Rhythm Master 2 (Powerpoint) - 45 Mins - EMT-p

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Rhythm Master 2 (Powerpoint) - 45 Mins - EMT-p - Quiz

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Questions and Answers
  • 1. 

    Description This is the normal heart rhythm. It originates in the SA node and follows the appropriate conduction pathways. The rate is normal, and the rhythm is regular. Every beat has a P wave, and every P wave is followed by a ventricular response. EKG Criteria Rate: 60-100 bpm. Rhythm: Regular. A normal variant called Sinus Arrythmia changes rhythm in response to respiration. This is seen most often in young healthy people. Pacemaker: Each beat originates in the SA node. P wave: look the same, all originate from the same locus (SA node) PRI: 120-200 msec QRS: 80-120 msec, narrow unless effected by underlying anomoly

    Explanation
    Normal Sinus Rhythm (NSR) is the correct answer for this question. NSR is the normal heart rhythm that originates in the SA node and follows the appropriate conduction pathways. The rate is normal, ranging from 60-100 bpm, and the rhythm is regular. Each beat originates in the SA node, and every beat has a P wave followed by a ventricular response. The P waves look the same and all originate from the same locus (SA node). The PRI is between 120-200 msec and the QRS duration is between 80-120 msec, which is narrow unless there is an underlying anomaly.

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  • 2. 

    Description Sinus bradycardia originates in the SA node. It has reduced rate generally from a reduction in sympathetic input, or excessive vagal (parasympathetic) tone. This rhythm may accompany inferior MI's, hypoxia, hypothermia, or drug reactions. At moderately slow rates, the patient may be asymptomatic. At slower rates, they may become hypotensive and present with symptoms consistant with decreased perfusion: dizziness, syncope, shock like signs and symptoms. Treatment is aimed at increasing the heart rate. Therapies include atropine, transcutaneous and transvenous pacing, epinephrine, dopamine, isoproterenol. EKG Criteria Rate: <60 bpm. Rhythm: Regular generally. Pacemaker: SA node P wave: Present, all originating from SA node, all look the same. PRI: <200 msec, and constant. QRS: Normal, 80-120 msec.

    Explanation
    Sinus bradycardia is a condition characterized by a slow heart rate originating from the SA node. It is typically caused by a decrease in sympathetic input or an increase in parasympathetic (vagal) tone. This rhythm can be seen in various conditions such as inferior myocardial infarctions, hypoxia, hypothermia, or drug reactions. The patient may be asymptomatic at moderately slow rates, but at slower rates, they may experience symptoms of decreased perfusion such as dizziness, syncope, or signs of shock. Treatment for sinus bradycardia aims to increase the heart rate and may include interventions like atropine, pacing, or administration of medications like epinephrine or dopamine. The EKG criteria for sinus bradycardia include a heart rate of less than 60 bpm, regular rhythm, SA node as the pacemaker, presence of P waves originating from the SA node, constant PRI (less than 200 msec), and a normal QRS duration of 80-120 msec.

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  • 3. 

    Description This arrythmia originates from the SA node. It is defined as a sinus rhythm exceeding 100 bpm. Sinus tach is a normal rhythm which occurs in response to increased oxygen demand. This occurs with exercise, infection, hypovolemia, hypoxia, myocardial infarct, and in response to stimulant drugs, The rate usually has a gradual onset and elimination. Treatment is not usually needed, but is aimed at treating the underlying condition. EKG Criteria Rate: >100 bpm. Rhythm: Regular, generally. Pacemaker: SA node. P wave: Present and normal, may be buried in T waves in rapid tracings. PRI: 120-200 msec., generally closer to 120 msec. QRS: Normal.

    Explanation
    Sinus tachycardia is a type of arrhythmia that originates from the SA node and is characterized by a sinus rhythm exceeding 100 bpm. It is considered a normal response to increased oxygen demand in the body, which can occur during exercise, infection, hypovolemia, hypoxia, myocardial infarction, or in response to stimulant drugs. Sinus tachycardia usually has a gradual onset and elimination. Treatment is typically not required, as it is aimed at addressing the underlying condition causing the increased heart rate. On an EKG, sinus tachycardia is characterized by a rate exceeding 100 bpm, regular rhythm, normal P waves (which may be buried in T waves in rapid tracings), a PRI of 120-200 msec (generally closer to 120 msec), and normal QRS complexes.

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  • 4. 

    Description These complexes originate in the atria. They often originate from ectopic pacemaker sites within the atria which results in an abnormal P wave. The complex occurs before the normal beat is expected, hence the prematurity. It is followed by a pause. There are many causes including: increased sympathetic input, exogenous stimulants, drug interactions, AMI, cardiac ischemia, idiopathic. These complexes can indicate increased automaticity. They may lead to re-entry rhythms. EKG Criteria Rate: Underlying rhythm. Rhythm: Irregular with PACs. Pacemaker: Ectopic atrial pacemaker outside SA node. P wave: Ectopic P wave present, generally different than normal SA P wave. PRI: Generall normal range 120-200 msec, but differ from underlying rhythm. QRS: Same as underlying rhythm.

    Explanation
    Premature Atrial Complexes (PACs) originate in the atria and often come from ectopic pacemaker sites within the atria, resulting in an abnormal P wave. PACs occur before the expected normal beat, causing prematurity, and are followed by a pause. They can be caused by increased sympathetic input, exogenous stimulants, drug interactions, AMI, cardiac ischemia, or be idiopathic. PACs indicate increased automaticity and may lead to re-entry rhythms. On an EKG, the rate is determined by the underlying rhythm, the rhythm is irregular with PACs, and the pacemaker is an ectopic atrial pacemaker outside the SA node. The P wave is ectopic and different from the normal SA P wave, while the PRI and QRS are the same as the underlying rhythm.

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  • 5. 

    Description This is the most common sustained cardiac arrhythmia. It is characterized by an undulating baseline replacing P waves and an irregularly irregular ventricular response. This arrhythmia occurs with hypertension, ischemic, mitral, myocardial and pericardi al disease, thyrotoxicosis, aging and sometimes occurs in normals. Treatment includes anticoagulation, drugs to slow ventricular conduction and/or cardioversion EKG Criteria Undulating baseline replaces P waves Rhythm: Irregularly irregular

    Explanation
    Atrial fibrillation, also known as A-Fib, is the most common sustained cardiac arrhythmia. It is characterized by an undulating baseline replacing P waves and an irregularly irregular ventricular response. This arrhythmia can occur due to various factors such as hypertension, ischemic, mitral, myocardial and pericardial disease, thyrotoxicosis, aging, and sometimes in individuals with no underlying conditions. Treatment for atrial fibrillation includes anticoagulation, drugs to slow ventricular conduction, and/or cardioversion.

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  • 6. 

    Description This is the most common sustained cardiac arrhythmia. It is characterized by an undulating baseline replacing P waves and an irregularly irregular ventricular response. This arrhythmia occurs with hypertension, ischemic, mitral, myocardial and pericardi al disease, thyrotoxicosis, aging and sometimes occurs in normals. Treatment includes anticoagulation, drugs to slow ventricular conduction and/or cardioversion EKG Criteria Undulating baseline replaces P waves Rhythm: Irregularly irregular

    Explanation
    This arrhythmia is characterized by an undulating baseline replacing P waves and an irregularly irregular ventricular response. It is the most common sustained cardiac arrhythmia and can occur with various conditions such as hypertension, ischemic, mitral, myocardial and pericardial disease, thyrotoxicosis, aging, and sometimes in individuals without any underlying conditions. Treatment for atrial fibrillation includes anticoagulation, drugs to slow ventricular conduction, and/or cardioversion. Therefore, the correct answer is Atrial Fibrillation (A-Fib).

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  • 7. 

    Description Atrial flutter is characterized by "sawtooth" atrial activity and a conduction ratio to the ventricles of 2:1 to 8:1. It is caused by a reentrant circuit located in the right atrium. It may occur when the atria are enlar ged in chronic obstructive lung disease, mitral or tricuspid disease, pericarditis or post-operatively. Definitive treatment is direct-current cardioversion, surgical or catheter ablation. EKG Criteria Rate: 250 - 350 bpm (atrium) Rhythm: Atrial rate regular, ventricular conduction 2:1 to 8:1 Pacemaker: Reentrant circuit rhythm located in the right atrium P wave: Saw-tooth or picket fence PRI: Constant onset

    Explanation
    Atrial flutter is characterized by "sawtooth" atrial activity and a conduction ratio to the ventricles of 2:1 to 8:1. It is caused by a reentrant circuit located in the right atrium. It may occur when the atria are enlarged in chronic obstructive lung disease, mitral or tricuspid disease, pericarditis or post-operatively. Definitive treatment is direct-current cardioversion, surgical or catheter ablation. The EKG criteria for atrial flutter include a rate of 250-350 bpm in the atrium, regular atrial rhythm, ventricular conduction ratio of 2:1 to 8:1, a reentrant circuit rhythm located in the right atrium, and a characteristic saw-tooth or picket fence P wave pattern.

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  • 8. 

    Description There are several different types of SVT depending on the site of reentry (accessory pathway, atrioventricular node or atrium). This rapid rhythm starts and stops suddenly. Treatment includes vagal maneuvers, antiarrhythmia medication, radio-frequency ablation or surgical modification of site of reentry. \par }\pard \s15\widctlpar\adjustright {EKG Criteria \par Rate: \par Rhythm: \par Pacemaker: \par PRI: \par \par Atrium - Normal or prolonged (>200 msec) \par QRS: \par }} EKG Criteria Rate: 140 - 220 bpm Rhythm: Regular Pacemaker: Reentry circuit Accessory pathway: Normal or short (if down accessory pathway) A-V nodal reentry: Hidden in or at end of QRS PRI: Depends on location of circuit QRS: Normal if accessory pathway used - prolonged (>120 msec) with delta wave

    Explanation
    The correct answer is Supraventricular Tachycardia (SVT). This is indicated by the EKG criteria provided, which includes a rate of 140-220 bpm, regular rhythm, and a pacemaker that is a reentry circuit. Additionally, the criteria mentions that the QRS may be normal or prolonged, depending on the location of the circuit.

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  • 9. 

    Description Adenosine, given as a rapid intravenous bolus, can produce a potent vagal effect and convert supraventricular tachycardia in a few seconds. Side effects include flushing, bronchospasm and short-lived high-grade atrioventricular block.

    • A.

      SUPRAVENTRICULAR TACHYCARDIA CONVERTED WITH ADENOSINE

    • B.

      V-Fib

    • C.

      A-Fib

    Correct Answer
    A. SUPRAVENTRICULAR TACHYCARDIA CONVERTED WITH ADENOSINE
    Explanation
    Adenosine is known to have a potent vagal effect, meaning it stimulates the vagus nerve which can slow down the heart rate. In the case of supraventricular tachycardia (SVT), where the heart beats too fast due to abnormal electrical signals, adenosine can be used to convert it back to a normal rhythm. This is achieved by administering adenosine as a rapid intravenous bolus, which means a quick injection directly into the vein. The side effects mentioned, such as flushing, bronchospasm, and high-grade atrioventricular block, are known adverse effects of adenosine administration. Therefore, the correct answer is that the supraventricular tachycardia was converted with adenosine.

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  • 10. 

    Description These premature complexes originate in the atrioventricular junction. Retrograde conduction through the atria may cause an inverted P wave in Lead 2. Integrate conduction may be normal (<120 msec). Common etiologies include ischemia, hypoxemia, valvular disease, digitalis or normal variant. EKG Criteria Rate: Underlying rhythm Rhythm: Irregular with PJC's Pacemaker: Ectopic junctional pacemaker P wave: If present, negative in Lead 2 PRI: 120 msec or less QRS: 80-120 msec, unless prolonged by aberrant conduction

    Correct Answer
    PREMATURE JUNCTIONAL COMPLEXES
    PJC
    Explanation
    Premature Junctional Complexes (PJC) are ectopic beats that originate in the atrioventricular junction. They can cause an irregular rhythm with inverted P waves in Lead 2 due to retrograde conduction through the atria. The rate of the underlying rhythm remains the same, and the P wave, if present, is negative in Lead 2. The PR interval is typically 120 msec or less, and the QRS duration is usually between 80-120 msec, unless prolonged by aberrant conduction. Common causes of PJC include ischemia, hypoxemia, valvular disease, digitalis, or it may be a normal variant.

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  • 11. 

    Description An escape beat serves as a protective mechanism when higher centers in the conducting system fail to fire. Junctional escapes are recognized by their unchanged or only slightly changed QRS complex ending a cardiac cycle longer than the dominant cycle. This rhythm occurs with increased vagal tone to the sinoatrial node, hypoxemia, and digitalis toxicity. EKG Criteria Rate: 40 - 60 bpm Rhythm: Regular Pacemaker: Atrioventricular junction P wave: If present, negative in lead 2 PRI: 120 msec or less QRS: 80 -120 msec, unless prolonged by aberrant conduction

    Correct Answer
    JUNCTIONAL RHYHTM
    Explanation
    A junctional rhythm occurs when the atrioventricular (AV) junction takes over as the pacemaker of the heart. This can happen when the higher centers in the conducting system fail to fire. In a junctional escape beat, the QRS complex at the end of the cardiac cycle is either unchanged or only slightly changed compared to the dominant cycle. The rate of a junctional rhythm is typically between 40 and 60 beats per minute. This rhythm can be seen in conditions such as increased vagal tone to the sinoatrial node, hypoxemia, and digitalis toxicity. The P wave, if present, is negative in lead 2, the PRI is 120 msec or less, and the QRS duration is 80-120 msec, unless prolonged by aberrant conduction.

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  • 12. 

    Description Conduction disturbances are characterized as first degree, second degree Mobitz 1, second degree Mobitz II and complete heart block. The normal P-R interval is 120 - 200 msec. First degree AV block is a constant and prolonged PR interval. Possible etiologies include insult to AV node, hypoxemia, myocardial infarction, digitalis toxicity, ischemia of the conduction system and increased vagal tone but is also seen in normals. EKG Criteria Rhythm: Regular PRI: >200 msec

    Correct Answer
    FIRST DEGREE AV BLOCK
    Explanation
    First-degree AV block is characterized by a constant and prolonged PR interval on an EKG. This means that there is a delay in the conduction of electrical signals from the atria to the ventricles. Possible causes of first-degree AV block include insult to the AV node, hypoxemia, myocardial infarction, digitalis toxicity, ischemia of the conduction system, and increased vagal tone. However, first-degree AV block can also be seen in individuals with no underlying medical conditions. The correct answer, therefore, is first-degree AV block.

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  • 13. 

    Description Wenkebach is characterized by progressive delay at the AV node until the impulse is completely blocked. Etiologies are the same as cause first degree AV block and is also seen in normals. This conduction abnormality does usually not progress to higher degree heart blocks. EKG Criteria Rhythm: Irregular PRI: Progressive lengthening of PRI until dropped beat. A clue to Wenckebach is that the QRS's appear to occur in groups.

    Correct Answer
    SECOND DEGREE AV BLOCK MOBITZ I
    (WENKEBACH)
    Explanation
    Wenckebach, also known as Second Degree AV Block Mobitz I, is characterized by a progressive delay at the AV node until the impulse is completely blocked. This can be seen on an EKG by a progressive lengthening of the PRI until a dropped beat occurs. A clue to Wenckebach is that the QRS complexes appear to occur in groups. This conduction abnormality is caused by similar etiologies as first degree AV block and can also be seen in individuals with normal hearts. However, it typically does not progress to higher degree heart blocks.

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  • 14. 

    Description This is a higher degree of conduction block then Mobitz I and may progress to complete AV block. AV conduction appears normal until suddenly there is no AV conduction following one P wave. This may occur in a pattern (every 2nd, 3rd or 4th complex) or may occur randomly. This is intermittent block at the AV node and may progress to complete heart block. EKG Criteria PRI: Constant on conducted complexes until a sudden block of AV conduction. That is, a P wave is abruptly not followed by a QRS

    Correct Answer
    SECOND DEGREE AV BLOCK MOBITZ II
    Explanation
    Second-degree AV block Mobitz II is characterized by intermittent block at the AV node, where AV conduction appears normal until suddenly there is no AV conduction following one P wave. This can occur in a pattern or randomly, such as every 2nd, 3rd, or 4th complex. It is a higher degree of conduction block than Mobitz I and has the potential to progress to complete AV block. On an EKG, the PR interval is constant on conducted complexes until a sudden block of AV conduction occurs, where a P wave is abruptly not followed by a QRS complex.

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  • 15. 

    Description Third degree AV block is total lack of conduction through the AV node. The rate and the interval between the QRS depend upon the origin of the escape mechanism. This conduction defect is dangerous and may progress to ventricular standstill. Treatment is an artificial ventricular pacemaker. EKG Criteria P wave: Independent P waves and QRS's with no relationship with the two (AV dissociation) QRS: The QRS is normal in duration and slow (40-60 msec) with junctional escape rhythm. The QRS is wide (>120 msec) and slower (30-40 bpm) with ventricular escape rhythm.

    Correct Answer
    THIRD DEGREE AV BLOCK
    Explanation
    Third degree AV block, also known as complete heart block, is a condition where there is a total lack of conduction through the AV node. This means that the electrical signals from the atria do not reach the ventricles, leading to an independent rhythm between the two. The P waves and QRS complexes have no relationship with each other, resulting in AV dissociation. In this condition, the QRS complexes can be normal in duration and slow (40-60 msec) with a junctional escape rhythm, or they can be wide (>120 msec) and slower (30-40 bpm) with a ventricular escape rhythm. Third degree AV block is a serious condition that may progress to ventricular standstill and requires treatment with an artificial ventricular pacemaker.

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  • 16. 

    Description A PVC is a depolarization that arises in either ventricle before the next expected sinus beat. The normal sequence of depolarization is altered because the impulse originates in the ventricle. The two ventricules depolarize sequentially insteat of simultaneously. Conduction moves more slowely than through the specialized conduction pathways, this results in a widened QRS complex (greater than 0.12 sec). PVCs may occur as isolated complexes or may occur in pairs, triplets, or in a repeating sequence with normal QRS complexes. Three or more PVCs in a row is considered a run of Ventricular Tachycardia. If it lasts for more than 30 seconds it is designated sustained VT. Treatment: Rarely treated unless symptomatic. PVCs may indicate acute mycardial ischemia requiring rapid intervention including oxygen, NTG, morphine, thrombolytic. Treating with lidocaine will cease the PVC, but won't address the ischemic cause. EKG Criteria Rhythm: Irregular QRS: Is not normal looking. Broadened, greater than 0.12 seconds. P waves are usually obscured by the QRS, ST segment, or T wave of the OVC. The P wave may sometimes be seen as notching during the ST segment or T wave.

    Correct Answer
    PREMATURE VENTRICULAR CONTRACTIONS
    PVC
    Explanation
    Premature ventricular contractions (PVCs) are abnormal depolarizations that occur in the ventricles before the next expected sinus beat. This disrupts the normal sequence of depolarization and causes the ventricles to depolarize sequentially instead of simultaneously. As a result, the QRS complex on the EKG appears widened, lasting longer than 0.12 seconds. PVCs can occur as isolated complexes or in pairs, triplets, or repeating sequences. If there are three or more PVCs in a row, it is considered ventricular tachycardia. PVCs are rarely treated unless symptomatic, but may indicate acute myocardial ischemia requiring intervention. The EKG criteria for PVCs include an irregular rhythm, broadened QRS complex, and obscured P waves.

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  • 17. 

    Description PVC's may occur in patterns. When each normal complex is followed by a PVC forming groups of 2, the term "ventricular bigeminy" is used. EKG Criteria QRS: Normal QRS complex followed by premature wide bizarre complex (PVC) in patterns of 2

    Correct Answer
    BIGEMINY PVCs
    Explanation
    The correct answer is "BIGEMINY PVCs". This term is used to describe a pattern of PVCs where each normal QRS complex is followed by a PVC, forming groups of two. The QRS complex is normal and is followed by a premature wide bizarre complex, which indicates the presence of a PVC. This pattern is referred to as "ventricular bigeminy" in EKG criteria.

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  • 18. 

    Description Ventricular Tachycardia (VT) is defined as three or more beats of ventricular origin in succession at a rate greater than 100 beats per minute. There are no normal (narrow) looking QRS complexes. Consequences of VT depend on accompanying myocardial dysfunction. It may be well tolerated or associated with life-threatening hemodynamic compromise. Treatment: If patient is stable, they are initially treated with lidocaine, procainamide, or bretylium tosylate. Hemodynamically unstable VT (with a pulse) is cardioverted at 200J, 300J, 360J as needed. VT without a pulse is treated like VF and defibrillated. EKG Criteria No normal looking QRS complexes, often bizzare with notching. Width of QRS>0.12 sec. ST segment and T wave are opposite polarity to the QRS. Sinus node may be depolarizing normally. There is usually complete AV dissociation. P waves are sometimes seen between QRS complexes. They have no impact on the QRS complexes. Rate: Generally 100 to 220 bpm Rhythm: Generally regular, on occassion can be modestly irregular.

    Correct Answer
    VENTRICULAR TACHYCARDIA
    Explanation
    Ventricular tachycardia (VT) is a condition characterized by three or more consecutive beats of ventricular origin at a rate greater than 100 beats per minute. In VT, there are no normal-looking QRS complexes, and the QRS complexes are often bizarre with notching. The width of the QRS complex is greater than 0.12 seconds, and the ST segment and T wave are opposite in polarity to the QRS complex. VT can be well tolerated or can lead to life-threatening hemodynamic compromise, depending on accompanying myocardial dysfunction. Treatment involves medications such as lidocaine, procainamide, or bretylium tosylate for stable patients, and cardioversion or defibrillation for unstable patients.

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  • 19. 

    Description Ventricular escape rhythm is a protective escape mechanism when higher centers in the conducting system fail to conduct to the ventricle. Ventricular escapes are recognized by the slow rate, wide QRS, and absence of preceding P waves. A slow ventricular escape rhythm is an ominous sign. Treatment is an artificial ventricular pacemaker. EKG Criteria Rate: 40 bpm Rhythm: Regular P wave: Regular if present PRI: If present, varies (no relationship to QRS complex [AV dissociation]) QRS: QRS interval >120 msec wide and bizarre

    Correct Answer
    IDIOVENTRICULAR RHYTHM
    Explanation
    Idioventricular rhythm is a type of ventricular escape rhythm where the ventricles take over as the primary pacemaker of the heart. It occurs when the higher centers in the conducting system fail to conduct to the ventricles. The characteristics of idioventricular rhythm include a slow rate (40 bpm), regular rhythm, wide QRS complexes, and the absence of preceding P waves. It is considered an ominous sign because it usually indicates significant damage or dysfunction of the heart's conduction system. The treatment for idioventricular rhythm is the use of an artificial ventricular pacemaker.

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  • 20. 

    Description Ventricular Fibrillation is a rhythm in which multiple areas within the ventricles display marked variation in depolarization and repolarization. There is no organized depolarization, therefore the ventricles do not contract as a unit. The myocardium is quivering when visualized grossly. There is no cardiac output. This is the most common arrythmia seen in cardiac arrest from ischemia or infarction. The rhythm is described as coarse or fine VF. Coarse VF indicates recent onset of VF. Prolonged delay without defibrillation results in fine VF and eventually asysyole. Resuscitation becomes more difficult as VF becomes finer. Treatment is always immediate unsynchronized defibrillation at 200J, 300J, 360J for adult patients. EKG Criteria Rate: Very rapid, too disorganized to count. Rhythm: Irregular, waveform varies in size and shape No normal QRS complexes. Absent ST segments, P waves, T waves.

    Correct Answer
    VENTRICULAR FIBRILLATION
    Explanation
    Ventricular Fibrillation is a rhythm in which there is no organized depolarization in the ventricles, resulting in the ventricles not contracting as a unit. This leads to the myocardium quivering instead of pumping blood effectively, resulting in no cardiac output. Ventricular Fibrillation is the most common arrhythmia seen in cardiac arrest due to ischemia or infarction. It is described as coarse or fine VF, with coarse VF indicating recent onset and fine VF indicating prolonged delay without defibrillation. Immediate unsynchronized defibrillation is the recommended treatment for ventricular fibrillation. The EKG criteria for ventricular fibrillation include a very rapid and irregular rate, waveform variations in size and shape, and the absence of normal QRS complexes, ST segments, P waves, and T waves.

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  • 21. 

    Description Ventricular Fibrillation is a rhythm in which multiple areas within the ventricles display marked variation in depolarization and repolarization. There is no organized depolarization, therefore the ventricles do not contract as a unit. The myocardium is quivering when visualized grossly. There is no cardiac output. This is the most common arrythmia seen in cardiac arrest from ischemia or infarction. The rhythm is described as coarse or fine VF. Coarse VF indicates recent onset of VF. Prolonged delay without defibrillation results in fine VF and eventually asysyole. Resuscitation becomes more difficult as VF becomes finer. Treatment is always immediate unsynchronized defibrillation at 200J, 300J, 360J for adult patients. EKG Criteria Rate: Very rapid, too disorganized to count. Rhythm: Irregular, waveform varies in size and shape No normal QRS complexes. Absent ST segments, P waves, T waves.

    Correct Answer
    VENTRICULAR FIBRILLATION
    Explanation
    Ventricular fibrillation is a rhythm in which multiple areas within the ventricles display marked variation in depolarization and repolarization. This leads to no organized depolarization and the ventricles do not contract as a unit. The myocardium appears to be quivering. As a result, there is no cardiac output. Ventricular fibrillation is the most common arrhythmia seen in cardiac arrest caused by ischemia or infarction. The rhythm can be described as coarse or fine, with coarse VF indicating recent onset and fine VF indicating prolonged delay without defibrillation. Immediate unsynchronized defibrillation is the recommended treatment, with different energy levels depending on the patient's age. EKG criteria for ventricular fibrillation include a very rapid and irregular rate, waveform variations, and the absence of normal QRS complexes, ST segments, P waves, and T waves.

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  • 22. 

    Description Asystole represents the total absence of ventricular electrical activity. Since depolarization does not occur, there is no ventricular contraction. This may occur as a primary event in cardiac arrest, or it may follow VF or pulseless electrical activity (PEA). Ventricular asystole can occur also in patients with complete heart block in whom there is no excape pacemaker. VF may masquerade as asystole; it is best always to check two leads perpendicular to each other to make sure that asystole is not VF. Treatment for each arrythmia is very different. Fine VF which may mimic asystole should be treated with defibrillation. But defibrillating asystole is potentially harmful. Treatment: Epinephrine and Atropine are administered. Consider causes: pulmonary embolism, acidosis, tension pneumothorax, cardiac tamponade, hyperkalemia, hypokalemia, hypoxia, hypothermia, overdose, myocardial infarction. (Pneumonic: PATCH(4)-O-MIne. EKG Criteria Complete absence of ventricular electrical activity. Occasional P waves or erratic ventricular beats may be seen. These patients will be pulseless. Treatment must be immediate if the patient is to have any chance at resusctiation. Rate: None Rhythm: None

    Correct Answer
    ASYSTOLE
    Explanation
    Asystole is the total absence of ventricular electrical activity, resulting in no ventricular contraction. It can occur as a primary event in cardiac arrest or follow other arrhythmias like VF or PEA. It may mimic asystole, so it is important to check multiple leads to confirm the absence of VF. Treatment for asystole involves administering epinephrine and atropine, while defibrillation is not recommended. Various causes can lead to asystole, including pulmonary embolism, acidosis, tension pneumothorax, cardiac tamponade, electrolyte imbalances, hypoxia, hypothermia, overdose, and myocardial infarction. Immediate treatment is crucial for any chance of resuscitation.

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  • 23. 

    Description Indications for artificial ventricular pacemakers include symptomatic unreliability or failure of the patient's own conduction system. A ventricular pacemaker is typically placed in the right ventricle and can sense and (or pace with) the ventricle. An atrioventricular (A-V) synchronous pacemaker has an additional wire is were placed in the right atrium which can sense and/or pace the atrium. EKG Criteria Spike precedes wide bizarre QRS when ventricular pacing. Spike precedes P wave when atrial pacing. With dual chamber (AV synchronous) pacemaker, a spike may be seen only before the A wave, only before the QRS or before both.

    Correct Answer
    PACED RHYTHM
    Explanation
    The correct answer is "PACED RHYTHM" because the description provided explains the indications and placement of ventricular pacemakers, as well as the EKG criteria for ventricular and atrial pacing. A paced rhythm refers to a rhythm that is generated by an artificial pacemaker rather than the patient's own conduction system.

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  • 24. 

    Description Indications for artificial ventricular pacemakers include symptomatic unreliability or failure of the patient's own conduction system. A ventricular pacemaker is typically placed in the right ventricle and can sense and (or pace with) the ventricle. An atrioventricular (A-V) synchronous pacemaker has an additional wire is were placed in the right atrium which can sense and/or pace the atrium. EKG Criteria Spike precedes wide bizarre QRS when ventricular pacing. Spike precedes P wave when atrial pacing. With dual chamber (AV synchronous) pacemaker, a spike may be seen only before the A wave, only before the QRS or before both.

    Correct Answer
    PACED RHYTHM
    Explanation
    The correct answer is "PACED RHYTHM" because the description provided explains that a pacemaker is used when the patient's own conduction system is unreliable or fails. A ventricular pacemaker can sense and pace the ventricle, while an atrioventricular (A-V) synchronous pacemaker can sense and/or pace the atrium. The EKG criteria mentioned also support this, stating that a spike precedes a wide bizarre QRS when ventricular pacing, and a spike precedes a P wave when atrial pacing. Therefore, "PACED RHYTHM" is the appropriate answer based on the given information.

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  • 25. 

    Description Pathologic Q waves indicate myocardial death. Infarction locations are determined by the presence of Q wave; Anterior: Q waves in leads V1, V4, I and AVL. Inferior: Q waves in leads II, III, AVF, Lateral: Q waves in leads V5-V6, I and AVL. Posterior: Tall R waves in leads V1-V2. ST segment elevation may be present in an acute MI but also with Prinzmetal's angina, LV aneurysm, pericarditis or a normal variant. With MI, ST segment elevation resolves within days but pathologic Q waves may remain. EKG Criteria Pathologic Q waves are >30 msec wide or 1/3 length of the QRS complex. ST segment elevation is >1mm above the isoelectric line. Leads involved will localize the area of the myocardium involved.

    Correct Answer
    MYOCARDIAL INFARCTION
    Explanation
    Pathologic Q waves indicate myocardial death, which is a characteristic feature of myocardial infarction (MI). The location of the infarction can be determined by the presence of Q waves in specific leads. In this case, the answer "MYOCARDIAL INFARCTION" is correct because the description mentions the presence of Q waves in leads V1, V4, I, and AVL, which indicates an anterior infarction. Additionally, the description states that ST segment elevation may be present in an acute MI, further supporting the answer choice.

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