APII lab practical II

EKG, Heart, Blood, Endocrine, Spirometry

Sinoatrial node

Start of electrical pathway in heart

Internodal pathway

Connection between sinoatrial node and atrioventricular node

Atrioventricular node

rebroadcasts the signal to AV bundle

Atrioventricular bundle

Path of electrical activity after leaving atrioventricular node

Bundle branches

Where atrioventricular bundle forks into two paths

Purkinjie fibers

thin fibers that deliver electrical fiber to cardiac muscle tissue

Lead

a pair of electrodes that measures electrical current in one direction

Lead I (standard)

measures from right arm to left arm

lead II (standard)

measures from right arm to left leg

lead III (standard)

measures from left arm to left leg

what direction does electricity flow?

negative to positive

Which one of the 3 standard leads measures electrical activity in the same direction as the orientation of the heart?

II

What plane do the 3 standard leads measure electrical activity in?

coronal/frontal plane

What happens when a patient needs a thorough cardiac work-up?

12 lead EKG

3 standard leads + 3 argumented leads + 6 precordial lead

What plane does the argumented lead measure electrical activity in?

Coronal/Frontal

Argumented leads

Center out: aVF, aVL, aVR

aVR lead

CT (center) to right shoulder

aVL

Center (CT) to left shoulder

aVF

Center (CT) down

6 precordial leads (chest leads) placement

V1 - under median end of right clavicle under 4th rib

V2 - under median end of left clavicle under 4th rib

V3 - directly lateral to V2 on 5th rib

V4 - on mid clavicle line in 5th intercostal space

V5 - on side of chest in line with V4

V6 - under arm on side of torso in line with V5

ECG standard grid paper measurement

1 second = 25mm

1 small ECG box =

0.04 sec

in height 1 small ECG box =

0.1 mv

one big box = 5 small boxes. How long?

0.04×5=0.2 sec

How many big ECG boxes in 1 sec?

5

What is the p wave?

atrial depolarization

How long should the p wave be?

0.12 sec or less

what is the QRS complex

ventricular depolarization

How long should the QRS complex last

0.08 sec or less

What is the T wave?

Ventricular repolarization

Where should the T wave start and why?

isometric baseline because there is no current in heart during this wave

What is the PR interval?

indictive of how long it takes for signal to travel from SA node and be rebroadcasted from AV node

How long should the PR interval be?

0.2 sec

P-P or R-R interval

goes from start of one to start of next

helps determine heart rate

ST segment

If elevated indicates MI

from start of P wave to start of QRS complex

PR interval

from end of P wave to start of QRS complex

PR segment

QRS complex

from start of Q wave to end of S wave

from start of QRS complex to end of T wave

QT interval

From end of QRS complex to start of T wave

ST segment

steps of determining heart rate from ECG graph

1) count up small boxes in P-P or R-R interval

2) multiply this number by 0.04

3) divide 60 by answer to 2

Sinus Rhythm

normal heart rate

slower than normal heart rate

Sinus Bradycardia

faster than normal heart rate

Sinus Tachycardia

Irregularly irregular ECG

atrial fibrillation

normal ECG pattern

regularly regular

Regularly irregular

incorrect wave pattern but predictable timing (consistent P-P/R-R)

Irregularly regular

Normal Wave pattern, not consistent P-P or R-R

Irregularly irregular

completely unpredictable

Graph of squiggles

Ventricular fibrillation

Ventricular tachycardia

hill like ECG

Heart block

long pauses in ECG

Premature ventricular contraction (PVC)

sharp downward spike in ECG

Spirometry

A voluntary test regarding the strength of the inspiratory and expiratory muscles of the patient as well as the lungs ability to stretch and recoil

what does SVC stand for

Slow vital capacity test

What does FVC stand for

Forced vital capacity test

Tidal volume

Volume inhaled or exhaled in a quiet breath (~500ml)

Inspiratory reserve volume

Volume inhaled beyond a normal tidal inhalation (max)

Expiratory reserve volume

Volume Exhaled beyond a normal tidal inhalation (max)

Residual volume

volume of air left after maximal exhalation

Functional residual capacity

amount of air remaining after quiet exhalation

Inspiratory capacity

Air we can inhale after quiet exhalation

Vital capacity

Maximum amount of voluntarily movable air

Total lung capacity

Maximum air lungs can hold

What is the equation for Functional residual capacity

FRC = ERV + RV

What is the equation for vital capacity

VC = TV + IRV + ERV

What is the equation for total lung capacity

TLC = TV + IRV + ERV + RV

What is the equation for inspiratory capacity

IC = TV + IRV

FEV1

Air exhaled after 1 sec

PIF

peak inspiratory flow. fastest moving air in (neg side)

PEV

peak expiratory flow. fastest moving air out (pos side)

Restrictive lung pathology

FVC would be small

FEV1 would be low

FEV1/FVC would be 75%+

SVC would be small

Obstructive lung pathology

FVC would be normal

FEV1 would be low

FEV1/FVC would be <75%

SVC would be normal

What are these?

Erythrocyte

What are these?

Thrombocyte

What is this?

Monocyte

What is this?

Neutrophil

What is this?

Basophil

What is this?

Eosinophil

What is this?

Lymphocyte

What is sound one when using a stethoscope?

Closing of atrioventricular valves

What is sound Two when using a stethoscope?

Closing of semilunar valves

What is the average pulse rate?

70-74 bpm

What is the normal range for resting pulse?

60-100 bpm

What are the blood pressure units?

mm/Hg (millimeters of mercury)

what is a typical blood pressure?

<120/80

What is the blood pressure cuff called?

Sphygmomanometer

What is the top blood pressure number?

Systolic pressure (action)

What is the bottom blood pressure number?

Diastolic pressure (relax)

What is the first sound heard when taking blood pressure?

Korotkoff sound (systolic pressure)

What is the last sound heard when taking blood pressure?

Diastolic pressure (still a Korotkoff sound)

Pulse pressure equation

PP = SP - DP (30-50 normal)

What is equation for mean arterial pressure?

MAP = DP + 1/3 PP (> or equal to 60 mmHg good)

Normal female hematocrit range

35-45%

Normal male hematocrit range

43-55%

what antibody does type A blood have

Anti B

what antibody does type B blood have

Anti A

what antibody does type AB blood have

none

what antibody does type O blood have

Anti A and anti B

type A + can donate to?

A+ or AB+