# Heart Rate. Fast & Easy ECGs A Self-Paced Learning Program

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1 3 Heart Rate Fast & Easy ECGs A Self-Paced Learning Program Q A

2 Dysrhythmias rregularities in heart rate or rhythm Some are of little significance whereas others are life threatening

3 ECG Analysis Five Step Process is a logical and systematic process for analyzing ECG tracings

4 Normal Sinus Rhythm Characteristics Rate: BPM Rhythm: Regular P waves: Upright and round, one preceding each QRS complex QRS complexes: Narrow, seconds in duration PR nterval: seconds in duration T waves: Upright and slightly asymmetrical

5 Determining Heart Rate First step in analyzing an ECG rhythm Begin by quickly checking ECG monitor or tracing to see if rate is slow, normal or fast

6 Calculating Heart Rate Several methods can be used including: 6-Second nterval x 10 Method 300, 150, 100, 75, 60, 50 Method 1500 Method Rate Calculator

7 6-Second nterval x 10 Method Quick and easy and does not require tools or devices Not as accurate as other methods Multiply by 10 the number of QRS complexes found in a six second portion of ECG tracing

8 Practice Makes Perfect Determine the heart rate using the 6-second interval x 10 method

9 Practice Makes Perfect Determine the heart rate using the 6-second interval x 10 method

10 Practice Makes Perfect Determine the heart rate using the 6-second interval x 10 method

11 300, 150, 100, 75, 60, 50 Method Quick, fairly accurate, requires no special tools, or calculations Cannot be used with irregular rhythms Find an R wave located on a bold line. Then find the next consecutive R wave. Bold line it falls on (or is closest to) represents the heart rate.

12 300, 150, 100, 75, 60, 50 Method f the second R wave does not fall on a bold line the heart rate is approximated Example: if it falls between the 4th and 5th bold line the heart rate is between 60 and 75 BPM

13 300, 150, 100, 75, 60, 50 Method f the second R wave falls in between two bold lines the heart rate can be more precisely determined using the identified values for each thin line

14 Practice Makes Perfect Determine the heart rate using the 300, 150, 100, 75, 60, 50 method

15 Practice Makes Perfect Determine the heart rate using the 300, 150, 100, 75, 60, 50 method

16 Practice Makes Perfect Determine the heart rate using the 300, 150, 100, 75, 60, 50 method

17 1500 Method Most accurate and requires no special tools but math calculation must be done to determine heart rate Cannot be used with irregular rhythms Count the number of small squares between two consecutive R waves and divide 1500 by that number

18 Practice Makes Perfect Determine the heart rate using the 1500 method

19 Practice Makes Perfect Determine the heart rate using the 1500 method

20 Practice Makes Perfect Determine the heart rate using the 1500 method

21 Rate Calculators Easy to use but not always available neffective on irregular rhythms where a consistent baseline is not present Position the start mark on an R wave Then find the next consecutive R wave where it lines up is the approximate heart rate

22 Heart Rates Average adult has a heart rate of BPM Heart rate < 60 BPM called bradycardia Heart rate > 100 BPM called tachycardia

23 Sinus Bradycardia Slow rate that arises from SA node May or may not have an adverse affect on cardiac output n extreme cases it can lead to severe reductions in cardiac output and eventually deteriorate into asystole

24 Sinus Arrest Transient failure of SA node to initiate a heart beat Can lead to a slow heart rate

25 AV Heart Blocks Blockage of the impulse traveling through the AV node can cause a slow heart rate 2nd degree AV heart block

26 AV Heart Blocks 3rd - degree AV heart block occurs with complete blockage of AV node

27 Rapid Atrial Rates With Slow Ventricular Rates Because of the rapid rate not all atrial impulses are conducted through to the ventricles A slower than normal ventricular rate can result if the number of atrial impulses reaching the ventricles falls to less than normal

28 Atrial Flutter

29 Atrial Fibrillation

30 Sinus Tachycardia Fast rate, > 100 BPM, arises from the SA node

31 Tachycardia From an Ectopic Pacemaker Results from rapid depolarization that overrides the SA node Supraventricular tachycardia is term used for ectopic tachycardia arising from above the ventricles Atrial tachycardia Generally BPM Junctional tachycardia Generally BPM

32 Tachycardia From an Ectopic Site

33 Tachycardia From an Ectopic Pacemaker Ventricular tachycardia arises in the ventricles and has a rate of BPM

34 Rapid Atrial Rates With Fast Ventricular Rates n addition to having either a normal or slow ventricular rate in atria flutter the ventricular rate can also be fast

35 Rapid Atrial Rates With Fast Ventricular Rates n addition to having either a normal or slow ventricular rate in atria fibrillation the ventricular rate can also be fast

36 Summary Approach each ECG tracing analysis in a logical and systematic manner. Some dysrhythmias are of no problem to the patient whereas others are life threatening. Five steps to analyzing an ECG rhythm are determining the: 1. Heart rate 2. Regularity 3. Presence of and characteristics of P waves 4. Presence of and characteristics of QRS complexes 5. Presence of and characteristics of the PR intervals

37 Summary To determine the heart rate first check to see if the rate is slow, normal or fast. The 6-second interval x 10 method multiplies by 10 the number of QRS complexes found in a 6-second portion of the ECG tracing. The 300, 150, 100, 75, 60, 50 method involves locating an R wave on a bold line on the ECG paper, then finding the next consecutive R wave and using the 300, 150, 100, 75, 60, 50 values for subsequent bold lines to determine the rate. To use the 1500 method count the number of small squares between two consecutive R waves and divide 1500 by that number.

38 Summary A heart rate less than 60 beats per minute is called bradycardia. Slow heart rates are seen with sinus bradycardia, junctional escape rhythm, idioventricular rhythm, AV heart block and atrial flutter or fibrillation with slow ventricular response. A heart rate greater than 100 beats per minute is called tachycardia. Fast heart rates are seen with sinus tachycardia, atrial tachycardia, junctional tachycardia, ventricular tachycardia and atrial flutter or fibrillation with rapid ventricular response.

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Arrhythmia Monitoring Algorithm Application Note Introduction The ST/AR (ST and Arrhythmia) algorithm is an ECG algorithm that the HeartStart MRx and XL+ monitor/defibrillators utilize for basic and cardiotach

### Basic Life Support & Automated External Defibrillation

Basic Life Support & Automated External Defibrillation Check response Shake gently Ask loudly: Are you all right? If not responsive Open airway & check for breathing If not breathing normally or not breathing