This document provides an overview of ECG basics, including the cardiac conduction system, components of the cardiac cycle, a systematic approach to rhythm interpretation, and descriptions of common arrhythmias. It discusses the normal P-QRS-T waveform, conduction velocities, factors used to analyze rhythms like regularity and rate, and examples of arrhythmias including sinus arrhythmia, sinus block, WAP, MAT, A-fib, flutter, blocks, and SVTs. It also reviews lead placement, electrical axis, vector concepts, and a systematic approach to 12-lead ECG interpretation.
Case-1:
A 23 years old medical student presented with occasional palpitation, shortness of breath and chest discomfort. He had the following ECG.
A 53 years old gentleman presented with palpitations for last 5 hours. He is smoker, diabetic, dyslipidemic and hypertensive. He had exertional chest discomfort for last 5 years and did coronary angiogram 3 years back and CAG revealed TVD and advised for revascularization. But he refused and was irregular in medication and reluctant for life style modification. He came to emergency department with this ECG.
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsMichael-Joseph Agbayani
Simple ECG lecture about sinus arrest, sinoatrial exit block, AV block and escape rhythms. Slideshow was made with an audience of medical professionals in mind.
Also known as an electrocardiogram or an EKG, an ECG is a test that detects and records the strength and timing of the electrical activity in your heart. This information is recorded on a graph that shows each phase of the electrical signal as it travels through your heart.
Case-1:
A 23 years old medical student presented with occasional palpitation, shortness of breath and chest discomfort. He had the following ECG.
A 53 years old gentleman presented with palpitations for last 5 hours. He is smoker, diabetic, dyslipidemic and hypertensive. He had exertional chest discomfort for last 5 years and did coronary angiogram 3 years back and CAG revealed TVD and advised for revascularization. But he refused and was irregular in medication and reluctant for life style modification. He came to emergency department with this ECG.
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsMichael-Joseph Agbayani
Simple ECG lecture about sinus arrest, sinoatrial exit block, AV block and escape rhythms. Slideshow was made with an audience of medical professionals in mind.
Also known as an electrocardiogram or an EKG, an ECG is a test that detects and records the strength and timing of the electrical activity in your heart. This information is recorded on a graph that shows each phase of the electrical signal as it travels through your heart.
This presentation will enable the fresh medical/nursing and other health professionals to understand basics of ECG along with they can able to interpret in beginning.
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
ecg basics made easy, with description of most common ecg types especially in emergency situation.
easy to memorize points and mnemonics included.
approach to ecg diagnosis.
sample ecgs.
An electrocardiogram (ECG or EKG) records the electrical signal from your heart to check for different heart conditions. Electrodes are placed on your chest to record your heart's electrical signals, which cause your heart to beat. The signals are shown as waves on an attached computer monitor or printer
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
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This includes tasks like:
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Performing procedures as directed by doctors.
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
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According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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2. DISCLOSURES
None of the planners or presenters of this
session have disclosed any conflict or
commercial interest
3. Objectives
Identify the conduction system of the heart and the
components of the cardiac cycle
Discuss a systematic approach to rhythm interpretation
Review common cardiac arrhythmias
Describe the process for interpretation of a 12 lead ECG
8. Normal P-QRS-T
P Wave PR Interval QRS Complex ST Segment
Represents Atrial
depolarization
atrial depolarization and
delay at the AV Node
(AV conduction time)
Ventricular
depolarization
Interval between
ventricular
depolarization and
repolarization
Duration < 0.12 seconds 0.11 - 0.20 seconds 0.06 - 0.11 seconds Measure from end of
QRS (J-point) to
beginning of T wave
Height < 2.5 mm Measure start of P wave
to start of QRS
Q- First negative
deflection
R- First positive
deflection
S- Negative deflection
after R wave
Shape Smooth Prolonged indicates a
conduction block
Shortened indicates
accelerated conduction or
junctional in origin
In relation to iso-
electric line:
Depression/Negative
indicates ischemia
Elevation/Positive
indicates injury
Orientation Positive in Leads
I,II,aVF, V4
Negative in aVR
13. Guess the Rhythm
Rate 60-100
Regularity Varies with respirations
P wave Normal
QRS Normal
Grouping None
Dropped beats None
Sinus Arrhythmia
14. Sinus Block & Pause
Rule Rule
Rhythm Rhythm
Rhythm Irregular when SA block occurs
Rate Normal or Slow
P wave Normal
PR
Interval
Normal (0.12-0.20sc.)
QRS Normal (0.06-0.10sc.)
Notes Pause time is an integer multiple
of the P-P interval.
Rhythm Irregular due to pause
Rate Normal to Slow
P wave Normal
PR
Interval
Normal (0.12-0.20sc.)
QRS Normal (0.06-0.10sc.)
Notes Pause time is not an integer
multiple of the P-P interval
15. WAP & MAT
Rhythm May be irregular
Rate Normal (60-100)
P wave Changing shape from beat to
beat. At least 3 different shapes
PR
Interval
Variable
QRS Normal (0.06-0.10sc.)
Notes If HR exceeds 100 may be MAP
Rhythm Irregular
Rate > 100
P wave Changing shape from beat to
beat. At least 3 different shapes
PR
Interval
Variable
QRS Normal (0.06-0.10sc.)
Notes T wave often distorted
18. Rhythm Regular
Rate Underlying rate
P wave Normal
PR Interval > 0.20 sc
QRS Normal (0.06-0.10sc.)
Notes Impulses through AV node are
delayed not blocked. No missed
beats
Rhythm Irregular with progressively
longer PR interval lengthening
Rate Underlying rate
P wave Normal
PR Interval Progressively longer until QRS
dropped then cycle repeats
QRS Normal (0.06-0.10sc.)
Notes
Rhythm Regular or Irregular depending
on conduction ratio
Rate Atrial rate usually normal (60-
100) Ventricular rate slow (<60)
P wave Normal4.75
PR Interval Constant on conducted beats.
May be > 0.20sc
QRS Normal (0.06-0.10sc.)
Rhythm Regular atrial and ventricular
Rate Atrial rate usually normal and
ventricular rate 40-60 if
junctional & 20-40 if
ventricular
P wave Normal
PR Interval Not applicable
QRS Normal if junctional (0.06-
0.10sc.) or > 0.12 if ventricular
Notes Complete block at AV node
30. Vectors
•Each cell has its own electrical
impulse
•Vary in strength and direction
•According to physics can add and
subtract vectors
•The sum of all of these is the
electrical axis of the ventricle
32. Lead Placement
• Limb leads 10 cm from
heart
• Precordial leads placed
exact
• V1&V2 each side of
sternum 4th intercostal
• V4 5th intercostal mid-
clavicular line
33. Pictures of the Heart
•Electrodes are like cameras
•Pick up the electrical activity of vectors and turns it into waves
•3-D image of the heart
36. Manipulation of Leads
• Positive and negative poles for leads I, II, & III
• In physics two vectors (leads) are equal as long
as they are parallel and same polarity
• Move the leads to pass through the center of
the heart
• With vector manipulation ECG machine
creates aVR, aVL, & aVF
37.
38. Hexaxial System
• Used to determine
electrical axis
• What is the normal axis
for the heart?
• -30 to +90
39. Electrical Axis
Right Axis Deviation
-RVH
-Left posterior hemiblock
-Dextrocardia
-Ectopic ventricular beats and
rhythms
Left axis deviation
-Left Anterior hemiblock
-Ectopic ventricular beats and
rhythms
Extreme Right
42. R Wave Progression
• V1 overlays right
ventricle deep s wave
• V5 & V6 overlay left
ventricle tall positive R
waves. V5 usually the
tallest R wave
• Transition zone
between V3 & V4
47. Systematic Approach to Interpretation
• General Impression/Anything that sticks out?
• Rate, intervals & rhythm
• Axis
• Is there hypertrophy
• Ischemia or infarction
• Any other unusual findings
• Putting it all together for the patient
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61. References
ECG Clinical Interpretation: A to Z by diagnosis. Retrieved from: http://lifeinthefastlane.com/ecg-
library/basics/diagnosis/
Garcia, T. B. (2015). 12_Lead ECG The Art of Interpretation. Jones & Bartlett Learning Burlington, MA
Malcolm, T. S. (2012). The Only EKG Book You’ll Ever Need. Lipincott Williams & Wilkins. Philadelphia, PA
Walraven, G. (2011) Basic Arrhythmias Seventh Edition. Pearson Education Upper Saddle River, NJ