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![•
Rhythm = Regular or irregular. Map P-P and R-R
intervals
.
•
Rate = Number of P
’
s (atrial) R
’
s (ventricular)
per minute
)
6
second [
30
squares] X
10
=
(etar etunim
.
P rate:
8
x
10
=
80
R rate:
8
x
10
=
80
Interpretation](https://image.slidesharecdn.com/ecgechoplansunday-221010145326-03e383aa/75/basic-ECG-SAMPLE-WAY-12-2048.jpg)
basic ECG SAMPLE WAY
- 1. ECG INTERPRETATION: the basics Mohammed ayed CriticalCare Education Staff Development Unit
- 2. Overview • Conduction Pathways • Systematic Interpretation • Commonabnormalities in Critical Care – Supraventricular arrhythmias – Ventricular arrhythmias
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- 5. Lead Placement V1 =4th ICS right sternum V2 = 4th ICS left sternum V3 = midway between V2 and V4 V4 = 5th ICS midclavicular V5 = between V4 and V6 anterior auxiliary line V6 = midauxillary line lateral to V4 and V5
- 7. Lead Placement • II -inferior wall • III - inferior wall Augmented leads (unipolar) • aVR - no mans land • aVL - lateral wall • aVF - inferior wall Standard Leads (bipolar) Chest Leads (unipolar) • I - lateral wall • V1 - septal wall • V2 - septal wall • V3 - anterior wall • V4 - anterior wall • V5 - lateral wall • V6 - lateral wall
- 8. Lead Placement No-mans land,inferior, lateral, anterior, septal,
- 9. P wave = atrialdepolarisation. PR Interval = impulse from atria to ventricles. QRS complex = ventricular depolarisation. ST segment = isoelectric - part of repolarisation. T wave = usually same direction as QRS - ventricular repolarisation. QT Interval = This interval spans the onset of depolarisation to the completion of repolarization of the ventricles. Conduction Pathways
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- 11. VOLTAGE AND TIMECALIBRATION OF THE ELECTROCARDIOGRAM
- 12. • Rhythm = Regularor irregular. Map P-P and R-R intervals . • Rate = Number of P ’ s (atrial) R ’ s (ventricular) per minute ) 6 second [ 30 squares] X 10 = (etar etunim . P rate: 8 x 10 = 80 R rate: 8 x 10 = 80 Interpretation
- 13. 3. P wave= present, 1 per QRS, shape, duration, voltage. 4. P-R interval = length (0.12 - 0.2 sec = <1 big square), isoelectric. Interpretation
- 14. 5. QRS =duration (0.06 - 0.10 ), voltage, q or Q waves 6. ST Segment = shape, isoelectric with PR segment Interpretation
- 15. 7. T wave= shape, direction 8. QT interval = length (R-R/2 or QTc <0.40 sec) Interpretation
- 16. MAJOR CARDIAC ARRHYTHMIAS SINUS RHYTHMSATRIAL RHYTHMS VETRICULAR RHYTHMS ATRIO- VENTRICULAR (AV) RHYTHMS SINUS BRADY PREMATURE ATRIAL CONTRACTION (PAC) PREMATURE VENTRICULAR CONTRACTION (PVC) 1ST DEGREEAV BLOCK SINUS TACHICARDIA ATRIAL FLUTTER VENTRICULAR TACHICARDIA 2ND DEGREE AV BLOCK TYPE I SINUS ARRYTHMIA ATRIAL FIBRILATION VENTRICULAR FIBRILATION 2ND DEGREE AV BLOCK TYPE II SINUS ARREST ASYSTOLE 3RD DEGREE AV BLOCK
- 17. SINUS RHYTHMS CHARACTERISTICS -less than 60bpm -regularPP and RR -PR 0.12-.20 QRS0.10 WHAT TO DO? -watch the patient for s/s of bradycardia -If symptomatic; iv access, o2, transcuteneus pacing MEDICATION Atropine 0.5mg ivp
- 18. SINUS RHYTHMS CHARACTERISTICS - 101-150bpm -regular PPand RR -PR 0.12-.20 QRS0.10 or less WHAT TO DO? -watch the patient for s/s of Tachycardia -correct underlying problems/Never shock ST MEDICATION Atenelol/Meteprolol (Beta blockers)
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- 21. Abnormalities: Supraventricular arrhythmias • Atrial Fibrillation • AtrialFlutter • Supraventricular Tachycardia (SVT) • Premature Ventricular Complexes (PACs) Abnormalities: Ventricular arrhythmias
- 22. Abnormalities: atrial fibrillation Rhythm: Irregular Rate:A: 350 – 650; V: varies P: poorly defined P-R: N/A QRS: narrow complex S-T: normal T: normal Q-T: normal
- 23. Abnormalities: atrial flutter Rhythm: Regular/ Irregular Rate: A: 220 – 430; V: <300 (2:1, 3:1 or sometimes 4:1) P: Saw toothed appearance P-R: N/A QRS: narrow complex S-T: normal T: normal Q-T: normal
- 24. Abnormalities: supraventricular tachycardia (SVT) Rhythm:Regular Rate: >100 P: not visible P-R: not defined QRS: narrow complex S-T: depression (sometimes) T: normal Q-T: prolonged (sometimes)
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- 26. Abnormalities: heart block • • SA block(exit block) • 1st degree AV block • 2nd degree AV block – Wenckeback (type I) – Mobitz (type II) 3rd degree AV block
- 27. Abnormalities: heart block –SA block
- 28. Abnormalities: heart block –1st degree AV
- 29. Abnormalities: heart block –2nd degree AV Wenkeback Mobitz
- 30. Abnormalities: heart block –3rd degree AV
- 31. Abnormalities: life threatening arrhythmias • VentricularTachycardia • Ventricular Fibrillation • Asystole
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- 35. MI -- STElevation One way to diagnose an acute MI is to look for elevation of the ST segment.
- 36. ST Elevation (cont) Elevationof the ST segment (greater than 1 small box) in 2 leads is consistent with a myocardial infarction.
- 37. ELECTROLYTE ABNORMALITIES • Hyperkalaemia • Peaked Twaves • Disappearance of ST segment • Hypokalaemia • Flat T waves F/B U waves with • Prolonged QT interval • Hypocalcaemia • Prolonged QT interval • Hypercalcaemia • Short QT interval
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Editor's Notes
- #23 Nursing Management Control of ventricular rate - Prevention of embolism with anticoagulation therapy Obtain 12 lead ECG- chaotic rhythm with no P waves. Measure vitals- if unstable may need cardioversion. Hook patient to cardiac monitor. Administer drugs as prescribed. Administer anticoagulant.
- #24 What is the management of atrial flutter? administer an antiarrhythmic drug; (2) initiate DC cardioversion; Obtain 12 lead ECG- Measure vitals- if unstable may need cardioversion. Hook patient to cardiac monitor. Administer anticoagulant.
- #25 Nursing Management Obtain an order for oxygen per nasal cannula adjusted to oxygen saturation. Monitor ECG for rate, rhythm, and conduction. Assess vital signs and ECG and report abnormal changes to the clinician. Cardioversion.
- #26 Therapeutic Management Nursing Interventions. Determine underlying rhythm . Determine frequency of PVCs. Bigeminy. Trigeminy. Determine/treat the cause. Caffeine intake. Electrolyte imbalance. Hypoxia. Medications. ... . Continue to monitor. Symptomatic/Frequent. Medications. Antiarrhythmics. Beta blockers.
- #29 Nursing Management Monitor vital signs. Place the patient on a cardiac monitor. Obtain an ECG. Assess oxygenation. Check labs to ensure electrolytes are within normal limits. Place the patient at bed rest. Listen to the heart for murmurs. Monitor for fluid retention.
- #30 Nursing Management Monitor vital signs. Place the patient on a cardiac monitor. Obtain an ECG. Assess oxygenation. Check labs to ensure electrolytes are within normal limits. Place the patient at bed rest. Listen to the heart for murmurs. Monitor for fluid retention. initiating pacing as soon as this rhythm is identified.
- #31 Nursing Management Monitor vital signs. Place the patient on a cardiac monitor. Obtain an ECG. Assess oxygenation. Check labs to ensure electrolytes are within normal limits. Place the patient at bed rest. Listen to the heart for murmurs. Monitor for fluid retention. initiating pacing as soon as this rhythm is identified.
- #33 assess the patient first and see if there is a pulse present. mmediate cardiopulmonary resuscitation (CPR) and defibrillation
- #34 Treatment includes: CPR (cardiopulmonary resuscitation). The first response to V-fib may be CPR. ... Defibrillation. This is an electrical shock that is delivered to your chest wall to restore normal rhythm. ... Medicines. ... Implantable cardioverter defibrillator (ICD). ... Catheter ablation. ... Left cardiac sympathetic denervation