 bpm. P waves are absent. QRS duration is 0.14s. What am I?
Accelerated junctional rhythm
What are the 4 types of artifact and which is the most common. What gets confused as artifact often?
Somatic tremors (most common), wandering baseline, AC interference, static electricity.
Pacemaker spikes gets confused for artifact.
Name 2 reasons AVR may be upright.
Incorrect lead placement or dextrocardia.
What are the 3 extra leads for a pediatric ECG.
V3R, V4R and V7.
If the rhythm is NOT shockable during a VT/PEA code, what do you do instead?
Give epinephrine and continue compressions.
My rhythm is irregular and my rate is 133 bpm. My PRI is 0.30s. QRS duration is 0.15s. What am I?
Sinus tachycardia with sinus arrhythmia, a marked first degree AVB and a bundle branch block.
What are the 2 main reasons for wandering baseline artifact and give me 3 examples of how to fix it.
Sensors loose and dangling/tight wires. You can repeat skin prep, shave the area, place a towel on chest leads to weigh them down, ensure the wires have enough slack and are not pulling on the electrodes.
What is the standard paper speed and what happens when it is increased? Why would we increase it?
25 mm/s and the complexes will appear wider as the speed will slow down. We would increase it to see the P wave better, like in AFIB.
Tell me the anatomical positions for V7, V8 and V9.
V7 - left posterior axillary line. V8 - tip of the mid scapular. V9 - left paraspinal region
Which 3 medications does the VT/PEA algorithm say you can use?
Epinephrine, Lidocaine and Amiodarone.
My rhythm is irregular. My rate is 61 bpm. My PRI is variable. My QRS is 0.08s.
Sinus rhythm with a 2nd degree Mobitz type II.
If there is artifact in Lead I and II, which electrode are you checking? If unsure, how can you be sure?
Right arm. If unsure, tap the electrode (or move it) and refer to the ECG machine to see which leads obtain artifact.
Tell me the proper order for donning and doffing PPE
Donning: hand hygiene, gown, mask, goggles, gloves.
Doffing: gloves, gown, goggles, mask, hand hygiene.