Perfusion Strips and EKG Interpretation

This set of flashcards covers EKG interpretation units, various cardiac dysrhythmias (Sinus, Atrial, Junctional, and Ventricular), ACLS pharmacological dosages, and nursing interventions for perfusion management.

Small box

A unit of measure on EKG paper equal to $0.04$ seconds.

Large box

A unit of measure on EKG paper, comprised of $5$ small boxes, equal to $0.20$ seconds.

$6$-second strip

A length of EKG strip containing $30$ large boxes.

PR Interval (PRI)

The time required for an impulse to travel from the atria to the ventricles; normally less than $0.20$ seconds ($5$ small boxes).

QRS complex

Represents ventricular depolarization; normally measures between $0.04$ and $0.10$ seconds.

QT interval

The total time for ventricular depolarization and repolarization; normally less than $0.44$ seconds or $11$ small boxes.

ST segment abnormality

A deviation of greater than $1.5$ boxes above or below the isoelectric line, indicating elevation or depression.

Bradycardia

Any rhythm disorder with a heart rate less than $60$ beats per minute, typically less than $50/\text{min}$.

Symptomatic Bradycardia

A heart rate less than $60/\text{min}$ that elicits signs and symptoms due to the slow rate.

Functional (Relative) Bradycardia

A heart rate within normal sinus range that is insufficient for the patient’s condition, such as a rate of $80$ bpm during septic shock.

Atropine

The first drug of choice for symptomatic bradycardia; administered at $0.5$ mg IV push every $3-5$ minutes up to a total dose of $3$ mg.

Dopamine

A second-line chronotropic agent for symptomatic bradycardia used at an infusion dosage of $2-10\text{ micrograms/kg/min}$.

Epinephrine (Bradycardia dose)

An alternative to dopamine for symptomatic bradycardia when atropine is ineffective, dosed at $2-10\text{ micrograms/min}$ via infusion.

Transcutaneous pacing (TCP)

The treatment of choice for symptomatic bradycardia with poor perfusion; contraindicated in patients with hypothermia.

First degree AV block

A conduction disturbance characterized by a PR interval greater than $0.20$ seconds that remains equal throughout the strip.

Atrial Fibrillation (AF)

The most common sustained cardiac arrhythmia, characterized by an irregular rhythm and absent P waves; increases risk for hemodynamic impairment and thromboembolic events.

Ventricular Fibrillation (VF)

Chaotic electrical activity resulting in uncoordinated ventricular contractions and an absence of cardiac output; primary cause is hypoxia.

Defibrillation

The treatment of choice for ventricular fibrillation which should occur as soon as possible.

$2\text{nd}$ Degree AV Block, Mobitz I (Wenkebach)

A rhythm characterized by a cyclical, gradually prolonged PR interval until a QRS complex is dropped.

Ventricular Tachycardia (VT)

Three or more ventricular beats in a row at a rapid rate (e.g., $250$ bpm); can quickly deteriorate into ventricular fibrillation.

ST Segment Depression

An ECG sign of subendocardial ischemia, often seen in Non-ST-elevation myocardial infarction (NSTEMI).

ST Segment Elevation

An ECG sign indicating myocardial injury or transmural MI where ischemia involves the full thickness of the myocardium.

Premature Ventricular Contraction (PVC)

An ectopic beat originating in the ventricle, characterized by a wide and abnormally shaped QRS complex.

Ventricular Bigeminy

A pattern where a premature ventricular contraction (PVC) occurs every other beat.

Asystole

The absence of any cardiac electrical activity (flat line); treated with CPR, oxygen, and Epinephrine ($1.0$ mg IV push q $3-5$ minutes).

Artifact

Disruption in EKG monitoring caused by AC interference, muscle tremors, respiratory movements (wandering baseline), or loose electrodes.

Pulseless Electrical Activity (PEA)

A condition where an organized rhythm is observed on the EKG but does not produce a palpable pulse; most commonly caused by hypovolemia.

Vasopressin

A medication that can be given as a one-time dose of $40$ Units IV/IO to replace the first or second dose of epinephrine in the PEA algorithm.

$3\text{rd}$ Degree AV Block (Complete Heart Block)

A total block of atrial impulses at the AV junction or bundle branches, resulting in independent atrial and ventricular rhythms.

Torsades de Pointes

A form of polymorphic ventricular tachycardia characterized by the QRS complexes "twisting" around the baseline; treated with IV magnesium sulfate.

Supraventricular Tachycardia (SVT)

A rapid heart rate ($> 100$ bpm) originating above the ventricles, often including rhythms like Atrial Flutter and PSVT.

Agonal Rhythm

An EKG pattern associated with a dying heart, characterized by a very slow rate and wide, bizarre QRS complexes.

Junctional Rhythm

A rhythm originating in the AV junction (AV node to bundle of His), often presenting with inverted or hidden P waves.

Standard 5-Lead Placement

White (RA, $2\text{nd}$ ICS), Black (LA, $2\text{nd}$ ICS), Brown (Chest), Green (RL), and Red (LL).