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Medicine: Strobel ACLS Rhythms

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1

what is the path of the cardiac conduction system

SA node to internodal atrial pathways to AV node to AV junction to AV node to Bundle of His to r and l bundle branch to purkinje fibers

2

which limb always has a positive electrode at all times

left foot

3

except in its own lead, what limb lead is always negative electrode

right hand

4

where do all the limb leads project

down to the left leg

5

if the ECG lead (negative to positive) is in the parallel direciton of current what does the ECG read

sharp upstroke

6

if the ECG lead (negative to positive) is in the oblique direction of current what does the ECG read

blunter upstroke

7

if the ECG lead (negative to positive) is in the perpendicular direction of current what does the ECG read

no deflection

8

if the ECG lead (negative to positive) is in the opposite direciton of the current what does the ECG read

sharp downward deflection

9

if the ECG lead (negative to positive) is in the oblique opposite direction of the current what does the ECG read

blunter downward deflection

10

if there is no current flow what does the ECG read

0

11

where does PR segment go from

end of P to beginning of Q

12

where does the PR interval go from

beginning of P to beginning of Q (includes P wave)

13

where does the QRS interval go from

beginning of Q to end of S

14

where does teh ST segment go from

end of S to beginning of T

15

how much time are the small boxes on the ECG

0.04 seconds apiece

16

how much time are the larger segments on the ECG

0.2 seconds

17

what is the P wave synonymous with

atrial excitation

18

what is signified by the PR interval

impulse delay at AV juction

19

what is the QRS complex

electrical excitation of the ventricles

20

what is the T wave

ventricular repolarization

21

what are the pulseless rhythms

v tach
v fib
asystole

22
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what is this rhythm

v tach

23

what is v tach charaterized by

wide complex
regular
fast
no P waves

24
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what is this rhythm

v fib

25

what characterizes v fib

irregular and disorganized ventricular activity

discrete QRS complexes not observed

26

what is asystole

flat line

27

what are the types of tachyarrythmia

supraventricular tachycardia
atrial fib
atrial flutter

28
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what rhythm is this

supraventricular tachycardia

29

is the SVT complex wide or narrow

narrow

30

is SVT regular or irregular

regular

31

is SVT fast or slow

fast

32

are there visible P waves in SVT

no

33

how are AV nodal reentrant tachycardisa terminated acutely

vagal manuevers or adenosine

34
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what is this rhythm

atrial fibrillation

35

how is atrial fibrillation often desribed

"irregularly irregular"

36

are there visible P waves in a fib

no

37

where does baseline go in a fib

everywhere

38
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what rhythm is this

atrial flutter

39

what is the classic pattern of atrial flutter

sawtooth

40

is atrial flutter regular or irregular

can be either

41

what are the brady arrythmias

sinus bradycardia
2,d degree AV block type I (Wenckebach/Mobit I)
2nd degree AV block type II
3rd degree AV block/complete heart block

42

what are the PP intervals like in 2nd degree type I

regular

43

what are the PR intervales like in 2nd degree type I

progressively prolongs until dropped

44

what is characteristic of the QRSs in 2nd degree type I

grouped

45
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what is this

2nd degree AV block type I

46
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what is this

2nd degree AV block type I

47

what happens to PR interval in 2nd degree blok type II

remains contant until dropped or nonconducted beat

48

is there suggestion or other evidence for conduction block system disaese in 2nd degree AV block type II

yes like BBB or 1st degree AV block

49
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what is this

2nd degree block type II

50
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what is t his

3rd degree AV block

51

does complete AV block onset quickly

acute (syncope) or vague (fatigue, dyspnea, dementia)

52

what does complete AV block ECG show

regular but dissociated atrial and vetnrciular activity

53

when does complete heart block with narrow jucntional escape often occur

acute inferior MI

54
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what is this rhythm

sinus rhythm

55
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what is this rhythm

fine vfib

56
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what is this rhythm

sinus tachy

57
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what is this rhythm

a fib?

58
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what is this rhythm

SVT

59
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what is this rhythm

type 1 2nd degree block

60
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what is this rhythm

type 2 2nd degree block

61
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what is this rhythm

type 1 2nd degree block

62

what is a junctional rhythm

an abnormal heart rhythm resulting from impulses coming from a locus of tissue in the area of the atrioventricular node,the "junction" between atria and ventricles.

63
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what is this rhythm

fine v fib

64

what is first degree AV block

when PR interval is lengthened beyond 0.2 seconds

65

what are the bipolar ECG leads

leads I, II, and III

66

what are the unipolar ECG leads

aVR, aVL, aVF

67

what are the precordial ECG leads

V1-V6

68

what leads form the einthoven's triangle

card image

leads I through III

69

what are the unipolar or augmented limb leads

card image

aVR, VL, VF

70

what are the lateral leads

I, aVL, V5, V6

71

what are the inferior leads

II, III, aVF

72

what are the septal leads

V1, V2

73

what are the anterior leads

V3, V4

74

what should we think about with ECG's

speed
amplitude and deflection
calibration

75

how long is the PR interval usually

120-200 msec

76

how long is the QRS interval usually

80-120 msec

77

how long is the QT interval usually

330-420 msec

78

what are the iimportant time intervals in the ECG (one segment, three intervals)

PR int
QRS int
ST seg
QT int

79

what is the 4 step analysis for ECG

rate
rhythm
axis
morphologies

80

what is the stepwise analysis of the morphology of an ECG (wave, complex, 2 intervals and a segment)

P wave
PR interval
QRS complex
ST segment
QT interval

81

what's the triplicate method for HR determination

300, 150, 100
75, 60, 50
43, 38

82

what are the rhythms possible

regular
occasionally irregular
regularly irregular
irregularly irregular

83

what is axis determination quickly done by

looking at lead I and II

84

what does RAD look like in lead I and II

lead I negative with positive lead II

85

what does LAD look like in lead I and II

lead I positive with negative lead II

86

how should progression of P wave evaluation flow

present
regularity
size
P and QRS
upright or inverted
do they all look alike

87

what should be assessed with P waves present rhythms?

sinus or junctional rhtyhm

88

what types of things could be possible in P wave regularity

PAC
sinus arrest

89

what could change P wave size

RA or LA enlargement

90

if there is not one P wave for each QRS what will this be called

AV block

91

if P wavss are inverted what could this signal

sinus rhythm/ectopic atrial rhythm

92

if P waves don't all look alike, what could this signal

multifocal atrial tachycardia

93

what would an abnormal PR interval indicate

1st degree AV block or type I 2nd degree AV block

94

what would an abnormal QRS duration indicate

BBB
IVCD

95

what could ST segment depression indicate

ischemia/hypertrophy

96

what could ST segment elevation indicate

injury/pericarditis/early repol/aneurysm/prinzmetal's angina


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