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Full download Ecgs Made Easy 6th Edition Aehlert Test Bank all chapter 2024 pdf
Full download Ecgs Made Easy 6th Edition Aehlert Test Bank all chapter 2024 pdf
Full download Ecgs Made Easy 6th Edition Aehlert Test Bank all chapter 2024 pdf
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Chapter 06: Ventricular Rhythms
Aehlert: ECGs Made Easy, 6th Edition
MULTIPLE CHOICE
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
3. How would you differentiate a junctional escape rhythm at 40 beats/min from a ventricular
escape rhythm at the same rate?
a. It is impossible to differentiate a junctional escape rhythm from a ventricular
escape rhythm.
b. The junctional escape rhythm will have a narrow-QRS complex; the ventricular
escape rhythm will have a wide QRS complex.
c. The rate (40 beats/min) would indicate a junctional escape rhythm, not a
ventricular escape rhythm.
d. The junctional escape rhythm will have a wide QRS complex; the ventricular
escape rhythm will have a narrow-QRS complex.
ANS: B
Although junctional and ventricular rhythms are ectopic pacemaker sites, their rhythms
can generally be differentiated by the width of their QRS complexes. The junctional
escape rhythm will have a narrow-QRS complex; the ventricular escape rhythm will have
a wide QRS complex.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an accelerated idioventricular rhythm.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
TRUE/FALSE
1. The term premature ventricular complex is technically more correct than premature
ventricular contraction.
ANS: T
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS: F
Cardiopulmonary resuscitation and defibrillation are the treatments of choice for pulseless
ventricular tachycardia or ventricular fibrillation.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for ventricular fibrillation.
ANS: T
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
ANS: F
An idioventricular rhythm (IVR), which is also called a ventricular escape rhythm, exists
when three or more ventricular escape beats occur in a row at a rate of 20 to 40 beats/min
(i.e., the intrinsic firing rate of the Purkinje fibers).
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
ANS: T
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
SHORT ANSWER
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for ventricular fibrillation.
ANS:
Monomorphic ventricular tachycardia at 150 beats/min
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
ANS:
Sinus bradycardia with a PVC (third complex from the left) and a fusion beat (fourth
complex from the left)
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Sinus tachycardia with multiform PVCs
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Idioventricular rhythm (ventricular escape rhythm)
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
ANS:
Accelerated idioventricular rhythm (AIVR)
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an accelerated idioventricular rhythm.
ANS:
Rhythm Ventricular not discernible; atrial may be
discernible.
Rate Ventricular not discernible but atrial
activity may be observed (i.e., P-wave
asystole).
P waves Usually not discernible.
PR interval Not measurable.
QRS duration Absent.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for asystole.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
ANS:
Sinus bradycardia with an interpolated PVC and ST-segment elevation
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Sinus tachycardia with frequent uniform PVCs
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Polymorphic VT
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for PMVT.
12. Complete the following ECG criteria for an accelerated idioventricular rhythm:
Rhythm
Rate
P waves
PR interval
QRS duration
ANS:
Rhythm Ventricular rhythm is essentially regular.
Rate 41 to 100 (41 to 120 per some
cardiologists) beats/min.
P waves Usually absent or, with retrograde
conduction to the atria, may appear after
the QRS (usually upright in the ST
segment or T wave).
PR interval None.
QRS duration Greater than 0.12 second; the T wave is
frequently in the opposite direction of the
QRS complex.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an accelerated idioventricular rhythm.
ANS:
Fine ventricular fibrillation
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for ventricular fibrillation.
ANS:
Sinus rhythm at 60 beats/min with an R-on-T interpolated PVC
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
15. Complete the following ECG criteria for polymorphic ventricular tachycardia:
Rhythm
Rate
P waves
PR interval
QRS duration
ANS:
Rhythm Ventricular rhythm may be regular or
irregular.
Rate Ventricular rate 150 to 300 beats/min;
typically 200 to 250 beats/min.
P waves None.
PR interval None.
QRS duration 0.12 second or more; there is a gradual
alteration in the amplitude and direction
of the QRS complexes; a typical cycle
consists of 5 to 20 QRS complexes.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for PMVT.
ANS:
Sinus rhythm with a run of VT (i.e., nonsustained VT) and one episode of ventricular
couplets
OBJ: Explain the terms sustained and nonsustained VT, monomorphic VT, and polymorphic VT.
ANS:
Sinus tachycardia at 102 beats/min with uniform PVCs; ST-segment elevation
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Accelerated idioventricular rhythm (AIVR) at 42 beats/min
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an accelerated idioventricular rhythm.
ANS:
Sinus rhythm with two R-on-T PVCs
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
20. Complete the following ECG criteria for monomorphic ventricular tachycardia:
Rhythm
Rate
P waves
PR interval
QRS duration
ANS:
Rhythm Ventricular rhythm is essentially regular.
Rate 101 to 250 (121 to 250 per some
cardiologists) beats/min.
P waves Usually not seen; if present, they have no
set relationship with the QRS complexes
that appear between them at a rate
different from that of the VT.
PR interval None.
QRS duration 0.12 second or greater; often difficult to
differentiate between the QRS and T
wave.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
ANS:
Polymorphic VT at 250 to 333 beats/min
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for PMVT.
ANS:
Accelerated idioventricular rhythm (AIVR) at 94 beats/min (lead III)
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an accelerated idioventricular rhythm.
ANS:
Rhythm Ventricular rhythm is essentially
regular.
Rate Ventricular rate 20 to 40 beats/min.
P waves Usually absent or, with retrograde
conduction to the atria, may appear
after the QRS (usually upright in the
ST segment or T wave).
PR interval None.
QRS duration 0.12 second or greater; the T wave is
frequently in the opposite direction of
the QRS complex.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
ANS:
Sinus bradycardia at 54 beats/min with ventricular bigeminy; ventricular rate
approximately 100 beats/min if PVCs counted in the rate
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Coarse ventricular fibrillation
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for ventricular fibrillation.
ANS:
Idioventricular rhythm at less than 25 beats/min (may also be called an agonal rhythm
when ventricular rate is less than 20 beats/min)
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for asystole.
ANS:
Polymorphic VT
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for PMVT.
ANS:
Sinus rhythm at 94 beats/min with an episode of couplets and a run of VT (i.e.,
nonsustained VT)
OBJ: Explain the terms sustained and nonsustained VT, monomorphic VT, and polymorphic VT.
ANS:
Sinus rhythm at 94 beats/min
ANS:
Ventricular fibrillation, shock (defibrillation), idioventricular rhythm at 40 beats/min
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an idioventricular rhythm.
ANS:
Sinus rhythm at 62 beats/min with an interpolated PVC; inverted T waves
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Narrow-QRS tachycardia (SVT) at 147 beats/min with ST-segment depression
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for atrioventricular nodal reentrant tachycardia (AVNRT).
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Sinus rhythm at 94 beats/min to monomorphic ventricular tachycardia (VT) at 150
beats/min
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
ANS:
Agonal rhythm, asystole
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for asystole.
ANS:
Sinus rhythm at 83 beats/min with ventricular trigeminy
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
ANS:
Sinus bradycardia at 30 beats/min with ventricular bigeminy (ventricular rate
approximately 60 if PVCs counted), inverted T waves, horizontal ST-segments
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Sinus rhythm at 86 beats/min with uniform PVCs
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for monomorphic VT.
ANS:
Coarse ventricular fibrillation
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for ventricular fibrillation.
ANS:
Sinus rhythm at 60 beats/min with a PAC
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature atrial complexes (PACs).
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and emergency
management of sinus bradycardia.
ANS:
Accelerated junctional rhythm at 79 beats/min with ST-segment elevation
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for an accelerated junctional rhythm.
ANS:
Sinus beat to junctional escape rhythm at 52 beats/min with inverted T waves
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for a junctional escape rhythm.
47. List four reasons when the ventricles may assume responsibility for pacing the heart.
ANS:
The ventricles may assume responsibility for pacing the heart if the sinoatrial (SA) node
fails to discharge, an impulse from the SA node is generated but blocked as it exits the SA
node, the rate of discharge of the SA node is slower than that of the ventricles, or an
irritable site in either ventricle produces an early beat or rapid rhythm.
OBJ: N/A
ANS:
Common causes of PVCs include acid-base imbalance, acute coronary syndromes,
cardiomyopathy, digitalis toxicity, electrolyte imbalance (e.g., potassium, magnesium),
exercise, heart failure, hypoxia, an increase in catecholamines and sympathetic tone (e.g.,
emotional stress, anxiety), medications (e.g., sympathomimetic drugs), normal variant,
stimulants (e.g., caffeine, tobacco), valvular heart disease, and ventricular aneurysm.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
ANS:
Atria (PACs), AV junction (PJCs), and ventricles (PVCs)
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for premature ventricular complexes (PVCs).
50. What is the name given to polymorphic VT that occurs in the presence of a long QT
interval?
ANS:
Polymorphic VT that occurs in the presence of a long QT interval is called torsades de
pointes.
OBJ: Describe the ECG characteristics, possible causes, signs and symptoms, and initial
emergency care for PMVT.
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LA MER
LA MINE
Je n’ai jamais connu, sur mer, un équipage plus gai, plus vaillant,
plus allant, depuis le dernier des novices jusqu’au commandant, qui
disait aux passagères inquiètes : « Mais non, mesdames, ils ne nous
couleront pas ! Nous sommes trop petits !… Quoique ça, ne quittez
pas vos ceintures de sauvetage, et dormez sur le pont ! »
C’était pendant la guerre, en 1917, et ils ont tous été noyés, les
pauvres diables, noyés comme des rats, par un sous-marin
allemand, un mois plus tard, entre Corfou et Brindisi, dans
l’Adriatique. Je n’avais passé que trois jours avec eux, et ça me fait
peine encore, quand j’y pense, une vraie peine, comme si on m’avait
tué de très vieux, de très sûrs amis.
C’était un tout petit vapeur, qui s’appelait l’Édouard-Corbière, du
nom de son ancien propriétaire, père du poète Tristan Corbière. Ce
vieux capitaine au long cours, qui fut corsaire, négrier, journaliste,
romancier et même poète, était un homme d’entreprise : il avait créé,
entre je ne sais plus quel port d’Armorique et l’Angleterre, une petite
ligne de navigation dont le fret le plus habituel se composait de
cochons engraissés en France et destinés à la nourriture des
insulaires de Grande-Bretagne. Les vieux matelots du bord
rappelaient en riant cette époque de paix et de tranquillité. Ces gens
qui chaque jour attendaient la mort — et qui l’ont reçue — étaient
d’une sublime et magnifique insouciance. Chaque jour ils prenaient
leurs repas de l’après-midi en plein air, devant le poste d’équipage,
sur un prélart qui couvrait l’entrée de la cale, tout près du hublot de
ma cabine. Ils ne me voyaient point, ignoraient ma présence et
causaient librement. J’ai entendu là, de leur bouche, sans qu’ils s’en
pussent douter, les plus belles histoires, presque toutes fausses.
Les marins sont comme les enfants : ils ne demandent jamais
« si c’est arrivé » ; ils lisent peu, ou pas du tout ; leur âme ingénue et
malicieuse à la fois a besoin pourtant de romans : ils inventent des
romans parlés. Toutes les races de nos côtes étaient représentées
parmi ces condamnés à mort, et qui le savaient sans doute, si
simplement et joyeusement braves : les mokos de la rive
méditerranéenne, les pêcheurs du golfe de Gascogne, les Bordelais,
les Vendéens, les Bretons, les Normands de Granville et de Saint-
Malo, les gens de Boulogne, de Calais, de Dunkerque. Il y en avait
— c’était le plus grand nombre — qui ne faisaient qu’écouter et rire,
ou s’émouvoir, mais rire le plus souvent. Par réaction contre le
danger, ils semblaient, en effet, préférer le rire aux larmes. Ils
goûtaient mieux, par un sentiment populaire, instinctif, l’aventure qui
finit bien ; ils aimaient aussi celle qui réserve une surprise à la fin, et
déconcerte. A leur manière, ils avaient le goût aiguisé, ils étaient des
amateurs difficiles. Et celui qui contait le mieux ce que nos voisins
d’Angleterre nomment le yarn, ce que nos compatriotes du Midi
appellent la galéjade, n’était point, chose surprenante, de Toulon ou
de Marseille : un Flamand de Bray-Dunes, pêcheur à l’Islande, puis
marin à l’État. Je me souviens de son nom, un nom de mon pays :
Bogaërt. Ça se prononce « Bogart », en faisant sonner le t. Il était
lourd, rond, puissant, musculeux et gras, avec un air d’assurance
pour affirmer les choses les plus invraisemblables ; il filait le conte
comme un curé son prêche, si sérieusement qu’on y était toujours
pris. Voilà une de ses histoires. Je vais m’efforcer de la dire autant
que possible telle que je l’ai entendue :
… Il se pouvait que celle-là ne fût pas seule, qu’elle fît partie d’un
chapelet. Le grand paquebot ralentit sa marche. Il n’avança plus
qu’avec prudence, comme à tâtons. Les vagues poussèrent à sa
rencontre de larges lambeaux de chair, de l’huile, de la graisse qui
surnageaient.
— Pauvre bête ! dit un passager en frissonnant.
— J’aime mieux que ce soit elle que nous, répondit un autre : elle
nous a rendu un fier service !
A vingt milles de là, les cachalots étaient remontés à la surface.
Une femelle se rapprocha d’un vieux mâle, un pacha fier de son
harem ; sa carapace de lard était toute couturée de cicatrices,
nobles traces des batailles d’amour qu’il avait livrées.
— Qu’est-ce que c’était que ça, dit-elle, Qu’est-ce que ça veut
dire ?…
— Une mine ! grogna le vieux mâle. C’est honteux ! Ça ne nous
regarde pas, ces choses-là, ce n’est pas pour nous !