King Bay ECG/STEMI

2. Assistant Professor, Emergency Med Deputy Medical Director

5. RA RV LA LV

6. IVC RA RV LA LV To Lung s From Lung s Aorta

7. Basics of EKG RA RV LA LV P T QT STPR QRS

8. Atrial Contraction = P WAVE SA node  AV Node Causes atrial contraction P WAVE SA AV P Q RS T PR QT

9. PR Interval RA RV LA LV P T PR QT At the AV Node Allows delay before Ventricular contraction

10. Ventricular contraction = QRS RA RV LA LV P QRS T QTPR Electricity passes down LV and RV Depolarizes Ventricle

11. ST segment RA RV LA LV P T STPR QRS During ventricular contraction (depolarization) before relaxation (repolarization)

12. Ventricular Relaxation = T wave Ventricles repolarize in same direction as depolarized R A RV LA LV P T QT STPR QRS

13. RA LA RL LL V1 V2 V3 V4 V5 V6

14. RA LA RL LL V1 V2 V3 V4 V5 V6

15. aVF IIIII I aVLaVR

17. INFERIOR LATERAL LATERAL LATERAL ANTERIOR SEPTAL

19. ECG Interpretation Rate Rhythm Intervals

20. Rate 300 150 100 75 60 50 300 / # big boxes

21. Tachycardia vs Bradycardia

22. Rhythm Regular or irregular?

23. Rhythm Is the rhythm “sinus” Are P waves present Is there a P for every QRS

24. Intervals

25. Intervals

26. PR Interval 120-200 ms Normal >200 ms AV Block

27. AV Blocks

28. RA RV LA LV T PR Partial or complete block of impulse transmission from atria to ventricles

29. 1st degree AV Block 1st degree: prolonged PR > 200 ms

30. 2nd degree type 1 Progressively increasing PR interval until non-conducting p wave

31. 2nd degree type 1

32. 2nd degree type 2 Intermittent non-conducting p waves without progressive prolongation of PR interval

33. 3rd degree Complete dissociation between P and QRS

34. 2nd Degree Type II & 3rd Degree AV Blocks May Require Pacing

35. QRS Complex < 100 ms Narrow >120 ms Wide

36. QRS

37. QRS SUPRAVENTRICULAR Sinus Rhythms (SA) Atrial Rhythms Junctional Rhythms (AV)

38. QRS Ventricular Rhythms Bundle Branch Blocks

39. Supraventricular Arrhythmias

40. Supraventricular (above the ventricles)

41. Atrial Fibrillation

44. Atrial Fibrillation Irregularly irregular No discernable P waves

46. A fib with RVR Rapid Ventricular Rate

47. Atrial Flutter

48. Atrial flutter

49. Atrial flutter

50. Atrial flutter Regular “Saw-tooth” waves

51. Atrial flutter

52. “SVT” Actually “AV Nodal Reentry Tachycardia”

53. AV Nodal Re-entry Tachycardia

55. AV Nodal Re-entry Tachycardia Regular No P waves Rate typically ~ 150

57. Ventricular Arrhythmias

58. Ventricular Tachycardia

59. Ventricular Tachycardia

60. Ventricular Tachycardia Regular (usually) Wide Complex No P waves

61. Ventricular Fibrillation

64. Ventricular Fibrillation Rapid, chaotic, Irregular No obvious P, QRS

65. Let’s do some ECGs

66. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS

71. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Normal Sinus

76. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Sinus Tachycardia

81. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS AVNRT (“SVT”)

85. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Junctional Rhythm

90. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Atrial Fibrillation (RVR)

95. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS 2nd Deg (Type 1) AV Block

98. Rhythm Reg Irreg P wave (lots) No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS

99. Rhythm Reg Irreg P wave (lots) No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Atrial Flutter

104. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS V Tach (Torsades)

109. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Paced Rhythm

114. Rhythm Reg Irreg P wave No P Wave Rate Brady Normal Tachy Intervals PR normal AV Block Narrow QRS Wide QRS Sinus Bradycardia

115. Morphology But first a break

117. QRS Morphology

118. Bundle Branch Blocks

119. Bundle Branch Blocks

121. Left Bundle Branch Block

123. Right Bundle Branch Block

124. T wave Morphology

125. Ischemia

127. Hyperkalemia

130. ST Segment Morphology

131. STEMIs

132. Coronary artery occlusion Infarction (tissue death)

133. ST Elevation > 2mm in 2 contiguous leads + CP, SOB, Nausea, Syncope OR ECG reads “Acute MI”

134. Reciprocal ST Depressions

138. STEMI Alert

141. STEMI ALERT – ECC Kings Bay – ETA 20

146. STEMI Treatment

147. Which of the following are proven to improve survival from STEMI? • Lights and Sirens • Aspirin • Morphine • Oxygen • Cardiac Catheterization • ALS unit • Helicopter transport • Nitroglycerin

148. Aspirin +

149. Cardiac Catheterization

151. STEMI Geography

152. INFERIOR LATERAL LATERAL LATERAL ANTERIOR SEPTAL

153. Inferior STE: II, III, aVF STD: aVL Septal STE: V1-V2 Anterior STE: V3, V4 Lateral STE: V5, V6, aVL Posterior STE: V7-V9 STD: V1-V2

154. STEMI ECGs

158. Anterior MI

162. Anterolateral MI

163. From Kings Bay

164. From Kings Bay

166. From Kings Bay Inferior MI

167. What is special about Inferior MI?

168. Right Ventricle Preload Dependent High risk of hypotension with Nitro

169. How do we determine right side involvement?

170. Right Sided ECG Switch V4 to right side V4R

171. Pre-hospital ECG

172. ED ECG

173. Right Side ECG V4R

174. If ST Elevation in V4R, hold Nitro Remember, Nitro doesn’t save lives

175. What ELSE is special about Inferior MI?

176. SA and AV Nodes Sinus Bradycardia AV Blocks

177. Pre-hospital ECG

182. 3rd Degree AV Block Complete A-V Dissociation

183. Morphology?

184. Morphology?

185. Inferior MI + 3rd Degree AV Block Complete A-V Dissociation

186. EC ECG

187. Right Side ECG V4R

188. STEMI Mimics

189. +

190. A C B

191. LBBB + MI ECG: www.emedu.org

192. LBBB + MI A: Concordant STE > 1mm V5-V6 C: Discordant STE > 5mm V3 ECG: www.emedu.org

193. Pericarditis 30 yo male, healthy, recent URI ECG: www.lifeinthefastlane.com

194. Pericarditis Widespread concave STE Widespread PR depression (often late, not specific) ECG: www.lifeinthefastlane.com

195. Pericarditis STEMI

196. Benign Early Repolarization 18 yo female, healthy, c/o dizziness ECG: www.lifeinthefastlane.com

197. Benign Early Repolarization Widespread concave STE Most prominent V2-V5 STE usually < 2mm Notching at J-point Usually prominent in V4 http://lifeinthefastlane.com/

198. Benign Early Repol STEMI

199. Brugada 20 yo male presents with sudden cardiac arrest

200. Brugada “Sudden Unexplained Nocturnal Death Syndrome (SUNDS)” “Bangungut” (Phil) (“to rise and moan in sleep”) “PokkurI” (Japan) (“sudden and unexplained ceased phenomena”) ECG: www.ecgpedia.org

201. Brugada Mutation of cardiac sodium channel gene 60 mutations described May be familial ECG: www.ecgpedia.org

202. www.JaxEMS.com Field tools Video Lectures Case Feedback

203. Brugada Type I STE > 2mm in >1 of V1-V3 Followed by negative T www.lifeinthefastlane.com

King Bay ECG/STEMI

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (10)

Similar to King Bay ECG/STEMI

Similar to King Bay ECG/STEMI (20)

More from UFJaxEMS

More from UFJaxEMS (20)

Recently uploaded

Recently uploaded (20)

King Bay ECG/STEMI

Editor's Notes