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Cardiac Arrest Rhythm.pdf
1. Cardiac Arrest Rhythm
Oleh : PPP Nur Azhar bin Zainal
Penolong Pegawai Perubatan U42
Jabatan Kecemasan Dan Trauma
Hospital Ampang
2. Learning Outcomes
• To recognize the Normal Sinus Rhythm
• To recognize Shockable Rhythm
• To recognize Non Shockable Rhythm
• Management
• Defibrillation
• Drugs
5. Step By Step Rhythm Interpretation
• It’s important to have a systematic approach to reading &
reporting ECG’s. It makes sure you don’t miss anything.
• By following the steps below you can assess any ECG in a
quick & effective manner
Step 1 - Calibration
Step 2 - Heart Rate
Step 3 - Heart Rhythm
Step 4 - P waves
Step 5 - P-R interval
Step 6 - QRS complex
Step 7 - ST segment
Step 8 - T waves
Step 9 - Calculate QT interval
6. Step 1: Calibration of the ECG (Standardization)
Standard calibration of the ECG is
10mm/ Mv and speed of 25 mm/sec
7. Step 2 – Heart Rate
Heart rate can be calculated with 3 simple method:
1. 1500/ R-R small square box (0.04sec) = HR
2. 300/ R-R square box (0.20sec) = HR
3. Calculate total of QRS in 6 sec x 10 = HR
8. Step 3 – Heart Rhythm
• Heart rhythm can be either regular or irregular
• This can be determined by looking again at the R-R
wave interval
• If the R-R interval is inconsistent then the rhythm would be
classed as irregular
9. Step 4 – P waves
Next we look at the p waves & comment on a number of things;
Are P-waves present?
Do they occur regularly?
Is there sinus rhythm (does a P wave precede each QRS
complex?)
Do the P-waves look normal? (smooth, rounded & upright)
10. Step 5 – P-R Interval
• The P-R interval should be between 0.12-2.0 seconds (3-5 small
squares)
• Are the P-R intervals consistent or do they change throughout the
ECG?
a) Prolonged P-R interval
b) Shortened P-R interval
with delta wave (WPW)
11. Step 6 – QRS complex
• Check the width of the QRS complexes
• The QRS complex should be 0.12 seconds (3 small squares)
• If longer than 0.12 seconds it suggests the complex originated
in the ventricles
• If shorter than 0.12 seconds it suggests the complex is supra-
ventricular in origin
12. Step 7 – ST Segment
• The ST segment is the part of the ECG between the end of the
S wave & start of the T wave
• In a healthy individual it should be an isoelectric line (neither
elevated or depressed)
ST SEGMENT ELEVATION ST SEGMENT DEPRESSION
13. Step 8 – T waves
Are the T waves inverted?
• One of the most common abnormalities found on ECG
• Inverted T-waves in V1 & V2 are not significant & seen in healthy
individuals
• Comment cause : ACS (new & previous), Bundle Branch Block etc
Are the T-waves Tall?
• T-wave is considered tall when it is greater than;
• 5mm in the standard leads
• 10mm in the precordial leads
• Comment caused ; Hyperkalaemia, Myocardial Ischemia
17. SHOCKABLE
Ventricular Fibrillation (VF)
• Bizarre irregular waveform
• No recognisable QRS complexes
• Random frequency and amplitude
• Uncoordinated electrical activity
• Coarse/fine
• Electrical interference
18. SHOCKABLE
Ventricular Tachycardia (VT)
Polimorphic VT
Monomorphic VT
Ventricular tachycardia should be
described by
• Type (monomorphic or polymorphic),
• Duration (sustained or non-sustained)
• Rapid heart rate —150 bpm to 300 bpm.
• Broad complex rhythm
19. Treatment of shockable rhythms (VF/VT)
• Confirm cardiac arrest – check for signs of life
• Call for help – Resus Team
• Perform High-quality CPR – Minimum Interruptions
• Attach defibrillator
If possible, use a manual defibrillator over an
AED since the use of the AED can result in
prolonged interruptions in chest compressions
for rhythm analysis and shock administration.
21. Shockable
Rhythm
(VT/ VF)
Rhythm checks should be performed after 5 cycles of CPR.
Limit rhythm checks to less than 10 seconds to minimize interruptions in CPR
2 minutes (5 cycles)
22.
23. Non Shockable Rhythm
Pulseless Electrical Activity (PEA)
• Pulseless electrical activity (PEA) is a condition where your
heart stops because the electrical activity in your heart is
too weak to make your heart beat
• Clinical features of cardiac arrest
25. Treatment of PEA and asystole
• Start CPR 30:2
• Give adrenaline 1 mg IV as soon as intravascular access is achieved
• Continue CPR 30:2 + Secure Airway
• Recheck the rhythm after 2 min:
If ROSC Start post resuscitation care
If no pulse / PEA or asystole Continue CPR. Give
further adrenaline 1 mg IV every 3–5 min
If VF/ VT at rhythm check, change to shockable side of
algorithm (ALS)
