clotting & ECGs

3 lead ecg

lead I: lateral view and upright waveform, shows current moving from right to left

lead II: views superior to inferior, most upright QRS and prominent P waves, current moving from SA nodes to ventricles

lead III: views superior to inferior upright waveform, looks at inferior wall

3 lead ECG

remember: white on right, smoke over fire

5 lead ECG

white on right, clouds over grass, smoke over fire

12 lead ECG

records 12 different views and provides a complete picture

• a diagnostic test to identify pathological conditions

heart rate determination

recommended: coutning R waves over 6 seconds and multiply by 10

• 300 method only works for regular rhythms

normal sinus rhythm

• PR: 0.16-0.2

• QRS: 0.06-0.12

• QT: 0.36-0.44

clotting

blood is converted from liquid to semi solid gel

• usaully starts when veins and arteries are injured

• may become impaired when clotting factors are not available or if blood clots forms when they are not physiologically indicated

clotting process

1. vasoconstriction

2. platelet plug(von Willebrand’s factor)

3. clotting factors→ clot formation

anticoagulants

• heparin- antidote= protamine sulfate

• LMWH→ tinzaparin, lovenox, dalteparin

• direct oral anticoagulants(DOACs): dabigatran, anisidine, apixaban

• warfarin/coumadin→ common s/e: prolonged bleeding, bruising

antiplatelets

• ASA

• clopidogrel(plavix)

fast acronym for Strokes

Face→ dropping

Arms→ weakness, can they raise their arms

Speech→ slurred, difficulty speaking

Time→ call 911 ASAP

warfarin and heparin antidotes

heparin antidote= protamine sulfate

warfarin antidotes= vitamin K

coagulation lab values

• Prothrombin time(PR): 10-13.5 seconds

• International normalized ratio(INR)→ 0.8-1.2 seconds(1-2) , critical= >5 seconds

• aPTT or PTT(activated partial thromboplastin time)→ 24-35 seconds, critical >150 seconds, therapeutic range for heparin 65-90 seconds

• anti-Xa assay→ prophylaxis= 0.1- 0.3 U/mL

• therapeutic range for DVT→ 0.3-0.7 U/mL (unfractionated)

• 0.4-1.1 U/mL for LMWH

bleeding

• 40% loss: hypotension, tachypnea, cold clammy skin

• 50% loss: hemorrhage shock and death

pulmonary embolism

• shortness of breath

• chest pain

• tachycardia

• sweating

• anxiety

• coughing

myocardial infarction

• chest pain

• shortness of breath fatigue

clotting cascade

PT= extrinsic pathway

aPTT=intrinsic pathway