12 Lead Acquisition and Interpretation APRIL 23 11:00 AM
|
|
- Suzan Dalton
- 5 years ago
- Views:
Transcription
1 12 Lead Acquisition and Interpretation APRIL 23 11:00 AM Presented by : Jennifer Robson, Prehospital Care Specialist Dr. Don Eby, Local Medical Director
2 Objectives Upon completion of this webinar, you should be able to: Describe 12-lead ECG use in the prehospital setting Discuss conditions that may alter the acquisition/ interpretation of a 12-lead ECG Relate 12-lead ECG acquisition/interpretation to simulated prehospital case studies 2
3 The Why: Identify an acute myocardial infarction, and door to reperfusion time Identify transient ischemic changes in angina or acute coronary syndromes 3
4 The Who and Why: 2010 AHA Guidelines Diagnosis time Reperfusion time EMS should routinely acquire an ECG as soon as possible for all pts exhibiting signs and symptoms of ACS Recommend implementing 12-lead ECG diagnostic programs 4
5 The When: Suspected cardiac ischemia * Arrhythmia Rhythm interpretation 5
6 The How: Lead placement is critical Limb leads : LA, RA, LL, RL 6
7 The How: Precordial (Chest) Leads Lead placement is critical 7
8 Important to consider Privacy Scene time Critical patients 8
9 The Challenges Clear Accurate Prompt 9
10 The Challenges: Lead contact (hair, skin condition) Movement (patient, vehicle, cables) 10
11 The Challenges: Electro-magnetic interference 11
12 What does an ECG represent? ECG represents electrical activity measured as voltage and how it changes over time Voltage- Vertical lines (mm): 1 milli-volt = 10 mm (2 large boxes) Time- Horizontal lines: 0.04 sec = 1 mm square (small box) 0.20 sec = dark box/ 5x 1 mm square (large box) 1.0 sec = 5 large boxes/ 25 small boxes 12
13 Back to the Basics ECG Interpretation 5 Step Method: Rate Rhythm P wave PR interval QRS 13
14 ECG changes with ischemia and infarction 14
15 Interpreting a STEMI What to look for: ST Elevation (0.04 sec after J point) > 1mm (one small box) in limb leads > 2mm in chest leads Present in two anatomically contiguous leads 15
16 Interpreting a STEMI Septal Anterior Lateral Inferior V1 V2 V3 V4 V5 V6 I avl II III avf LII LI ASS (backwards) ALL L S A I L S L I I A L 16
17 Interpreting a STEMI Reciprocal changes: ST depression Infarction on the opposite side Ischemia II, III, avf I, avl,v leads 17
18 18 Interpreting a STEMI STEMI Mimickers Left Ventricular Hypertrophy Left Bundle Branch Block Ventricular Rhythms Benign Early Repolarization Pericarditis Hemorrhagic Stroke Pulmonary Embolism Aortic Dissection Brugada Syndrome Hypothermia Hyperkalemia Coronary Vasospasm Ventricular Aneurysm Paced rhythm
19 Interpreting a STEMI Remember: ST elevation is presumptive of an AMI 12-Lead ECG can be a useful tool in the prehospital setting if done promptly and accurately A normal 12-Lead ECG does NOT rule out an AMI 19
20 AskMAC #1 Question: When treating a patient with suspected cardiac ischemia, should I acquire a 12-Lead ECG before giving nitro or ASA? 20
21 AskMAC #2 Question: What position should patients be in when we are doing a 12-Lead ECG? 21
22 AskMAC #3 Question: I was under the impression that 12 leads were to be done on patient's with chest pain or symptoms consistent with ischemia. Should we be doing 12 leads on other patients to rule out any underlying cardiac conditions? 22
23 Case Study 1 Code 4 at 0845hrs to a residence for a 88 y/o male c/o back pain, chest pain diaphoretic, agitated, obvious distress, c/o 7/10 heavy-like chest discomfort unchanged with palpation, movement or respiration, seems to move down both arms, mildly SOB and slightly nauseous since 0700hrs. 23
24 Case Study 1 PmHx: smoker, HTN, hyperlipidemia The patients wife tells you that recently her husband has been under increased stress at work. HR: 50 R/S RR: 24 R/S BP: 105/66 Sp02: 97% Skin: pale, cool, diaphoretic Pupils: ERL 3mm Lead II: NSR BGL: 6.2mmol/L 24
25 Case Study 1 12-Lead ECG #1 25
26 Case Study 1 12-Lead ECG #2 (5 minutes later) 26
27 Question from the crowd What exactly does avr represent? a refers to augmented (magnified) V refers to voltage R refers to right arm 27
28 Case Study 2 Code 1130hrs for an 80 y/o F pt. - syncope elderly female sitting in a chair with an unaltered LOA. Tells you she was in church when she had a sudden onset of feeling ++ tired and hot and woke up lying on the floor with surrounding bystanders who had called 911 Bystanders state episode lasted approx. 30 seconds, they assisted the pt. to the floor. 28
29 Case Study 2 PmHx: HTN, Osteoporosis, episodes of weakness over the past month HR: 70 R S RR: 20 R S BP: 150/74 Sp02: 98% Skin: pale, warm, dry Pupils: ERL 4mm Cap: 2 seconds GCS: 15 Lead II: NSR BGL:7.6mmol/L 29
30 Case Study 2 12-Lead ECG ***Meets STEMI Criteria*** 30
31 Bottom Line 12-Lead ECG s are used by emergency physicians to diagnose and manage patients with suspected cardiac conditions As Case 2 illustrates, prehospital 12-Lead ECG s can also be used by paramedics to change their treatment of patients 31
32 References Aehlert, B. (2013). ECG s Made Easy (Fifth Ed.) St. Louis, Missouri: Elsevier. Davis M, Lewell M, McLeod S, Dukelow A. A prospective evaluation of the utility of the prehospital 12-lead electrocardiogram to change patient management in the emergency department. Prehosp. Emerg. Care 2013;18(June 2012):9-14. Ontario Base Hospital Group Education Subcommittee. (2008). Medical Advisory Committee 12-Lead Medical Directive Training. Hamilton, Ontario: Ontario Base Hospital Group. O Connor, R., Brady, W., Brooks, S., Diercks, D., Ghaemmaghami, C., Menon, V., O Neil, B., Travers, A., & Yannopoulos, D Phalen, T., & Aehlert, B. (2012). The 12-Lead ECG in Acute Coronary Syndromes (Third Ed.). Maryland Heights, Missouri: Elsevier. SWORBHP. (2015). askmac. Retrieved April 3, 2015 online at: 32
Marcin Dada, MD December 03, 2013
STEMI Imposters Marcin Dada, MD December 03, 2013 Marcin Dada, MD Associate Director, Chest Pain Center Hartford Hospital, Hartford, CT Member, AHA Mission Lifeline Steering Committee Outline of Topics
More informationThe Fundamentals of 12 Lead EKG. ECG Recording. J Point. Reviewing the Cardiac Conductive System. Dr. E. Joe Sasin, MD Rusty Powers, NRP
The Fundamentals of 12 Lead EKG Dr. E. Joe Sasin, MD Rusty Powers, NRP SA Node Intranodal Pathways AV Junction AV Fibers Bundle of His Septum Bundle Branches Purkinje System Reviewing the Cardiac Conductive
More informationAcute Coronary Syndromes Unstable Angina Non ST segment Elevation MI (NSTEMI) ST segment Elevation MI (STEMI)
Leanna R. Miller, RN, MN, CCRN-CSC, PCCN-CMC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Evaluate common abnormalities that mimic myocardial infarction. Identify
More information12 Lead Electrocardiogram (ECG) PFN: SOMACL17. Terminal Learning Objective. References
12 Lead Electrocardiogram (ECG) PFN: SOMACL17 Slide 1 Terminal Learning Objective Action: Communicate knowledge of 12 Lead Electrocardiogram (ECG) Condition: Given a lecture in a classroom environment
More informationHot Topics in Cardiac Arrest. Should the patient go To the Cath Lab?
Hot Topics in Cardiac Arrest Should the patient go To the Cath Lab? Tim Russert 1950-2008 Host of NBC s Meet the Press Sudden Cardiac Arrest : Autopsy showed plaque rupture in his LAD ( per LA Times,
More informationFamily Medicine for English language students of Medical University of Lodz ECG. Jakub Dorożyński
Family Medicine for English language students of Medical University of Lodz ECG Jakub Dorożyński Parts of an ECG The standard ECG has 12 leads: six of them are considered limb leads because they are placed
More informationChapter 3 for 12 Lead Training -Precourse-
ONTARIO BASE HOSPITAL GROUP Chapter 3 for 12 Lead Training -Precourse- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE ONTARIO BASE HOSPITAL GROUP Introduction and Purpose Introduction
More informationAll About STEMIs. Presented By: Brittney Urvand, RN, BSN, CCCC. Essentia Health Fargo Cardiovascular Program Manager.
All About STEMIs Presented By: Brittney Urvand, RN, BSN, CCCC Essentia Health Fargo Cardiovascular Program Manager Updated 10/2/2018 None Disclosures Objectives Identify signs and symptoms of a heart attack
More information12 Lead Interpretation
12 Lead Interpretation Objectives Ischemia, injury and infarction ECG complex review J point ST segment STEMI recognition Ischemia to Infarct Infarction is an evolving process As the infarct evolves ECG
More information12 Lead ECG. Presented by Rebecca Sevigny BSN, RN Professional Practice & Development Dept.
12 Lead ECG Presented by Rebecca Sevigny BSN, RN Professional Practice & Development Dept. Two Main Coronary Arteries RCA LCA which branches into Left Anterior Descending Circumflex Artery Two Main Coronary
More informationINTRODUCTION TO ECG. Dr. Tamara Alqudah
INTRODUCTION TO ECG Dr. Tamara Alqudah Excitatory & conductive system of the heart + - The ECG The electrocardiogram, or ECG, is a simple & noninvasive diagnostic test which records the electrical
More information12 Lead ECG Interpretation: Color Coding for MI s
12 Lead ECG Interpretation: Color Coding for MI s Anna E. Story, RN, MS Director, Continuing Professional Education Critical Care Nurse Online Instructional Designer 2004 Anna Story 1 Objectives review
More information10 ECGs No Practitioner Can Afford to Miss. Objectives
10 ECGs No Practitioner Can Afford to Miss Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine University of Missouri School of Medicine No disclosures Objectives 1.
More informationBy the end of this lecture, you will be able to: Understand the 12 lead ECG in relation to the coronary circulation and myocardium Perform an ECG
By the end of this lecture, you will be able to: Understand the 12 lead ECG in relation to the coronary circulation and myocardium Perform an ECG recording Identify the ECG changes that occur in the presence
More information12 Lead EKG. The Basics
12 Lead EKG The Basics Objectives Demonstrate proper 12 EKG lead placement Determine electrical axis Identify ST and T wave changes as they relate to myocardial ischemia Describe possible complications
More informationEkg pra pr c a tice D.HAMMOUDI.MD
Ekg practice D.HAMMOUDI.MD Anatomy Revisited RCA (Right Coronary Artery) Right ventricle Inferior wall of LV Posterior wall of LV (75%) SA Node (60%) AV Node (>80%) LCA (Left Coronary Artery) Septal wall
More information12 Lead ECG Interpretation: The Basics and Beyond
12 Lead ECG Interpretation: The Basics and Beyond Cindy Weston, DNP, RN, CCRN, CNS-CC, FNP-BC Assistant Professor Texas A&M University College of Nursing cweston@tamhsc.edu Objectives Review the basics
More informationElectrocardiogram ECG. Hilal Al Saffar FRCP FACC College of medicine,baghdad University
Electrocardiogram ECG Hilal Al Saffar FRCP FACC College of medicine,baghdad University Tuesday 29 October 2013 ECG introduction Wednesday 30 October 2013 Abnormal ECG ( ischemia, chamber hypertrophy, heart
More informationElectrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD
Electrocardiography Abnormalities (Arrhythmias) 7 Faisal I. Mohammed, MD, PhD 1 Causes of Cardiac Arrythmias Abnormal rhythmicity of the pacemaker Shift of pacemaker from sinus node Blocks at different
More informationECG Workshop. Nezar Amir
ECG Workshop Nezar Amir Myocardial Ischemia ECG Infarct ECG in STEMI is dynamic & evolving Common causes of ST shift Infarct Localisation Left main artery occlusion: o diffuse ST-depression with ST elevation
More information12 Lead ECGs: Ischemia, Injury & Infarction. Kevin Handke NRP, FP-C, CCP, CMTE STEMI Coordinator Flight Paramedic
12 Lead ECGs: Ischemia, Injury & Infarction Kevin Handke NRP, FP-C, CCP, CMTE STEMI Coordinator Flight Paramedic None Disclosures Objectives Upon completion of this program the learner will be able to
More informationACUTE CORONARY SYNDROME
12 LEAD ECG INTERPRETATION in ACUTE CORONARY SYNDROME WAYNE W RUPPERT, CVT, CCCC, NREMT-P Cardiovascular Clinical Coordinator Bayfront Health Seven Rivers Crystal River, FL Education Specialist St. Joseph
More informationECG Basics Sonia Samtani 7/2017 UCI Resident Lecture Series
ECG Basics Sonia Samtani 7/2017 UCI Resident Lecture Series Agenda I. Introduction II.The Conduction System III.ECG Basics IV.Cardiac Emergencies V.Summary The Conduction System Lead Placement avf Precordial
More informationMasqueraders of STEMI
Masqueraders of STEMI Steven M. Costa, M.D. Assistant Professor Department of Medicine Division of Cardiology Scott & White Memorial Hospital and Clinic Texas A&M University Health Science Center Disclosures
More informationSection V. Objectives
Section V Landscape of an MI Objectives At the conclusion of this presentation the participant will be able to Outline a systematic approach to 12 lead ECG interpretation Demonstrate the process for determining
More information12 Lead ECG Skills: Building Confidence for Clinical Practice. Presented By: Cynthia Webner, BSN, RN, CCRN-CMC. Karen Marzlin, BSN, RN,CCRN-CMC
12 Lead ECG Skills: Building Confidence for Clinical Practice NTI 2009 Preconference Session 803 Presented By: Karen Marzlin, BSN, RN,CCRN-CMC 1 12 Lead ECG Fundamentals: The Starting Place for Linking
More informationPreface: Wang s Viewpoints
AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part IV, Ischemia and Infarction Presented by: WANG, TZONG LUEN, MD, PhD, JM, FACC, FESC, FCAPSC Professor,
More information12 Lead ECG Workshop. Virginia Hass, DNP, FNP-C, PA-C Kim Newlin, CNS, ANP-C, FPCNA. California Association of Nurse Practitioners March 18, 2016
12 Lead ECG Workshop Virginia Hass, DNP, FNP-C, PA-C Kim Newlin, CNS, ANP-C, FPCNA California Association of Nurse Practitioners March 18, 2016 Learning Objectives Identify key changes on the ECG which
More informationDR QAZI IMTIAZ RASOOL OBJECTIVES
PRACTICAL ELECTROCARDIOGRAPHY DR QAZI IMTIAZ RASOOL OBJECTIVES Recording of electrical events in heart Established electrode pattern results in specific tracing pattern Health of heart i. e. Anatomical
More informationIntroduction to ECG Gary Martin, M.D.
Brief review of basic concepts Introduction to ECG Gary Martin, M.D. The electrical activity of the heart is caused by a sequence of rapid ionic movements across cell membranes resulting first in depolarization
More informationModule 1: 12-Lead ECG Interpretation
Module 1: 12-Lead ECG Interpretation York Region Base Hospital Program Markham Stouffville Hospital April 2003 Acknowledgements Prepared by: Edited by: John Anderson, Program Coordinator Warren Beckett,
More informationRelax and Learn At the Farm 2012
Relax and Learn At the Farm 2012 Session 2: 12 Lead ECG Fundamentals 101 Cynthia Webner DNP, RN, CCNS, CCRN-CMC, CHFN Though for Today Mastery is not something that strikes in an instant, like a thunderbolt,
More information12 Lead ECG Interpretation
12 Lead ECG Interpretation Julie Zimmerman, MSN, RN, CNS, CCRN Significant increase in mortality for every 15 minutes of delay! N Engl J Med 2007;357:1631-1638 Who should get a 12-lead ECG? Also include
More informationMICS OF MYOCARDIAL ISCHEMIA AND INFARCTION REVISED FOR LAS VEGAS
ECG MIMICS OF MYOCARDIAL ISCHEMIA AND INFARCTION 102.06.05 Tzong-Luen Wang MD, PhD, JM, FESC, FACC Professor. Medical School, Fu-Jen Catholic University Chief, Emergency Department, Shin-Kong Wu Ho-Su
More informationPlease check your answers with correct statements in answer pages after the ECG cases.
ECG Cases ECG Case 1 Springer International Publishing AG, part of Springer Nature 2018 S. Okutucu, A. Oto, Interpreting ECGs in Clinical Practice, In Clinical Practice, https://doi.org/10.1007/978-3-319-90557-0
More informationECG. Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13
ECG Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13 The Concept When the cardiac impulse passes through the heart, electrical current
More informationElectrocardiography for Healthcare Professionals. Chapter 14 Basic 12-Lead ECG Interpretation
Electrocardiography for Healthcare Professionals Chapter 14 Basic 12-Lead ECG Interpretation 2012 The Companies, Inc. All rights reserved. Learning Outcomes 14.1 Discuss the anatomic views seen on a 12-lead
More informationThe Basics of 12 Lead EKG s
Presents The Basics of 12 Lead EKG s NOTICE: You DO NOT Have the Right to Reprint or Resell this Publication. However, you MAY give this report away, provided you do not change or alter the contents. Copyright
More informationIntroduction to Electrocardiography
Introduction to Electrocardiography Class Objectives: Introduction to ECG monitoring Discuss principles of interpretation Identify the components and measurements of the ECG ECG analysis ECG Monitoring
More informationAcute Coronary Syndromes. Disclosures
Acute Coronary Syndromes Disclosures I work for Virginia Garcia Memorial Health Center, Beaverton, OR. Jon Tardiff, BS, PA-C OHSU Clinical Assistant Professor And I am a medical editor for Jones & Bartlett
More informationECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology
ECG Cases and Questions Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology 32 yo female Life Insurance Physical 56 yo male with chest pain Terminology Injury ST elevation Ischemia T wave inversion
More information5- The normal electrocardiogram (ECG)
5- The (ECG) Introduction Electrocardiography is a process of recording electrical activities of heart muscle at skin surface. The electrical current spreads into the tissues surrounding the heart, a small
More informationA few new tools for better detection and understanding of STEMIs in the field.
A few new tools for better detection and understanding of STEMIs in the field. Let s talk, prep and placement. Try to shoot for quality, consistency and no artifact! (looking sometimes for 1 or 2 mm changes)
More informationREtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book
Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A
More information12 LEAD EKG BASICS. By: Steven Jones, NREMT P CLEMC
12 LEAD EKG BASICS By: Steven Jones, NREMT P CLEMC ECG Review Waves and Intervals P wave: the sequential activation (depolarization) of the right and left atria QRS complex: right and left ventricular
More informationCORONARY ARTERIES HEART
CARDIAC/ECG MODULE THE HEART CORONARY ARTERIES FIBRILLATING HEART CORONARY ARTERIES HEART PRACTICE RHYTHMS PRACTICE RHYTHMS ELECTRICAL CONDUCTION SA Node (60 100) Primary pacemaker AV Node (40 60) ***Creates
More informationElectrical System Overview Electrocardiograms Action Potentials 12-Lead Positioning Values To Memorize Calculating Rates
Electrocardiograms Electrical System Overview James Lamberg 2/ 74 Action Potentials 12-Lead Positioning 3/ 74 4/ 74 Values To Memorize Inherent Rates SA: 60 to 100 AV: 40 to 60 Ventricles: 20 to 40 Normal
More informationThis presentation will deal with the basics of ECG description as well as the physiological basics of
Snímka 1 Electrocardiography basics This presentation will deal with the basics of ECG description as well as the physiological basics of Snímka 2 Lecture overview 1. Cardiac conduction system functional
More informationBasic electrocardiography reading. R3 lee wei-chieh
Basic electrocardiography reading R3 lee wei-chieh The Normal Conduction System Lead Placement avf Limb Leads Precordial Leads Interpretation Rate Rhythm Interval Axis Chamber abnormality QRST change What
More informationECG ABNORMALITIES D R. T AM A R A AL Q U D AH
ECG ABNORMALITIES D R. T AM A R A AL Q U D AH When we interpret an ECG we compare it instantaneously with the normal ECG and normal variants stored in our memory; these memories are stored visually in
More informationCASE 10. What would the ST segment of this ECG look like? On which leads would you see this ST segment change? What does the T wave represent?
CASE 10 A 57-year-old man presents to the emergency center with complaints of chest pain with radiation to the left arm and jaw. He reports feeling anxious, diaphoretic, and short of breath. His past history
More informationThe Electrocardiogram part II. Dr. Adelina Vlad, MD PhD
The Electrocardiogram part II Dr. Adelina Vlad, MD PhD Basic Interpretation of the ECG 1) Evaluate calibration 2) Calculate rate 3) Determine rhythm 4) Determine QRS axis 5) Measure intervals 6) Analyze
More informationElectrocardiography. Hilal Al Saffar College of Medicine,Baghdad University
Electrocardiography Hilal Al Saffar College of Medicine,Baghdad University Which of the following is True 1. PR interval, represent the time taken for the impulse to travel from SA node to AV nose. 2.
More informationMyocardial Infarction. Reading Assignment (p66-78 in Outline )
Myocardial Infarction Reading Assignment (p66-78 in Outline ) Objectives 1. Why do ST segments go up or down in ischemia? 2. STEMI locations and culprit vessels 3. Why 15-lead ECGs? 4. What s up with avr?
More informationDiagnosis of Myocardial Infarction/Ischemia with Bundle Branch Blocks
Diagnosis of Myocardial Infarction/Ischemia with Bundle Branch Blocks Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair Associate Residency Director Department of Emergency Medicine University
More informationINTERPRETAZIONE ECG NEL PAZIENTE CON SOSPETTO STEMI
INTERPRETAZIONE ECG NEL PAZIENTE CON SOSPETTO STEMI Giacomo Veronese Scuola di Specializzazione Medicina d Emergenza e Urgenza Università Milano-Bicocca Siete d accordo se vi propongo per una relazione..
More informationFoundations EKG I - Unit 1 Summary
Foundations EKG I - Unit 1 Summary The accurate diagnosis of ST elevation myocardial infarction (STEMI) is one of the most time critical duties in the practice of EM. Diagnosis is not always easy so guidelines
More information12 Lead EKG Chapter 4 Worksheet
Match the following using the word bank. 1. A form of arteriosclerosis in which the thickening and hardening of the vessels walls are caused by an accumulation of fatty deposits in the innermost lining
More information12-Lead ECG Interpretation. Kathy Kuznar, RN, ANP
12-Lead ECG Interpretation Kathy Kuznar, RN, ANP The 12-Lead ECG Objectives Identify the normal morphology and features of the 12- lead ECG. Perform systematic analysis of the 12-lead ECG. Recognize abnormalities
More informationDisclosures. STEMI:To Call or Not to Call. Disclosures 9/18/2017. Alternate Title: Hey Doc, If you re not doing anything Saturday Night
STEMI:To Call or Not to Call Disclosures No financial disclosures September, 2017 Frederick James Trip Meine III MD, FACC, FSCAI Cape Fear Heart Associates, Wilmington, NC Disclosures Alternate Title:
More informationConsiderations about the polemic J point location
Considerations about the polemic J point location V) The J-point of the electrocardiogram Approximate point of convergence between the end of QRS complex and the onset of ST segment. It is considered the
More informationElectrocardiography Normal 5. Faisal I. Mohammed, MD, PhD
Electrocardiography Normal 5 Faisal I. Mohammed, MD, PhD 1 Objectives 2 1. Describe the different waves in a normal electrocardiogram. 2. Recall the normal P-R and Q-T interval time of the QRS wave. 3.
More informationFebruary 2009 CE. Site Code #107200E Revisions to the CMC EMS System CE Program and Determining ST Elevation on 12-Lead EKG s
February 2009 CE Site Code #107200E-1209 Revisions to the CMC EMS System CE Program and Determining ST Elevation on 12-Lead EKG s Prepared by: Bill Glade, DC, Wauconda Fire Department Sharon Hopkins, RN,
More informationMohamud Daya MD, MS Jonathan Jui MD, MPH
Mohamud Daya MD, MS Jonathan Jui MD, MPH STEMI criteria > 2 mm STE in 2 contiguous precordial leads > 1 mm STE in 2 contiguous limb leads leads 2011 STEMI Mimics Pericarditis, Early Repolarization Hyperkalemia,
More informationJune 2009 CE. Site code # E-1209
1 June 2009 CE Site code # 107200E-1209 Region X SOP Review ACS, Asystole/PEA, Bradycardia, VF/Pulseless VT, Conscious Sedation, Region X Field Triage Criteria Prepared by: Sharon Hopkins, RN, BSN, EMT-P
More informationSIMPLY ECGs. Dr William Dooley
SIMPLY ECGs Dr William Dooley 1 No anatomy just interpretation 2 Setting up an ECG 3 Setting up an ECG 1 V1-4 th Right intercostal space at sternal border 2 V2-4 th Left intercostal space at sternal border
More informationAll under the division of cardiovascular medicine University of Minnesota
The Team 1) Demetris Yannopoulos M.D. Medical Director, 2) Kim Harkins, Program Manager 3) Lucinda Klann, CARES Data Manager 4) Esther Almeida, Administrative Assistant All under the division of cardiovascular
More informationSTAT 12 Lead ECG Workshop: Basics & ACS
STAT 12 Lead ECG Workshop: Basics & ACS Part 2: Acute Coronary Syndrome WAYNE W RUPPERT, CVT, CCCC, NREMT-P Cardiovascular Coordinator Bayfront Health Seven Rivers Crystal River, Florida Interventional
More informationSOPs: ACS, Bradycardia with a Pulse; Narrow QRS Complex Tachycardia; Wide Complex Tachycardia with a Pulse.
Northwest Community EMS System Continuing Education Program April 2018 ACS, ECG/12 Lead Interpretation, Dysrhythmia Management PARTICIPANT handout Jennifer Dyer, RN, BS, EMT-P References: SOPs: ACS, Bradycardia
More informationAppendix D Output Code and Interpretation of Analysis
Appendix D Output Code and Interpretation of Analysis 8 Arrhythmia Code No. Description 8002 Marked rhythm irregularity 8110 Sinus rhythm 8102 Sinus arrhythmia 8108 Marked sinus arrhythmia 8120 Sinus tachycardia
More informationPart One Objectives. Don t Worry About It. All done for you Paper Speed 25 mm/sec Calibration 1 mv charge over 20 ms = 10 mm tall Lincoln Hat
12-lead and ACS Review North Lyon Refresher Part One Objectives 12 lead ECG Basics Anatomy and Physiology STEMI Diagnosis Types of MI ACS Review STEMI System and Interventional Cardiology Review The Value
More informationGoals: Widen Your Understanding of the Wide QRS!
Goals: Widen Your Understanding of the Wide QRS! 1. Describe an approach to diagnosis of LBBB 2. Describe the predictive value of New LBBB 3. Describe the ST segment changes that are diagnostic of AMI
More informationEKG. Danil Hammoudi.MD
EKG Danil Hammoudi.MD What is an EKG? The electrocardiogram (EKG) is a representation of the electrical events of the cardiac cycle. Each event has a distinctive waveform, the study of which can lead to
More informationWE ARE STEMI HUNTERS. LearningObjectives. I have no relevant disclosures. Myth: Jennifer Carlquist PA-C, ER CAQ
WE ARE STEMI HUNTERS Jennifer Carlquist PA-C, ER CAQ Salinas Valley Memorial, ER Central Coast Cardiology, Specializing in EP LearningObjectives How to use pattern recognition to detect ischemia Triage
More informationEMS Report Writing. Principles and Elements of Quality PCR Reports. David Ghilarducci MD FACEP
EMS Report Writing Principles and Elements of Quality PCR Reports David Ghilarducci MD FACEP Outline For This Session Role of the EMS PCR The Narrative Section w SOAPP Format Why We Write Reports Patient
More informationLeft posterior hemiblock (LPH)/
ECG OF THE MONTH Left Postero-inferior Depolarization Delay Keywords Electrocardiography Intraventricular conduction delay, Inferoposterior hemiblock, Left posterior fascicular block, Left posterior hemiblock
More informationECG CONVENTIONS AND INTERVALS
1 ECG Waveforms and Intervals ECG waveforms labeled alphabetically P wave== represents atrial depolarization QRS complex=ventricular depolarization ST-T-U complex (ST segment, T wave, and U wave)== V repolarization.
More information3/26/15 HTEC 91. EKG Sign-in Book. The Cardiac Cycle. Parts of the ECG. Waves. Waves. Review of protocol Review of placement of chest leads (V1, V2)
EKG Sign-in Book HTEC 91 Review of protocol Review of placement of chest leads (V1, V2) Medical Office Diagnostic Tests Week 2 http://www.cvphysiology.com/arrhythmias/a013c.htm The Cardiac Cycle Represents
More informationCardiac Ischemia ECG Workshop
Cardiac Ischemia ECG Workshop Classic, Confusing, and Confounding Patterns Amal Mattu, MD, NE Professor and Vice Chair Department of Emergency Medicine University of Maryland School of Medicine amalmattu@comcast.net
More informationalso aid the clinician in recognizing both the obvious and subtle abnormalities that may help guide therapy.
Karen Lieberman, MS, CRNP f the many diagnostic tools used to screen for and evaluate cardiac abnormalities, the 12-lead electrocardiogram (ECG) is among the most basic. This inexpensive and noninvasive
More informationECG pre-reading manual. Created for the North West Regional EMET training program
ECG pre-reading manual Created for the North West Regional EMET training program Author:- Dr Juan Carlos Ascencio-Lane juan.ascencio-lane@ths.tas.gov.au 1 Disclaimer This handbook has been created for
More informationBASIC CONCEPT OF ECG
BASIC CONCEPT OF ECG Electrocardiogram The electrocardiogram (ECG) is a recording of cardiac electrical activity. The electrical activity is readily detected by electrodes attached to the skin. After the
More informationDisclosure. 3. ST depression indicative of ischemia is most commonly observed in leads: 1. V1-V2. 2. I and avl 3. V
Interpreting Stress Induced Ischemia by ECG, Bundle Branch Block & Arrhythmias Disclosure Gregory S Thomas MD, MPH Medical Director, MemorialCare Heart & Vascular Institute, Long Beach Memorial Astellas
More informationA walk through a STEMI
A walk through a STEMI M.M. s Story Kim Robison Ashley Corcoran Situation M.M. is an 82 year old male brought in by private vehicle on 10/22/17 to the Emergency Department Pt. c/o left arm numbness, pain
More informationELECTROCARDIOGRAPHY KEVIN REBECK PA-C. For more presentations
ELECTROCARDIOGRAPHY KEVIN REBECK PA-C For more presentations www.medicalppt.blogspot.com Objectives ECG History Pathophysiology Basics Case Historys Electrical activation of the heart In the heart
More informationPennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016
Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016 Disclosures: EKG Workshop Louis Mancano, MD Speaker has no disclosures
More informationThe Normal Electrocardiogram
C H A P T E R 1 1 The Normal Electrocardiogram When the cardiac impulse passes through the heart, electrical current also spreads from the heart into the adjacent tissues surrounding the heart. A small
More informationOffice ECG Interpretation
Office ECG Interpretation Jason Evanchan, DO Assistant Professor of Medicine Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center Outline of topics High risk ischemia T wave
More informationReturn to Basics. ECG Rate and Rhythm. Management of the Hospitalized Patient September 25, 2009
Management of the Hospitalized Patient September 25, 2009 ECG Refresher and Update 2009 Return to Basics Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare with
More informationECG Underwriting Puzzler. Presented by: Bill Rooney, M.D.
ECG Underwriting Puzzler Presented by: Bill Rooney, M.D. Obtaining Best Results from this presentation For best results please do the following: Select Slide Show from the menu option on top Select From
More informationBundle Branch & Fascicular Blocks. Reading Assignment (p53-58 in Outline )
Bundle Branch & Fascicular Blocks Reading Assignment (p53-58 in Outline ) Objectives 1. QRS analysis of Right and Left BBB 2. Uncomplicated vs complicated BBB 3. Diagnosis of RBBB with LAFB and LPFB 4.
More informationPECTUS EXCAVATUM WITH SPONTANEOUS TYPE 1 ECG BRUGADA PATTERN OR BRUGADA LIKE PHENOTYPE: ANOTHER BRUGADA ECG PHENOCOPY
PECTUS EXCAVATUM WITH SPONTANEOUS TYPE 1 ECG BRUGADA PATTERN OR BRUGADA LIKE PHENOTYPE: ANOTHER BRUGADA ECG PHENOCOPY ANDRÉS RICARDO PÉREZ RIERA MD Chief of the Sector of Electro-Vectocardiography of the
More informationECG Interpretation Cat Williams, DVM DACVIM (Cardiology)
ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) Providing the best quality care and service for the patient, the client, and the referring veterinarian. GOAL: Reduce Anxiety about ECGs Back to
More informationSIMPLY ECGs. Dr William Dooley
SIMPLY ECGs Dr William Dooley Content Basic ECG interpretation pattern Some common (examined) abnormalities Presenting ECGs in context Setting up an ECG Setting up an ECG 1 V1-4 th Right intercostal space
More informationNorthwest Community EMS System November 2018 CE: Cardiac Treatment Credit Questions
Northwest Community EMS System November 2018 CE: Cardiac Treatment Credit Questions Name: EMS Agency/hospital: EMSC/Educator reviewer: Date submitted: Credit awarded (date): Returned for revisions: Revisions
More information2009 Unit-Based Competencies
2009 Unit-Based Competencies Alameda County Medical Center Highland Hospital Emergency Department Janis Farnholtz Provinse, RN, MS, CNS, CEN, ED Clinical Nurse Specialist Nurses play a pivotal role in
More informationECG S: A CASE-BASED APPROACH December 6,
ECG S: A CASE-BASED APPROACH December 6, 2018 1 Faculty Disclosure Faculty: Lorne Gula MD, FRCPC Professor, Western University Cardiologist, Hearth Rhythm Specialist Director, Electrophysiology Laboratory,
More informationReturn to Basics. ECG Rate and Rhythm. Management of the Hospitalized Patient October 4, 2007
Management of the Hospitalized Patient October 4, 2007 ECG Refresher for the Hospitalists Return to Basics Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare
More informationEach student should record the ECG of one of the members of the lab group and have their own ECG recorded.
EXPERIMENT 1 ELECTROCARDIOGRAPHY The purpose of this experiment is to introduce you to the techniques of electrocardiography and the interpretation of electrocardiograms. In Part A of the experiment, you
More informationSolutions for Every Day Problems Cardiologists and the ECG: Are We Really That Good at It? Part II Daniel José Piñeiro Profesor Titular de Medicina,
Solutions for Every Day Problems Cardiologists and the ECG: Are We Really That Good at It? Part II Daniel José Piñeiro Profesor Titular de Medicina, Universidad de Buenos Aires, Argentina Member, Membership
More information