PARAMEDIC 2 FINAL EXAM COMPLETE
STUDY AHEAD DOCUMENT 2022
P wave -The depolarization of the atria
QRS Complex -occurs after P wave, represents depolarization of the ventricles, usually
last no longer than 0.12s
T waves -represented by repolarization of the atria and ventricles
PR interval -delay at the AV junction(.12-.20s)
ST segment -Period between ventricular depolarization and begining of repolarization. It
should be the same level as the isoelectric line.
R-R interval -time between 2 ventricular depolarizations
J-point -begining of the T wave
What might an elevated or depressed ST segment indicate? -may indicate myocardial
ischemia or injury.
How does hyperkalemia look on a monitor? -tall or sharp peaked T waves
For a cardiac patient experiencing chest pain what is the proper dosage for morphine? -
2-4-mg IV doses as needed for pain, being sure to reasses patients blood pressure,
pulse, and respiratory rate after each dose until the patient experiences a relief in pain
or or a drop in pulse or BP(less than 100)
You respond to a call with an unconscious patient, what 2 pieces of equipment must
always come with you off the truck? -Monitor and airway bag
When do we consider calling a code? -2 rounds of drugs, obvious rigor mortis or levidity
What exactly are the purkinje fibers? -thousands of fibrils distributed through the
ventricles that carry electrical impulses to cause contraction
How will a patient with right ventricular failure present? -Patients experiencing an MI of
the right ventricle may already be HYPOTENSIVE, or may become extrememly
hypotensive IF NITROGLYCERINE IS GIVEN,
,So what are you well advised to perform anytime you find a patient with an inferior wall
MI? -a second EKG, a V4r, you may even be ordered to give 1-2 liters of fluid before
administering any nitro to keep from bottoming out there pressure.
How does right sided heart failure typically occur? -as a result of left sided heart failure,
also Pulmonary embolism, long standing COPD and Chronic bronchitis.
How will a patient in Right ventricular failure present and why? -Hypotensive, right sided
heart failure actually decreases the preload of the failing left side of the heart and may
lesses pulmonary congestion.
When would you not want to give a patient nitroglycerine? -when they have a systolic
blood pressure of 90!
What does a patient having Acute Coronary syndrome typically complain of having? -
Chest pain described as heavy ,squeezing, crushing or tight. Pain radiates to the arms,
WOMAN WILL COMPLAIN OF FATIGUE!!!!
Who typically dies from heart disease and why? -women, there symptoms are less clear
cut. They have nausea, epigastric burning, lightheadedness, WEAKNESS OR FEELING
TIRED.
What patients don`t experience chest pain during an AMI? -Diabetics, older people and
heart transplant patients. They have "Silent MI`s". they develop dypsnea, a drop in
pressure, loss of consciousness, stroke.
What is a first degree block? -Each impulse reaching the AV Node is delayed slightly
longer than expected resulting in PRI greater than .20 seconds. PROLONGED PRI IS
THE SIGNIFICANT SIGN!!
Which block is considered the least serious and why? -first degree block, because each
impulse eventually passes through the AV node causing a QRS complex but it is the
first indication of damage
What is the usual rate of a first degree block? -60-100 beats a min, low end. Rhythm is
regular
What is second degree heart block Type 1(WENCKEBACH)? -A second degree heart
block occurs when an impulse reaching the AV node is occasionally prevented.
OCCASIONAL MISSED QRS COMPLEX. EACH SUCCESSIVE IMPULSE IS
DELAYED A BIT LONGER TIL FINALY ONE IS NOT ALLOWED TO CONTINUE.
What does second degree type 1 look like? -60-100 bpm, irregular, prolonged R-R
interval, P wave for every QRS not a QRS for every P wave.
, When is second degree heart block treated in the prehospital setting? -If it is associated
with bradycardia
What is a second degree type 2(classic or mobitz)? -occurs when several impulses are
not allowed to continue, can be regular or irregular. PR interval is constant with the
occasional dropped QRS complex
When is second degree type 2 treated in prehospital setting? -when bradycardia is
associated with it
What is a third degree heart block? -A complete block. All impulses reaching the AV
node are prevented from passing through to the ventricles.
What happens since all impulses are blocked in a 3rd degree block? -the ventricles
develop there own pacemaker to cause circulation of the blood at a greatly reduced
rate.
What is the rate typically with a 3rd degree block? -typically less than 60, The P waves
and QRS complexes are all of same distance however there is no rhyme or reason to
how they are presented
How many boxes are there in a 6 second strip? -30 boxes
When is a person with an aneurism symptomatic? -When the aneurism starts to
expand, WHEN IT STARTS TO PUSH ON OTHER ORGANS
What occurs during diastole? -atrial and ventricular relaxation, 80% of ventricular filling
occurs during this time
What occurs during systole -atrial and ventricular contraction, the contents of each
atrium are squeezed into each ventricle to complete ventricular filling
What on an EKG strip is an indicator of wolf parkinsons white syndrome(WPW)? -A
delta wave
What is a delta wave? -its after the P wave and it is an upward slope turning into the
QRS complex.
What do patients with WPW have or use? -an accessory pathway between the atria and
ventricles called the bundle of kent, it bypasses the AV node and depolarizes the
ventricles early resulting in a rapid upward slope to the R wave
What is a myocyte? -Type of cell found in cardiac muscle responsible for contraction.
STUDY AHEAD DOCUMENT 2022
P wave -The depolarization of the atria
QRS Complex -occurs after P wave, represents depolarization of the ventricles, usually
last no longer than 0.12s
T waves -represented by repolarization of the atria and ventricles
PR interval -delay at the AV junction(.12-.20s)
ST segment -Period between ventricular depolarization and begining of repolarization. It
should be the same level as the isoelectric line.
R-R interval -time between 2 ventricular depolarizations
J-point -begining of the T wave
What might an elevated or depressed ST segment indicate? -may indicate myocardial
ischemia or injury.
How does hyperkalemia look on a monitor? -tall or sharp peaked T waves
For a cardiac patient experiencing chest pain what is the proper dosage for morphine? -
2-4-mg IV doses as needed for pain, being sure to reasses patients blood pressure,
pulse, and respiratory rate after each dose until the patient experiences a relief in pain
or or a drop in pulse or BP(less than 100)
You respond to a call with an unconscious patient, what 2 pieces of equipment must
always come with you off the truck? -Monitor and airway bag
When do we consider calling a code? -2 rounds of drugs, obvious rigor mortis or levidity
What exactly are the purkinje fibers? -thousands of fibrils distributed through the
ventricles that carry electrical impulses to cause contraction
How will a patient with right ventricular failure present? -Patients experiencing an MI of
the right ventricle may already be HYPOTENSIVE, or may become extrememly
hypotensive IF NITROGLYCERINE IS GIVEN,
,So what are you well advised to perform anytime you find a patient with an inferior wall
MI? -a second EKG, a V4r, you may even be ordered to give 1-2 liters of fluid before
administering any nitro to keep from bottoming out there pressure.
How does right sided heart failure typically occur? -as a result of left sided heart failure,
also Pulmonary embolism, long standing COPD and Chronic bronchitis.
How will a patient in Right ventricular failure present and why? -Hypotensive, right sided
heart failure actually decreases the preload of the failing left side of the heart and may
lesses pulmonary congestion.
When would you not want to give a patient nitroglycerine? -when they have a systolic
blood pressure of 90!
What does a patient having Acute Coronary syndrome typically complain of having? -
Chest pain described as heavy ,squeezing, crushing or tight. Pain radiates to the arms,
WOMAN WILL COMPLAIN OF FATIGUE!!!!
Who typically dies from heart disease and why? -women, there symptoms are less clear
cut. They have nausea, epigastric burning, lightheadedness, WEAKNESS OR FEELING
TIRED.
What patients don`t experience chest pain during an AMI? -Diabetics, older people and
heart transplant patients. They have "Silent MI`s". they develop dypsnea, a drop in
pressure, loss of consciousness, stroke.
What is a first degree block? -Each impulse reaching the AV Node is delayed slightly
longer than expected resulting in PRI greater than .20 seconds. PROLONGED PRI IS
THE SIGNIFICANT SIGN!!
Which block is considered the least serious and why? -first degree block, because each
impulse eventually passes through the AV node causing a QRS complex but it is the
first indication of damage
What is the usual rate of a first degree block? -60-100 beats a min, low end. Rhythm is
regular
What is second degree heart block Type 1(WENCKEBACH)? -A second degree heart
block occurs when an impulse reaching the AV node is occasionally prevented.
OCCASIONAL MISSED QRS COMPLEX. EACH SUCCESSIVE IMPULSE IS
DELAYED A BIT LONGER TIL FINALY ONE IS NOT ALLOWED TO CONTINUE.
What does second degree type 1 look like? -60-100 bpm, irregular, prolonged R-R
interval, P wave for every QRS not a QRS for every P wave.
, When is second degree heart block treated in the prehospital setting? -If it is associated
with bradycardia
What is a second degree type 2(classic or mobitz)? -occurs when several impulses are
not allowed to continue, can be regular or irregular. PR interval is constant with the
occasional dropped QRS complex
When is second degree type 2 treated in prehospital setting? -when bradycardia is
associated with it
What is a third degree heart block? -A complete block. All impulses reaching the AV
node are prevented from passing through to the ventricles.
What happens since all impulses are blocked in a 3rd degree block? -the ventricles
develop there own pacemaker to cause circulation of the blood at a greatly reduced
rate.
What is the rate typically with a 3rd degree block? -typically less than 60, The P waves
and QRS complexes are all of same distance however there is no rhyme or reason to
how they are presented
How many boxes are there in a 6 second strip? -30 boxes
When is a person with an aneurism symptomatic? -When the aneurism starts to
expand, WHEN IT STARTS TO PUSH ON OTHER ORGANS
What occurs during diastole? -atrial and ventricular relaxation, 80% of ventricular filling
occurs during this time
What occurs during systole -atrial and ventricular contraction, the contents of each
atrium are squeezed into each ventricle to complete ventricular filling
What on an EKG strip is an indicator of wolf parkinsons white syndrome(WPW)? -A
delta wave
What is a delta wave? -its after the P wave and it is an upward slope turning into the
QRS complex.
What do patients with WPW have or use? -an accessory pathway between the atria and
ventricles called the bundle of kent, it bypasses the AV node and depolarizes the
ventricles early resulting in a rapid upward slope to the R wave
What is a myocyte? -Type of cell found in cardiac muscle responsible for contraction.
