Birmingham Regional Emergency Medical Services System

Transcription

1 Birmingham Regional Emergency Medical Services System 2018 ALCTE Summer Conference EKG Basics Brian Gober, MAT, ATC, NRP, CSCS Education Services Manager ECC Training Center Coordinator Birmingham Regional EMS System

2 Birmingham Regional EMS System Address: th Street South Birmingham, AL Phone: Fax: Hours: Monday-Friday 8:00 am - 5:00 pm

3 Birmingham Regional EMS System Real-time EMS serving Blount, Chilton, Jefferson, Shelby, St. Clair, Walker, & Winston counties in North Central Alabama. BREMSS s main goal is to serve all providers of emergency care in the region so patient life & limb are saved, to lead with vision the EMSS of the region in development & implementation of a system that delivers patient care at the highest level, to educate the community about emergency medical care, & continue the education of healthcare personnel in the newest lifesaving knowledge, techniques, & skills.

4 Objectives Explain the basic anatomy and physiology of the cardiovascular system. Explain the difference between the mechanical and electrical components of the heart. Discuss the equipment and supplies needed to conduct an EKG. Explain proper lead placement for a 3 lead, 4 lead, 5 lead, and 12 lead EKG. Discuss teaching strategies for explaining EKGs to entry level students. Introduce the 5 step process for EKG interpretation.

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6 Electrocardiogram (ECG or EKG) An electrocardiogram records the electrical signals in your heart. It's a common test used to detect heart problems and monitor the heart's status in many situations. When the word electrocardiogram is translated into the German language, it is spelled Elektro-kardiographie or EKG

7 EKGs = A Foreign Language

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9 Anatomy of the Heart

10 Mechanical Function

11 Electrical Conduction System

12 SA Node vs. AV Node

13 SA Node = Sinoatrial Node The SA node is the heart's natural pacemaker. The SA node consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart). The electrical impulses are generated there. The SA node is also called thesinus node.

14 AV Node = Atrioventricular Node The AV node, which controls the heart rate, is one of the major elements in the cardiac conduction system. The AV node serves as an electrical relay station, slowing the electrical current sent by the sinoatrial (SA) node before the signal is permitted to pass down through to the ventricles.

15 AV Junction Separated the Atria and Ventricles The bundle of His (AV Bundle) is an important part of the electrical conduction system of the heart, as it transmits impulses from the atrioventricular node, located at the inferior end of the interatrial septum, to the ventricles of the heart

16 Ventricular Conduction

17 EKG Equipment

18 EKG Paper ECG tracings are recorded on grid paper. The horizontal axis of the EKG paper records time. The amplitude, or voltage, of the recorded electrical signal is expressed on an ECG in the vertical dimension and is measured in millivolts (mv

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22 EKG Electrodes ECG electrodes are typically wet sensors, requiring the use of a conductive gel to increase conductivity between skin and electrodes.

23 EKG Monitors

24 EKG Simulator Used to simulate EKG rhythms Allows you to minimize use of disposable supplies

25 Types of EKGs

26 3 Lead EKG 3 Lead: Common for initial assessment. Needed to identify the underlying heart rhythm and arrhythmias Ischemic Changes are not diagnosed based on this assessment

27 3 Lead EKG Einthovens Triangle Each Lead is Bipolar consisting of a positive and negative lead Lead I: Lateral Lead II: Inferior Lead III: Inferior

28 3 Lead EKG Application Skin Preparation (skin should be clean, shaving may be necessary) Limb Leads: Most manufacturers recommend placement of the leads on the extrimities. (Follow manufacturers recommendations) White (Salt), Black (Pepper), Red (Ketchup) leads

29 4 Lead EKG Conducts same assessment at 3 lead. Adds a neutral or ground lead located on the Right Leg

30 5 Lead EKG Same setup as a 3 lead EKG with the addition on the right leg lead (if not already placed) and V1 lead Seen in Clinical Settings

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32 12 Lead EKG A 12-lead ECG consists of three bipolar limb leads (I, II, and III), the unipolar limb leads (AVR, AVL, and AVF), and six unipolar chest leads, also called precordial or V leads.

33 12 Lead EKG Chest Leads (precordial Leads or V Leads) V1, V2, V3, V4, V5, and V6

34 12 Lead Placement

35 EKG Waveforms

36 Cardiac Electrophysiology Electrical properties of cardiac cells Depolarization: Occurs in the four chambers of the heart: both atria first, and then both ventricles. The sinoatrial (SA) node on the wall of the right atrium initiates depolarization in the right and left atria, causing contraction, which is symbolized by the P wave on an electrocardiogram. Repolarization: Return to the Action Potential needed for depolarization to occur.

37 Cardiac Electrophysiology Atrial and ventricular depolarization and repolarization are represented on the ECG as a series of waves: the P wave followed by the QRS complex and the T wave. The P Wave. The first deflection is the P wave associated with right and left atrialdepolarization.

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40 Rules of EKG Interpretation 5 Basic Steps Rate Is it Regular or Irregular? Is there a P wave Present? What is my PR Interval? How wide is my QRS complex?

41 ECG Rhythms

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49 Brian Gober, MAT, ATC, NRP, CSCS Education Coordinator ECC Training Center Coordinator (205) Extension 3 (205) bcg@uab.edu