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Ekg

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  • 1. ELECTROCARDIOGRAPHY SR DHO J.J. Nelson RN,CMA
  • 2. Course Objectives• Explain the normal electro-physiology of heart• To recognize the normal EKG complex and rhythm• Name 12 EKG leads• Identify electrode placements• List principles for recording EKG• Differentiate Holter Monitor, Echocardiogram and Stress test
  • 3. Normal Impulse Conduction Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers
  • 4. Impulse Conduction & the ECG Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers
  • 5. The “PQRST” • P wave - Atrial depolarization • QRS - Ventricular depolarization • T wave - Ventricular repolarization
  • 6. The PR Interval Atrial depolarization + delay in AV junction(AV node/Bundle of His)(delay allows time for the atria to contract before the ventricles contract)
  • 7. Watch an animation!http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw
  • 8. EKG Leads• Standard or Limb Leads = I,II & III• Augmented leads = AVR, AVL & AVF
  • 9. CHEST LEADS • V1 • V2 • V3 • V4 • V5 • V6
  • 10. ELECTRODES PLACEMENT• Skin must be cleansed with alcohol• Do not touch gel on electrode (need complete attachment to skin)• Shave prn
  • 11. Chest electrode placement
  • 12. The ECG Paper• Horizontally – One small box - 0.04 seconds – One large box - 0.20 seconds• Vertically – One large box - 0.5 mV – This helps in determining Heart rate
  • 13. Standardization Mark• Stylus are heated and react with treated paper to produce markings on paper.• The standard needs to be two large squares high (1 cm).
  • 14. The ECG Standardization Mark
  • 15. Speed Control• Regulates how fast or slow the paper runs• Run 25 Normal speed (25mm/sec)• Run 50 is twice as fast thus – Spreading out the complexes – Use for tachycardia – Handwrite the Run 50 on the EKG recording
  • 16. Gain Control (Sensitivity)• Regulates height of the EKG wave.• Measured in millimeters/millivolt• Normal is “1” (10 mm/mV)• To increase the height of the complex switch to “2” (20 mm/mV)• To decrease the height of the complex switch to “1/2” (5mm/mV)
  • 17. RECORDING• Record patient name• Age/ID#• Doctor (family Dr ----cardiologist must intrepret)• Date and time• Meds• Any changes (such as run or sensitivity)
  • 18. Normal EKG• http://www.getbodysmart.com/ap/circulatorysyst
  • 19. What do you do if you see this? Tachycardia PVC
  • 20. What would you do? Atrial fibrillation with irregular rate Ventricular fibrillation
  • 21. OTHER CARDIAC TESTS• HOLTER MONITOR• STRESS TEST• ECHOCARDIOGRAM
  • 22. QUESTIONS??

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