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Telemetry Certification Flashcards

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1
Q

PR interval

A

0.12-0.20 seconds

Represents electrical depolarization of the atria or the time it takes for the electrical impulse to travel from atria to ventricles

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2
Q

QRS complex

A

less than 0.10-0.12 seconds

Represents ventricular depolarization

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3
Q

QT interval

A

0.44 seconds

Reflects both ventricular depolarization and repolarization

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4
Q

one small box

A

.04 seconds and 1mm

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5
Q

one large box

A

0.2 seconds and 5mm

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6
Q

15 large boxes

A

3 seconds

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7
Q

30 large boxes

A

6 seconds

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8
Q

7 steps method to interpreting cardiac rhythm

A
  1. is the rhythm regular or irregular. measure the p:p and the r:r
  2. calculate the atrial rate and calculate the ventricular rate
  3. is there a p wave for every QRS?
  4. measure the QRS complexes (normal 0.10-0.12)
  5. measure the PR intervals (normal: <0.20) if > 0.20 you have a block
  6. interpretation of rhythm
  7. intervention
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9
Q

bradycardia intervention

A

atropine

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10
Q

focal atrial tachycardia intervention

A

adenosine

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11
Q

ventricular fibrillation intervention

A

defibrillation and cpr

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12
Q

torsades de pointes intervention

A

check for pulse

unsynchronized defibrillation

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13
Q

P wave

A

Represents electrical depolarization of the atria

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14
Q

T wave

A

Represents ventricular repolarization

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15
Q

ST segment

A

Represents ventricular repolarization

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16
Q

Normal Sinus Rhythm

A
  1. Rhythm: Regular
  2. Rate: Atrial 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Normal Sinus Rhythm
  7. Intervention: Continue to Monitor Patient
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17
Q

Sinus Bradycardia

A
  1. Rhythm: Regular
  2. RATE: Atrial <60 ; Ventricular <60
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Bradycardia
  7. Intervention: Continue to monitor and call physician if new onset

SLOW RATE

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18
Q

Sinus Tachycardia

A
  1. Rhythm: Regular
  2. RATE: Atrial 100-160 ; Ventricular 100-160
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Tachycardia
  7. Intervention: continue to monitor patient and call physician if new onset

FAST RATE

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19
Q

Sinus Arrhythmia

A
  1. RHYTHM: Irregular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Arrhythmia
  7. Intervention: Continue to monitor patient

IRREGULAR RHYTHM

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20
Q

Sinus Arrest/Pause

A
  1. RHYTHM: Irregular; need to find underlying rhythm
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes
  4. QRS complex: 0.10-0.12
  5. PR interval: 0.12-0.20
  6. Interpretation of Rhythm: Sinus Arrest with second pause
  7. Intervention: call physician

IRREGULAR RHYTHM & PAUSE

arrest: more than 2 p-p
pause: less than 2 p-p

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21
Q

Premature Atrial Complex (PAC)

A
  1. Rhythm: underlying rhythm is regular, individual PAC is irregular
  2. Rate: Atrial: 60-100 ; Ventricular: 60-100
  3. P wave: yes, p wave conducted with PAC will have different shape
  4. QRS complex: 0.10-0.12
  5. PR interval: <0.20
  6. Interpretation of Rhythm: Need to identify underlying rhythm and label accordingly
  7. Intervention: call MD

IRREGULAR RANDOM SHAPED P WAVE

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22
Q

Atrial Tachycardia (SVT)

A
  1. Rhythm: Regular
  2. Rate: Atrial: 100-250 ; Ventricular: 100-250
  3. P wave: often indiscernible, can be buried in T wave. If you have P wave will be different shape
  4. QRS complex: 0.10-0.12
  5. PR interval: UTA
  6. Interpretation of Rhythm: Atrial Tachycardia
  7. Intervention: Call MD

FAST P WAVE IN T WAVE

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23
Q

Atrial Flutter

Study These Flashcards
A
  1. Rhythm: regular
  2. Rate: Atrial: 220-350 ; Ventricular:
  3. P wave: replaces by flutter waves
  4. QRS complex: 0.10-0.12
  5. PR interval: UTA
  6. Interpretation of Rhythm: Atrial Flutter
  7. Intervention: Call MD

SAW TOOTH, NO P WAVES

24
Q

Atrial Fibrillation

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A
  1. Rhythm: irregularly irregular
  2. Rate: Atrial: UTA ; Ventricular: variable
  3. P wave: no, will see fibrillation line
  4. QRS complex: 0.10-0.12
  5. PR interval: UTA
  6. Interpretation of Rhythm: Atrial Fibrillation
  7. Intervention: Call MD

FIBRILLATORY WAVES, NO P WAVES

25
Junctional Rhythm
1. Rhythm: regular 2. Rate: Atrial: 40-60; Ventricular: 40-60 3. P wave: yes; inverted, during, absent, or after QRS 4. QRS complex: 0.10-0.12 5. PR interval: <0.20, if there are P waves 6. Interpretation of Rhythm: Junctional rhythm 7. Intervention: Call MD 40-60 BPM & P WAVES INVERTED, DURING, ABSENT OR AFTER QRS, PR INTERVAL <0.20 IF THERE ARE P WAVES 3 or more consecutive junctional beats
26
Accelerated Junctional
1. Rhythm: regular 2. Rate: Atrial: 60-100 ; Ventricular: 60-100 3. P wave: yes; inverted, during, absent or after QRS 4. QRS complex: 0.10-0.12 5. PR interval: <0.20 6. Interpretation of Rhythm: accelerated Junction 7. Intervention: Call MD 60-100 BPM, P WAVES INVERTED, DURING, ABSENT OR AFTER QRS, PR <0.20
27
Junctional Tachycardia
1. Rhythm: regular 2. Rate: Atrial: 100-160 ; Ventricular: 100-160 3. P wave: yes; inverted, during, absent or after QRS 4. QRS complex: 0.10-0.12 5. PR interval: < 0.20 6. Interpretation of Rhythm: Junctional Tachycardia 7. Intervention: Call MD 100-160 BPM, P WAVES INVERTED, DURING, ABSENT, OR AFTER QRS, PR <0.20
28
Ventricular Tachycardia
1. Rhythm: regular 2. Rate: Atrial: UTA ; Ventricular: 100-220 3. P wave: No 4. QRS complex: UTA, will be wide and bizarre 5. PR interval: UTA 6. Interpretation of Rhythm: ventricular tachycardia 7. Intervention: LETHAL call code! VENTRICULAR RATE 100-220, NO P WAVE, WIDE QRS, CALL CODE
29
Ventricular Fibrillation
1. Rhythm: irregular 2. Rate: Atrial: UTA ; Ventricular: UTA 3. P wave: No 4. QRS complex: UTA, only have fibrillation wave 5. PR interval: UTA 6. Interpretation of Rhythm: Ventricular fibrillation 7. Intervention: LETHAL call code! IRREGULAR RHYTHM, NO P WAVE, VFIB WAVE, CALL CODE
30
Idioventricular
1. Rhythm: can be regular and irregular 2. Rate: Atrial: < 40 ; Ventricular: < 40 3. P wave: No 4. QRS complex: wide and bizarre 5. PR interval: UTA 6. Interpretation of Rhythm: Idioventricular 7. Intervention: LETHAL call code! RATE<40, NO P WAVE, WIDE QRS, CALL CODE
31
Accelerated Idioventricular
1. Rhythm: regular 2. Rate: Atrial: 40-100 ; Ventricular: 40-100 3. P wave: No 4. QRS complex: Wide and bizarre 5. PR interval: UTA 6. Interpretation of Rhythm: Accelerated Idioventricular 7. Intervention: LETHAL call code! RATE 40-100, NO P WAVE, WIDE QRS, CALL CODE
32
Torsades de Pointes
1. Rhythm: Irregular 2. Rate: Atrial: UTA ; Ventricular: 250-350 3. P wave: No 4. QRS complex: UTA, wide and bizarre, twisting 5. PR interval: UTA 6. Interpretation of Rhythm: Torsades de Pointes 7. Intervention: LETHAL call code! IRREGULAR RHYTHM, VENTRICULAR RATE 250-350, NO P WAVE, TWISTING WIDE QRS, CALL CODE
33
Premature Ventricular Complex (PVCs)
1. Rhythm: regular, except for early beat 2. Rate: Atrial: determine underlying rhythm ; Ventricular: determine underlying rhythm 3. P wave: may or may not be visible with PVC 4. QRS complex: wide and bizarre 5. PR interval: < 0.20 6. Interpretation of Rhythm: Sinus rhythm with premature ventricular complex 7. Intervention: call MD EARLY BEAT IRREGULAR, P WAVE MAY OR MAY NOT BE VISIBLE, WIDE QRS, PR <0.20
34
Sinus Rhythm with First Degree
1. Rhythm: regular 2. Rate: Atrial: 60-100 ; Ventricular: 60-100 3. P wave: yes 4. QRS complex: 0.10-0.12 5. PR interval: > 0.20 6. Interpretation of Rhythm: Sinus rhythm with first degree AV block 7. Intervention: Call MD PR >0.20
35
Second Degree- Mobitz 1 (Wenckebach)
1. Rhythm: Usually Irregular 2. Rate: Atrial: 60-100 ; Ventricular: 60-100, is dependent on underlying rhythm 3. P wave: yes 4. QRS complex: 0.10-0.12, will have missing QRS complexes 5. PR interval: > 0.20, lengthens until a QRS is dropped 6. Interpretation of Rhythm: Second degree- Mobitz 1 7. Intervention: call MD Longer longer longer drop thats the sound of Wenckebach IRREGULAR, DROPPED QRS, CYCLIC LENGTHENING OF PR INTERVAL
36
Second degree- Mobitz 2
1. Rhythm: atrial rate: regular ; ventricular: irregular 2. Rate: Atrial: faster than ventricular 3. P wave: yes 4. QRS complex: wider than normal 5. PR interval: constant on conducted beats, may be normal or prolonged 6. Interpretation of Rhythm: Second degree- Mobitz 2 7. Intervention: call physician ATRIAL FASTER THAN VENTRICULAR RATE, R WAVES IRRGULAR, WIDE QRS, DROPPED QRS
37
Complete Heart block (3rd Degree)
1. Rhythm: atrial is regular. ventricular is regular but they are not communicating, beating independently of each other 2. Rate: Atrial: 60-100 ; Ventricular: <40 or can be junctional >40 3. P wave: normal, but not related to QRS 4. QRS complex: depends on the level of escape rhythm. can be normal or wide 5. PR interval: UTA 6. Interpretation of Rhythm: third degree heart block 7. Intervention: LETHAL call code! P & R WAVES ARE INDEPENDENT, QRS CAN BE NORMAL OR WIDE
38
Atrial Pacemaker
1. Rhythm: identify underlying rhythm 2. Rate: Atrial: depends on what the pacemaker is set at. a pacer spike before the P wave 3. P wave: yes 4. QRS complex: 0.10-0.12 5. PR interval: <0.20 6. Interpretation of Rhythm: atrial paced 7. Intervention: continue to monitor patient PACER SPIKE BEFORE P WAVE
39
Ventricular pacemaker
1. Rhythm: identify underlying rhythm 2. Rate: Atrial: depends what the pacemaker rate is set at, pacer spike before Q waves 3. P wave: yes 4. QRS complex: wide 5. PR interval: 0.12-0.20 6. Interpretation of Rhythm: ventricular paces 7. Intervention: continue to monitor patient SPACER SPIKE BEFORE Q WAVE, WIDE QRS
40
AV paced or Dual camber pacemaker
1. Rhythm: identify underlying rhythm 2. Rate: Atrial: depends what pacemaker is set at. pacer spine before p wave; Ventricular: depends on what pacemaker is set at, pacer spike before Q wave 3. P wave: yes 4. QRS complex: usually wide 5. PR interval: < 0.20 6. Interpretation of Rhythm: dual chamber paces 7. Intervention: continue to monitor patient SPACER SPIKE BEFORE P WAVE & PACER SPIKE BEFORE Q WAVE, WIDE QRS
41
Failure to sense- undersense or overpacing
1. Rhythm: pacemaker paces when it shouldn't "overpacing" irregular due to spike occurring too close to a previous beat 2. Rate: Atrial: depends what the pacemaker is set at ; Ventricular: depends what the pacemaker is set at 3. P wave: yes 4. QRS complex: wide 5. PR interval: <0.20 seconds 6. Interpretation of Rhythm: ventricular paced with failure to sense 7. Intervention: call MD OVERPACING, SPIKE OCCURING TOO CLOSE TO PREVIOUS BEAT, WIDE QRS
42
failure to sense- oversees or underpacing
1. Rhythm: pacemaker fails to pace when it should 2. Rate: Atrial: depends on what rate the pacemaker is set at ; Ventricular: depends on what rate the pacemaker is set at 3. P wave: yes 4. QRS complex: wide 5. PR interval: <0.20 6. Interpretation of Rhythm: atrial paced with failure to sense 7. Intervention: call physician UNDERPACING, PACEMAKER FAILS TO PACE WHEN IT SHOULD, WIDE QRS
43
failure to capture
1. Rhythm: pacemaker is firing appropriately, no corresponding complex after spike 2. Rate: Atrial: depends on rate pacemaker is set at ; Ventricular: depends on rate pacemaker is set at 3. P wave: atrial paced and failure to capture = no p wave 4. QRS complex: ventricular paced and failure to capture = no QRS. <0.12 for captured complexes 5. PR interval: <0.20 for captured intervals 6. Interpretation of Rhythm: AV paced with failure to capture 7. Intervention: call MD NO CORRESPONDING COMPLEX AFTER PACER SPIKE, NO P WAVE NO QRS WHEN NOT CAPTURED
44
failure to fire
1. Rhythm: varies according to present pacer rate, pacer is not firing, will see a pause 2. Rate: Atrial: depends on rate pacemaker is set ; Ventricular: depends what rate pacemaker is et at 3. P wave: atrial faced and failure to fire = no P wave 4. QRS complex: ventricular paces and failure to fire = no QRS 5. PR interval: < 0.20 6. Interpretation of Rhythm: atrial paced with failure to fire 7. Intervention: call MD WILL SEE A PAUSE, NO P WAVE NO QRS DURING PAUSE
45
asytole
1. Rhythm: UTA 2. Rate: Atrial: UTA ; Ventricular: UTA 3. P wave: UTA 4. QRS complex: UTA 5. PR interval: UTA 6. Interpretation of Rhythm: systole 7. Intervention: CALL CODE. check pulse and check rhythm in another lead. START CPR CALL CODE
46
artifact
1. Rhythm: UTA 2. Rate: Atrial: UTA ; Ventricular: UTA 3. P wave: UTA 4. QRS complex: UTA 5. PR interval: UTA 6. Interpretation of Rhythm: UTA 7. Intervention: check patient and leads, continue to monitor LOOKS LIKE SKETCH
47
Sinoatrial Exit block
less than or equal to 2 p-p intervals
48
sinus node dysfunction
often <50 bpm with short runs over 100 bpm
49
focal atrial tachycardia
normal sinus QRS followed by tachycardia
50
wandering atrial pacemaker
3 different p wave shapes
51
multifocal atrial tachycardia
3 different shaped p waves, rate greater than 100 bpm
52
premature junctional complex
early beat before next P wave
53
junctional escape beat
late beat, p waves before, after or buried in QRS and inverted
54
ventricular escape beat
late beat originating in the ventricles, no p wave on late beat
55
capture beats
narrow QRS between wide QRS complexes
56
fusion beats
hybrid QRS
57
LETHAL RHYTHMS
``` ventricular tachycardia ventricular fibrillation complete heart block idioventricular rhythm accelerated idioventricular torsades de pointes asytsole PEA ```
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