sodium channels close and sodium becomes the major intracellular ion

potassium begins to without

potassium is back in to cell

as sodium and calcium exits

what is inherent rate of the Purkinje fibers?

if it life sustainable?

40 BPM

NO

electrolyte imbalance

altered tissue perfusion

hypovolemia

from the beginning of the P wave to the end of the PR segment.

It normally measures from 0.12 to 0.20 second

(five small blocks max).

It is measured from the beginning of the QRS complex to the J point (the junction where the QRS complex ends and the ST segment begins).

It normally measures from 0.04 to 0.10 second

(up to three small blocks).

It occurs from the J point (the junction where the QRS complex ends and the ST segment begins) to the beginning of the T wave.

Its length varies

Measure the PR interval.

How should it be measured?

What should the measurment be?

Place one caliper point at the beginning of the P wave and the other point at the end of the PR segment.

The PR interval normally measures between 0.12 and 0.20 second. about 3 small boxes no more then 5

Measure the QRS duration.

 How should it be measured?

What should the measurment be?

Place one caliper point at the beginning of the QRS complex and the other at the J point, where the QRS complex ends and the ST segment begins.

The QRS duration normally measures between 0.04 and 0.10 second. about two small boxes

all intervals are normal (the P the QRS and the ST segments are all within normal limits)

the beat occurs early therefore it has an regular rhythm

absent P wave

abnormally shaped QRS segment

QRS segment wider than normal

> 5 per minute

multifocal

a PVC that occurs during the T segment

this indicates a high risk for developing V fib or V tach

absent P wave

no discernible QRS

erratic electrical impulse

medications such as epinephrine, lidocaine, and atropine need to be given before defibrillation is attempted.

It is mostly considered an unshakable rhythm

often times irreversible

first-degree heart block

second degree heart block ( type I and type II)

third-degree heart block

PR interval >.20 sec

(five small boxes)

what a common characteristics of second degree heart block type 1

P to P interval is normal

P-R interval widens and widens, until QRS is dropped altogether.

P-P interval is normal

PR interval does not increase

QRS spontaneously dropped

P – P interval is regular with a rate of 60-100

R-R is regular with the rate of < 60

no correlation P wave to QRS

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

Which leads give you an anterior view of the heart?

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

I, AVL

V3, V4

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

Which leads give you an inferior view of the heart?

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

II, III, AVF

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

Which leads give you an septal view of the heart?

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

V1, V2

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

Which leads give you an lateral view of the heart?

__I  AVR  V1  V4

_II   AVL   V2  V5

III   AVF   V3  V6

V5 V6 

must Exhibit 2/3

chest pain

changing EKG

elevated enzymes

transmeural

subendocardial

Stemi Q waves

indicates damage to the entire thickness of muscle wall

non-stmi

only damages inner wall

a down ward dEFLECTION in s-t segment >1x1 box 

(smily face)

Just for fun :)

enjoy

ST segment is elivated 

(frowning)

pathologic Q wave (wide and deep)- only on full thickness

Permint T wave inversion- all types

A- secure air way, assess stability

B- breathing either mechanically or supportive O2

C- circulation EKG, BP, MEDS: MONA

D- diagnoses labs etc

Totial myogloben 

Myogloben MB type 1 and 2

Q8 x 3

Streptokinase

Reteplase

t-PA ( CAN CAUSE V-FIB/TACH)

TNK-ase 

Alteplase

Eptifabatide

Tirofiban

Abciximab

adenosine

digoxin

calcium channel blockers

beta blockers

Mexiletine

Tocainide

propafenone

amiodarone

Bretylium

sotalol

lidocaine

increase contactility 

decrease rate

increase contractility 

increase rate

Digoxin

levophed

Epinephrine

dopamine

Amrinone

doubutamine

isoproternol

↓ rate

↓ contractility

propranolol

atenolol

vasoconstrict

↑ BP

dopamine

dobutamine

epinephrine

vasopressine

nitropresside

nitroglycerine

papaverine

milrinone

aCEinhiiters- (prill)

Ca blockes- (pine)

succinylcholine

used forintubation

pancuronium

vecuronium

cistacurium

A-fib

V-tach

V-fib

asystole

no qrs

a nurse is caring for a clientwith an implantable cardio defibrillator (ICD). the client develops symptoms of ventricular tachycardia but does not convert with the ICD.

what is the nurse's best action

administering IV antibiotics

(Oser's nodes are a key feature of infectious endocarditis)

high pulmonary wage pressures

(the mitral valve is located between the left atria and the right ventricle. When the valve fails, blood backs up into the left atrium and then into the pulmonary bed increasing pulmonary wedge pressures)

CVP ↑

PCWP↑

SVR↑

HR ↑

CO, LVSWI, BP↓

the client had an MI yesterday. The nurse notices ventricular fibrillation cardiac monitor. Which intervention takes priority.

assess the client

call physician

call a code

defibrillate the patient

hypotension with narrow pulse pressure

muffled heart sounds

JVD

tachycardia

decrease cardiac output

increased right arterial pressure

ST segment elevation

your patient's EKG shows large ST elevation, T waves changes, and deep Q w waves in leads V1 through V4.

Why injury should nurse suspect and in what area of the heart

myocardial infarction

anterior septal

1. initiate basic life support

2. defibrillate

3. Receiving CPR for five cycles

4. Check rhythm repeat shock if needed

5. Administer epinephrine

if patient has first-degree atrioventricular heart block. 

The nurse should expect to find a PR interval of:

if patient who received a transplant one year ago is having episodes of syncope, has complete heart block, heart rate of 30, but pressure 70/40 and is very drowsy.

what intervention should the nurse anticipate for this patient

the patient reports chest discomfort EKG shows ST segment elevation in leads II, III and AVF.

What is the suspected diagnosis and in which area of the heart

myocardial injury

inferior wall

2 joules/kg for first attempt

doubled for second and third attempt