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ECG BASICS 2
HOW TO DETERMINE THE RHYTHM
THERE ARE MANY ABNORMAL RHYTHMS THOUGH
DETERMINING A NORMAL RHYTHM IS EASY
• IN THIS SESSION WE WILL CONCENTRATE ON LOOKING AT A
NORMAL RHYTHM
• WE WILL THEN LOOK AT SOME COMMON ABNORMAL
RHYTHMS
• HOPEFULLY YOU WILL THEN BE MORE COMFORTABLE IN
ASSESSING AN ECG RHYTHM STRIP
ALSO NOTE THAT THE SPACE FROM THE START
OF EACH P TO EACH QRS IS 3-5 BLOCKS
NOTE THAT A QRS COMPLEX FOLLOWS EACH P-WAVE
THIS IS REFERRED TO
AS A SINUS RHYTHM
THERE ARE 4 CRITERIA
TO CONFIRM A SINUS RHYTHM YOU MUST HAVE?
1. NORMAL P WAVES, NEITHER TOO WIDE OR BIPHASIC
2. NARROW QRS COMPLEXES, WIDE COMPLEXES IMPLY
VENTRICULAR ORIGIN OF THE IMPULSE
3. DOES A QRS FOLLOW EACH P WAVE
4. DO THESE BATCHES OF P-WAVE/QRS- WAVE COMPLEXES
OCCUR REGULARLY
LETS CHECK OUR
STRIP AGAIN
1
2
33
4 4 4 4 4
1-NORMAL P’S
2-NARROW COMPLEXES
3-QRS AFTER EVERY P
4- REGULAR COMPLEXES
SO LETS TRY A FEW
DECIDE IF THESE ARE NORMAL OR
ABNORMAL
DON’T STRESS ABOUT DIAGNOSIS
REMEMBER LOOK FOR ALL 4 CRITERIA
CORRECT
THATS A NORMAL STRIP
ITS ABNORMAL
CORRECT
• THE PWAVES ARE NORMAL
• THE COMPLEXES ARE
NARROW
• BUT THERE ISN’T A QRS
AFTER EACH PWAVE
• THE GROUPS OCCUR
IRREGULARLY
IT IS ABNORMAL
CORRECT
• THE COMPLEXES ARE
NARROW
• THE GROUPINGS ARE
REGULAR
• BUT THERE ARE NO P
WAVES!
IT IS ABNORMAL
CORRECT
• THE PWAVES ARE NORMAL
SHAPE
• THE QRS GROUPINGS ARE
REGULAR
• BUT THE COMPLEXES ARE
WIDE
• AND EACH P IS NOT
FOLLOWED BY A QRS
IT IS ABNORMAL
CORRECT
• NO DISCERNIBLE P WAVES
• THE GROUPINGS ARE
IRREGULAR
• NO ASSOCIATION
BETWEEN P’S AND QRS
• BUT COMPLEXES ARE
NARROW
IT IS ABNORMAL
CORRECT
• NOTE THAT THE
COMPLEXES ARE NARROW
• THE P WAVES ARE NORMAL
• NOT EVERY P WAVE HAS A
QRS
• THE GROUPINGS ARE
IRREGULAR
• NOTE THE WIDENING PR
INTERVAL
• NOW THAT YOU’VE LEARNT HOW TO CHECK A RHYTHM STRIP,
YOU SHOULD GO AND READ ABOUT
• 1ST DEGREE HEART BLOCK
• MOBITZ TYPE 1 AND 2 BLOCK
• GRADE 3 HEART BLOCK AND AV DISSOCIATION
• ATRIAL FIBRILLATION AND FLUTTER
• MAT
• AV JUNCTIONAL RHYTHMS
• ECTOPIC BEATS
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Ecg basics 2 pdf

  • 1. ECG BASICS 2 HOW TO DETERMINE THE RHYTHM
  • 2. THERE ARE MANY ABNORMAL RHYTHMS THOUGH DETERMINING A NORMAL RHYTHM IS EASY • IN THIS SESSION WE WILL CONCENTRATE ON LOOKING AT A NORMAL RHYTHM • WE WILL THEN LOOK AT SOME COMMON ABNORMAL RHYTHMS • HOPEFULLY YOU WILL THEN BE MORE COMFORTABLE IN ASSESSING AN ECG RHYTHM STRIP
  • 3. ALSO NOTE THAT THE SPACE FROM THE START OF EACH P TO EACH QRS IS 3-5 BLOCKS NOTE THAT A QRS COMPLEX FOLLOWS EACH P-WAVE
  • 4. THIS IS REFERRED TO AS A SINUS RHYTHM
  • 5. THERE ARE 4 CRITERIA TO CONFIRM A SINUS RHYTHM YOU MUST HAVE? 1. NORMAL P WAVES, NEITHER TOO WIDE OR BIPHASIC 2. NARROW QRS COMPLEXES, WIDE COMPLEXES IMPLY VENTRICULAR ORIGIN OF THE IMPULSE 3. DOES A QRS FOLLOW EACH P WAVE 4. DO THESE BATCHES OF P-WAVE/QRS- WAVE COMPLEXES OCCUR REGULARLY
  • 7. 1 2 33 4 4 4 4 4 1-NORMAL P’S 2-NARROW COMPLEXES 3-QRS AFTER EVERY P 4- REGULAR COMPLEXES
  • 8. SO LETS TRY A FEW DECIDE IF THESE ARE NORMAL OR ABNORMAL DON’T STRESS ABOUT DIAGNOSIS
  • 9. REMEMBER LOOK FOR ALL 4 CRITERIA
  • 11.
  • 12. ITS ABNORMAL CORRECT • THE PWAVES ARE NORMAL • THE COMPLEXES ARE NARROW • BUT THERE ISN’T A QRS AFTER EACH PWAVE • THE GROUPS OCCUR IRREGULARLY
  • 13.
  • 14. IT IS ABNORMAL CORRECT • THE COMPLEXES ARE NARROW • THE GROUPINGS ARE REGULAR • BUT THERE ARE NO P WAVES!
  • 15.
  • 16. IT IS ABNORMAL CORRECT • THE PWAVES ARE NORMAL SHAPE • THE QRS GROUPINGS ARE REGULAR • BUT THE COMPLEXES ARE WIDE • AND EACH P IS NOT FOLLOWED BY A QRS
  • 17.
  • 18. IT IS ABNORMAL CORRECT • NO DISCERNIBLE P WAVES • THE GROUPINGS ARE IRREGULAR • NO ASSOCIATION BETWEEN P’S AND QRS • BUT COMPLEXES ARE NARROW
  • 19.
  • 20. IT IS ABNORMAL CORRECT • NOTE THAT THE COMPLEXES ARE NARROW • THE P WAVES ARE NORMAL • NOT EVERY P WAVE HAS A QRS • THE GROUPINGS ARE IRREGULAR • NOTE THE WIDENING PR INTERVAL
  • 21. • NOW THAT YOU’VE LEARNT HOW TO CHECK A RHYTHM STRIP, YOU SHOULD GO AND READ ABOUT • 1ST DEGREE HEART BLOCK • MOBITZ TYPE 1 AND 2 BLOCK • GRADE 3 HEART BLOCK AND AV DISSOCIATION • ATRIAL FIBRILLATION AND FLUTTER • MAT • AV JUNCTIONAL RHYTHMS • ECTOPIC BEATS