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FCARDIOVASCULAR Aortic: 2 nd ICS, (R) SB Pulmonic: 2 nd ICS, (L) SB Tricuspid: 5 th ICS, (L) SB Mitral: 5 th ICS, (L) MCL S1 – Mitral & Tricuspid valves close S2 – Aortic & Pulmonic valves close I) Management of Patients with Dysrhythmias and Conduction Problems Depolarization (E) – systole (M) (contraction) Repolarization (E) – diastole (M) (relaxation) DIASTOLE IS MORE IMPORTANT Little square 0.04 seconds; Big square 0.2 seconds Isoelectric line (DEAD SPACE) Components of EKG waveform P Wave – SA node - Contraction of Atrium (Duration 0.11 seconds; Height 3 mm) PR – AV conduction time (Duration 0.12 to 0.20 seconds; 3 - 5 small squares) QRS – Contraction of Ventricles (Duration 0.08 – 0.12; 2 - 3 small squares) Q Wave – 1 st downward deflection (MANY TIMES, MAY BE ABSENT) R Wave – 1 st upward deflection (May follow a Q wave, or be present by itself) ST Segment – EXTREMELY IMPORTANT IN DIAGNOSING MI; may be elevated slightly but no more than 1 mm. **ST ELEVATION OR FLAG – Tombstone (death of myocardial tissue) - MI T Wave – “AHH REST” – Ventricular repolarization – If ventricular response if initiated here, such as PVC, V-Tach can occur – USEFUL IN DIAGNOSING ISCHEMIA OR MI **TALL, PEAKED “T WAVE” – HYPER - K ALEMIA QT Interval – Repolarization TIME. Duration is less than ½ the preceding R-R interval. **PROLONGED QT – HYPO - CA LCEMIA U Wave – His-Purkinje system (Repolarization) – Not present on every strip **PROMINENT “U WAVE” – HYPERCA LCEMIA, HYPOK ALEMIA, DIG TOXICITY
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Dysrhythmias – Diagnosed by analysis of ELECTROGRAPHIC waveform Make sure Telipacs are moist with gel – helps with reading of heart conduction Lead II Placement: White is Right – under clavicle Green is Right Brown in Middle - Neutral Black is Left – under my cold heart Red is Left Tips for applying electrodes: 1) Make sure skin is dry (especially if diaphoretic) 2) Clip chest hair 3) Remove excess skin oil WITH ALCOHOL 4) Apply tincture of BENZOIN if keeping electrodes is difficult (Benzoin sticks hard) 5) Connect each lead wire to a disc BEFORE applying it to chest 6) Make sure CENTER of electrode disc is MOIST 7) AVOID applying over: BONY areas, SCAR tissue, MUSCLE mass, SKIN FOLDS, BREAST tissue, HEART APEX. Heart Rate Determination: Count the # of “R Waves” in 6 SECONDS x 10 (6 large blocks x 10 = 1 minute rate) Evaluation of Dysrhythmias: Holter Monitoring – Dr. will apply pads, go home, keep diary – chest pain – (1- 3 days) – go back to Dr. to interpret monitoring. Exercise treadmill testing (Stress Test) Normal Sinus Rhythm – Originates in SA Node – (60 – 100 bpm) Sinus BRADY cardia – HR < 60 is the only abnormality – Atropine all life, pacemaker instead? Causes: Carotid sinus massage Low temperature Increased vagal tone (Constipation) Administration of Parasympathomimetic drugs (metoprolol [Lopressor]) HYPO – thyroid INCREASED ICP Obstructive Jaundice Inferior wall MI Symptoms of BRADY cardia: Low BP; DIZZY Pale, COOL Skin WEAK Chest Pain; SOB Confused; Disoriented (LOC) Treatment of BRADY
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