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ECG 101
- 1. ECG 101
- 2. The eyes may be the window to the soul But the ECG is the window to the heart, lungs, toxicology, electrolytes, body temperature and sometimes even the brain
- 5. An ECG is put under your nose Immediately Interpret Time Name stamp Covers nurse/HCA’s arse Makes you read it We know who to educate if it’s wrong
- 8. ECG machine RR interval big squares: 300, 150, 100, 75, 60, 50 total number of complexes across the page x 6 Rate
- 9. Rhythm
- 10. Same patient after treatment for sepsis
- 11. Frontal axis
- 12. Why else do we care about axis? CQC
- 13. Incomplete trifascilar block RBBB, LAD and 1˚HB 1 myocyte away from complete heart block Don’t send this post syncope patient home
- 14. Then proceed through the complexes
- 15. p waves
- 16. PR interval
- 18. QRS complex
- 19. QRS complex
- 20. QRS complex
- 21. Killer Qs Pathological Qs > 40 ms (1 mm) wide > 2 mm deep > 25% of depth of QRS complex Seen in leads V1-3
- 22. ST segment
- 24. ST segment R
- 25. ST segment
- 26. ST segment
- 27. Original Sgarbossa Criteria Concordant ST-segment elevation ≥ 1 mm in any lead (5 points) oncordant ST-segment depression ≥ 1 mm in lead V1 – V3 (3 poin Discordant ST-segment elevation ≥ 5 mm in any lead (2 points)
- 28. ST segment
- 29. T waves
- 30. Repeat ECGs 13 minutes later, pain free:
- 31. T waves
- 32. T waves
- 33. T waves
- 34. QTc Long QT syndrome (genetic) Drugs incl amiodarone, digoxin, macrolides, antipsychotics, tricyclics, SSRIs, loratidine Hypothermia HyperCa HypoK, hypoMag Myocardial ischaemia ICH + others > 440ms in men or > 460ms in women
- 35. Methodical read Record your interpretation Time Name stamp Further actions esp repeat ECGs q10min x 3 for CP eg Trodat Printy 4910 http://www.selfinkingstamps.co.nz/shop/trodat-4910-26x9mm/ $20 delivered
- 36. References and images Most facts checked with and images obtained from Life in The Fast Lane http://lifeinthefastlane.com/
Editor's Notes
- 10-20 times a day a ECG will be put under your nose Nurses and HCAs trained: ECG not complete till it has been read by a doctor.
- Use I and aVF or I and II Ayo: ECG: Sinus tachycardia rate 114. Axis: -90- 120˚ With p pulmonale probably extreme R axis deviation. COPCXR consistent with pulmonary hypertension. JVP + 3cm, no oedema. ?Shd of had respiratory follow-up.
- Incomplete trifascilar block RBBB, LAD and 1˚HB
- P mitrale eg mitral stenosis
- 1˚ HB eg rheumatic fever, short PR in Lown-Ganong-Levine syndrome, PR depression (and elevation in aVR) in pericarditis. Mobitz 1 = Wenckeback. TP segment is the baseline.
- LBBB RBBB VT
- Na channel blockade / TCA overdose with prominent R wave in aVR Hyperkalaemia
- HyperK
- Q wave MI ≠ too late for thrombolysis HOCM
- LBBB Brugada LVH
- RV infarct Posterior STEMI
- Posterior-inferior-lateral MI
- Sgarbossa paced
- LMCA occlusion
- Clockwise: Chest pain, hyperacute Ts. Read 7 hours later. Wellen’s type A, hyper K, Wellen’s type B
- Wellens’
- Clock wise RV strain: PE, lateral TWI due to LVH, Lateral TWI due to LBBB
- HOCM, flattened Ts due to ischaemia
- Widespread ischaemia, SAH, hyperkalaemia