ABCs of ECGs. Shelby L. Durler
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1 ABCs of ECGs Shelby L. Durler
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3 Objectives Review the A&P of the cardiac conduction system Placement and obtaining 4-lead and 12-lead ECGs Overview of the basics of ECG rhythm interpretation
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6 Intrinsic Firing Rates SA Node AV Node Purkinje Fibers 20-40
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12 The Paper
13 Waveform P wave 1 st deflection Atrial Depolarization
14 Waveform QRS complex Ventricular Depolarization Q wave: 1 st deflection below IL R wave: 1 st deflection above IL S wave: 2 nd deflection below IL
15 Waveform
16 Waveform T wave 1 st defection after QRS Usually positive Ventricular Repolarization
17 Waveform U wave 2 nd positive deflection after the QRS NOT next P wave Recovery of Purkinje fibers
18 PR 0.20 sec (less than one large box) QRS sec (1-3 small boxes) QT 450 ms in men, 460 ms in women Based on gender/ heart rate Half the R-R interval with normal HR Normal Intervals
19 Rhythm Interpretation Develop a systematic approach that works for you 1. Rhythm 2. Rate 3. P wave 4. PR Interval 5. QRS 6. T wave 7. QT Interval 8. Other Components
20 Rhythm Regular or Irregular Atrial rhythm? P-P Ventricular rhythm? R-R V V V V V V A A A A A A A
21 Rhythm Paper and pencil method Caliper
22 Rhythm
23 Rate 10 times method Number of R waves in 6 second strip X10
24 Rate 1,500 method 1500 / # small squares between R-R 1500 / 20 = 75
25 Rate Sequence method Large boxes between R-R
26 P Wave Evaluate the P wave Present? One for every QRS?
27 PR Interval Measure the PR interval ? Is it consistent?
28 1 st Degree Heart Block
29 2 nd Degree Type 1 Heart Block
30 2 nd Degree Type 2 Heart Block
31 3 rd Degree Heart Block
32 QRS Duration One after every P wave? End of PR interval to end of S wave
33 Evaluate the T wave Present? Normal Shape? Normal/Same Amplitude? Concordant with QRS?
34 T Wave Morphology Ischemia Electrolyte Imbalances Hypothermia Positional Hypertrophy Idiopathic Benign
35 QT Interval Beginning of QRS and end of T wave
36 Corrected QT Interval (QTc) < 460 ms < 450 ms
37 Other Components Evaluate for ectopic beats ST segment changes U wave
38 Atrial Rhythms Any rhythm originating in the atria Generally initiated by SA node Intrinsic rate of
39 Normal Sinus Rhythm Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Regular Upright; present; one for every QRS Normal Normal duration Following each QRS Normal
40 Sinus Bradycardia Same as NSR Except rate <60
41 Sinus Tachycardia Same as NSR Except rate >100
42 Sinus Dysrhythmia Simply a variation in SA nodal firing times Respiratory pattern Normal variant Deeper complications
43 Sinus Arrest Same as NSR Except at some point the SA node fails to fire
44 Atrial Fibrillation Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Irregularly Irregular Varies Fibrillating None Normal Normal if present Normal if present
45 Atrial Flutter Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Varies Atrial: ~ ; Ventricular: varies F (flutter) waves Varies Normal May not be present May not be present
46 Supraventricular Tachycardia Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Regular >150 None None Narrow Normal Usually decreased
47 Premature Atrial Complex (PAC) Ectopic beat Originates somewhere other than SA node All components are the same at NSR
48 Junctional Rhythms Rhythms originating in the AV node (junction) Intrinsic rate of Occurs if the SA node fails
49 Junctional (Escape) Rhythm Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Regular Absent; inverted; after QRS complex None Normal Normal Normal
50 Accelerated Junctional Same as Junctional Rhythm Except rate:
51 Junctional Tachycardia Same as Junctional Rhythm Except rate: >100
52 Premature Junctional Complex (PJC) Ectopic beat Junctional complex occurring outside normal expected location
53 Ventricular Rhythms Rhythms originating below the AV junction Intrinsic rate of Occurs if the SA and AV nodes fail QRS complexes will be wide
54 Idioventricular Rhythm Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Regular None None >0.12 Discordant to QRS Varies if even measurable
55 Accelerated Idioventricular Same as Idioventricular Except rate:
56 Ventricular Tachycardia Same as idioventricular Except rate: >100
57 Ventricular Tachycardia Same as idioventricular Except rate: >100
58 Torsades de Pointes Twisting of Points Type of polymorphic v-tach Rate:
59 Ventricular Fibrillation Rhythm: Rate: P wave: PR Interval: QRS: T wave: QT: Irregular Impossible to determine None None None None None
60 Premature Ventricular Complex (PVC) Ectopic beat Ventricular complex occurring outside normal expected location
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63 Asystole & Agonal Rhythm
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67 Shelby Durler Paramedic Sources Life in the Fast Lane EMT Resource
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