Meds and Metabolic Derangements

Question 1

Digitalis/Digoxin causes what?

Answer 1

a scooped ST depression in therapeutic doses

Question 2

Symtpoms of Digoxin toxicity:
GI? 4
Visual? 3
CVS? 3
CNS? 4

Answer 2

GI: Nausea, vomiting, anorexia, diarrhea

Visual: Blurred vision, yellow/green discoloration, haloes

CVS: Palpitations, syncope, dyspnea

CNS: Confusion, dizziness, delirium, fatigue

Question 3

How does digoxin affect automaticity and the AV node and how does it do that?

Answer 3

Increased automaticity (increased intracellular calcium) and decreased AV conduction (increased vagal effects at the AV node)

Question 4

The classic dysrhythmia associated with digoxin toxicity is the combination of what?

Answer 4

a supraventricular tachycardia (due to increased automaticity) with a slow ventricular response (due to decreased AV conduction), e.g. ’atrial tachycardia with block’
(looks like a slow Aflutter)

Question 5

4 rhythms that are caused by too much digoxin?

8

Answer 5

1. Atrial and junctional premature beats
2. PAT with block
3. Sinus block
4. AV blocks
5. Atrial and junctional tachyarrhythmias
6. PVCs
7. VT
8. VF

Question 6

Characteristic changes of hyperkalemia on an EKG?

3

Answer 6

1. Classic change is that of peaked T waves
2. P wave can also flatten and widen
3. QRS complex can widen

Question 7

Characteristic changes of hypokalemia on an EKG?

3

Answer 7

1. Classic changes are the presence of U waves
2. T waves can flatten out and possibly invert
3. Causes irritation of ventricular foci which can lead to Torsades, VT, VF

Question 8

Characteristics of hypercalcemia on an EKG? 2

Answer 8

1. Short QT interval

2. J waves

Question 9

Characteristic of hypocalcemia on an EKG? 1

Answer 9

Prolonged QT interval

Question 10

Characteristics of hypomagnesemia on an EKG? 4

Answer 10

1. Prolonged QT
2. Torsades
3. Frequent PVCs, PACs
4. Ventricular and supraventricular tachyarrhythmias

Question 11

What is a J wave?

Answer 11

The Osborn wave (J wave) is a positive deflection at the J point (negative in aVR and V1)

Question 12

In hypothermia what leads are J waves most prominent?

Answer 12

precordial leads

Question 13

J waves may be seen in a number of other conditions besides hypothermia such as?
5

Answer 13

1. Normal variant
2. Hypercalcemia
3. Medications
4. Neurological insults such as intracranial hypertension, severe head injury and subarachnoid hemorrhage
5. (idiopathic VF)

Question 14

Pulmonary embolus EKG findings?

5

Answer 14

1. Most common finding is sinus tachycardia
2. Ekg changes may include S1Q3T3
3. Right axis deviation
4. Transient RBBB
5. T wave inversions in V1-V4

Question 15

What is the first change that you are going to see on an EKG with a pt with PE? and why?

Answer 15

Most common finding is sinus tachycardia because they are responding to the hypoxia

Question 16

What is S1Q3T3?

Answer 16

prominent S wave in I
Prominent Q wave in III
inverted T wave in III