RHYTHM ANALYSIS
WHAT IS A NORMAL PR INTERVAL RANGE?
0.12-0.20
WHAT IS THE VENTRICULAR RATE OF SINUS TACHYCARDIA?
100-160BPM
WHAT IS THE PURPOSE OF CONTINUOUS CARDIAC MONITORING?
TO ALLOW CONTINUOUS OBSERVATION OF THE HEARTS ELECTRICAL ACTIVITY AND IDENTIFICATION OF ARRHYTHMIAS, EVALUATE PACEMAKER FUNCTION AND MONITOR RESPONSES TO MEDICATIONS (EX: BETA BLOCKERS)
WHAT IS REPRESENTED BY A LOWER CASE LETTER IN RELATION TO THE QRS COMPLEX?
A WAVE OF SMALL AMPLITUDE DEFINED AS <5MM.
WHAT DOES THE QRS CORRESPOND TO IN TERMS OF ELECTRICAL EVENTS?
VENTRICULAR DEPOLARIZATION
IF YOU WANT TO CALCULATE THE ATRIAL RATE WHAT WILL YOU BE MEASURING?
THE INTERVALS BETWEEN P WAVES
WHAT IS THE CORRECT ANATOMICAL PLACEMENT OF THE RIGHT ARM LEAD?
REMEMBER: RIGHT ARM LEAD IS WHITE - WHITE ON THE RIGHT, 2ND INTERCOSTAL SPACE ON THE RIGHT MIDCLAVICULAR LINE
WHAT ELECTRICAL EVENT IS REPRESENTED BY THE T WAVE?
VENTRICULAR REPOLARIZATION
WHAT IS THE MAIN DIFFERENCE BETWEEN SINUS ARRHYTHMIA AND NORMAL SINUS RHYTHM?
RHYTHM IS IRREGULAR IN SINUS ARRHYTHMIA - THIS MEANS THAT THERE IS A DIFFERENCE OF >0.12 OR 3 SMALL BOXES WHEN CALCULATING YOUR R-R INTERVAL
WHICH RHYTHM IS APPROPRIATE FOR YOU TO USE THE RAPID-RATE CALCULATION?
A. SINUS ARRHYTHMIA
B. NORMAL SINUS RHYTHM
C. SINUS TACHYCARDIA
A - AS THE RHYTHM IS IRREGULAR AND YOU CAN ONLY USE THE RAPID-RATE CALCULATION. THE OTHER RHYTHMS ARE REGULAR, THEREFORE THE PRECISE METHOD SHOULD BE USED.
YOUR PATIENT HAS A VERY HAIRY CHEST - WHAT IS THE FIRST STEP IN PREPARING YOUR SKIN FOR ELECTRODE APPLICATION?
CLIP THE HAIR FROM THE SKIN USING CLIPPERS AND WIPE SITE FREE OF DEBRIS - DO NOT SHAVE. SHAVING CREATES MICROABRASIONS IN THE SKIN AND CAN PREDISPOSE YOUR PATIENT TO INFECTION.
TO CIRCULATE THE BLOOD AND PERFUSE THE REST OF THE BODY DURING CARDIAC BYPASS SURGERY
WHICH AUTONOMIC CENTRAL NERVOUS SYSTEM IS RESPONSIBLE FOR INDUCING SINUS BRADYCARDIA?
PARASYMPATHETIC NERVOUS SYSTEM - THE PRIMARY NEUROTRANSMITTER IS ACETYLCHOLINE
WHAT ELECTRICAL EVENT IS REPRESENTED BY THE P WAVE?
ATRIAL DEPOLARIZATION
WHICH ARTERY IS RESPONSIBLE FOR PERFUSING THE INFERIOR WALL FO THE LEFT VENTRICLE IN MOST PEOPLE?
THE RIGHT CORONARY ARTERY
WHICH ARTERY IS RESPONSIBLE FOR PERFUSING THE ANTERIOR 2/3 OF THE INTERVENTRICULAR SEPTUM?
THE LAD - LEFT ANTERIOR DESCENDING
WHY IS SINUS BRADYCARDIA SOMETIMES BENEFICIAL FOR PATIENTS WHO HAVE MYOCARDIAL DAMAGE (EX: MYOCARDIAL INFARCTION)
THE SLOWER HR DECREASES THE WORKLOAD OF THE HEART
WHICH NODE IS RESPONSIBLE FOR DISCHARGING ELECTRICAL IMPULSES IN SINUS RHYTHM ABNORMALITIES? (EX: SINUS TACHYCARDIA AND SINUS ARRHYTHMIAS)
SA NODE
A PATIENT RANG HIS CALL BELL AND IS COMPLAINING OF CHEST PAIN - WHAT IS THE FIRST ACTION YOU SHOULD DO FOR THIS PATIENT?
12 LEAD EKG - THIS WILL EVALUATE THE ELECTRICAL ACTIVITY, THE PATIENTS CARDIAC RHYTHM AND DETERMINE IF THE PATIENT IS HAVING A STEMI (EMERGENCY!).
WHAT IS THE DIFFERENCE BETWEEN SINUS ARREST AND SINUS EXIT BLOCK?
SINUS EXIT BLOCK IS A DISORDER OF CONDUCTIVITY THEREFORE THE UNDERLYING RHYTHM WILL RESUME ON TIME.
SINUS ARREST IS A DISORDER OF AUTOMATICITY THEREFORE THE UNDERLYING RHYTHM WILL NOT RESUME ON TIME.