12/10/ Lead ECG Interpretation PFN: SOMACL12. Terminal Learning Objective. References. Hours: Instructor:

Transcription

1 3 Lead ECG Interpretation PFN: SOMACL12 Hours: Instructor: Slide 1 Terminal Learning Objective Action: Communicate knowledge of 3 Lead ECG interpretation Condition: Given a lecture in a classroom environment Standard: Receive minimum score of 84% on AHA standardized written exam Slide 2 References Basic Arrhythmias, Seventh Edition, Gail Walraven Advanced Cardiovascular Life Support, Provider Manual 2010 Slide 3 1

2 Reason At some time, you will likely encounter the need to treat a critical cardiac patient. As the leader or a member of the medical team, a comprehensive understanding of cardiac arrhythmias will improve overall patient management. Slide 4 Agenda Review ECG waves, measurements, and the 6 step process of analyzing ECG rhythms Review sinus rhythms Review atrial rhythms Review junctional rhythms Review heart blocks Slide 5 Agenda Review ventricular rhythms Review miscellaneous rhythms Slide 6 2

3 ECG Waves and Measurements Slide 7 Waves and Measurements PAGE 18 Slide 8 Basic Rule of Electrical Flow If flow of electricity is toward a '+' electrode the pattern is upright If the electrical flow is toward a ' ' electrode then the pattern will be downward PAGE 19 Slide 9 3

4 Leads Electrode positions allow a single view of the heart s electrical pattern By rearranging the electrodes, different views are possible This method can triangulate to spots on the heart to assess arrhythmias PAGE 20 Slide 10 Graph Paper PAGE 21 Slide 11 Cardiac Cycle PAGE 24 Slide 12 4

5 Cardiac Cycle Slide 13 Waves and Measurements PAGE 28 Slide 14 Artifact/Interference 'Artifact' Electrical Interference PAGE 30 Slide 15 5

6 Refractory Periods PAGE 31 Slide 16 Components of Analyzing ECG Rhythms Slide 17 Analyzing ECG Rhythm Strips ECG s are more complex than fingerprints Everyone's is subtly and uniquely theirs Inadequate to simply memorize 'snapshots' of common ECG s Analysis of every ECG 'strip' using a systematic approach PAGE 58 Slide 18 6

7 Arrhythmias Categories Sinus Atrial Junctional Ventricular PAGE 58 Slide 19 Regularity: Analysis Format Regular or irregular? PAGE 59 Slide 20 Analysis Format Regularity: Regular or irregular? PAGE 61 Slide 21 7

8 Analysis Format Regularity: Regular or irregular? P Wave: Up right, rounded, uniform, saw toothed appearance or irregularly irregular PAGE 63 Slide 22 Analysis Format Regularity: Regular or irregular? P Wave: Up right, rounded, uniform Less than.20, constant PAGE 64 Slide 23 Analysis Format Regularity: Regular or irregular? P Wave: Up right, rounded, uniform Less than.20, constant PAGE 64 Slide 24 8

9 Analysis Format Regularity: Regular or irregular? P Wave: Up right, rounded, Uniform Less than.20, constant S T segment: Elevated or depressed? Slide 25 Sinus Rhythms Slide 26 Sinus Rhythms Normal Sinus Rhythm (NSR) Sinus Bradycardia Sinus Tachycardia Sinus Arrhythmia PAGE 80 Slide 27 9

10 Normal Sinus Rhythm (NSR) P wave: Present, up right rounded Constant, less than.20 ST segment: Back to isoelectric line PAGE 80 Slide 28 Sinus Bradycardia Less than 60 P wave: Present, up right rounded Constant, less than.20 ST segment: Back to isoelectric line PAGE 82 Slide 29 Sinus Tachycardia Greater than 100, <150 P wave: Present, up right rounded Constant, less than.20 ST segment: Back to isoelectric line PAGE 84 Slide 30 10

11 Sinus Arrhythmia Rhythm: Irregular Normal P wave: Present, up right rounded Constant, less than.20 ST segment: Back to isoelectric line PAGE 85 Slide 31 Atrial Rhythms Slide 32 Atrial Rhythms Wandering Pacemaker Atrial Tachycardia/Supraventricular Tachycardia (SVT) Premature Atrial Complexes (PAC) Atrial Flutter Atrial Fibrillation PAGE 110 Slide 33 11

12 Wandering Pacemaker, 1 complex out of place Normal P wave: Present, morphing Constant, less than.20 ST segment: Back to isoelectric line PAGE 110 Slide 34 Premature Atrial Complex (PAC) Normal P wave: Present, morphing Constant, less than.20 QRS: Less than.12, but came early; led a P wave ST segment: Back to isoelectric line PAGE 112 Slide 35 Supraventricular Tachycardia (SVT) P wave: May or may not be visible Often difficult to measure ST segment: Back to isoelectric line PAGE 114 Slide 36 12

13 Rhythm: P wave: Atrial Flutter Regular Atrial rate is ; ventricular rate slightly tachycardic Often present as "saw teeth"; more P waves than QRS Difficult to determine ST segment Back to isoelectric line PAGE 114 Slide 37 Atrial Fibrillation Rhythm: Grossly irregular Atrial: >350, ventricular WNL P wave: Not discernible Unable to measure ST segment: Back to isoelectric line; T waves often not seen PAGE 119 Slide 38 Junctional Rhythms Slide 39 13

14 Junctional Rhythms Junctional Pacemaker Premature Junctional Complex (PJC) Junctional Escape Rhythm Accelerated Junctional Rhythm Junctional Tachycardia PAGE 158 Slide 40 Junctional Pacemaker P wave: Inverted or absent Normal if present ST segment: Back to isoelectric PAGE 158 Slide 41 Premature Junctional Complex (PJC) with 1 irregular beat Depends on underlying rhythm P wave: QRS: ST segment: Normal; except the premature complex(s) Usually normal if present Less than.12 (underlying rhythm?) Back to isoelectric PAGE 161 Slide 42 14

15 Junctional Escape Rhythm P wave: Inverted or absent Normal if P waves present ST segment: Back to isoelectric (if normal) PAGE 164 Slide 43 Accelerated Junctional Rhythm BPM P wave: Inverted or absent Normal if present ST segment: Back to isoelectric PAGE 166 Slide 44 Junctional Tachycardia (usually) P wave: Inverted or absent Normal if P wave present ST segment: Back to isoelectric PAGE 168 Slide 45 15

16 Heart Blocks Slide 46 Heart Blocks First Degree Second Degree Type 1 Second Degree Type 2 Third Degree PAGE 199 Slide 47 First Degree , sometimes bradycardic P wave: Present normal Greater than.20 ST segment: Back to isoelectric PAGE 200 Slide 48 16

17 Second Degree Type 1 'Wenckebach'/Mobitz 1 Rhythm: Irregular , possibly bradycardic P wave: Present, normal Grows longer until QRS 'drops' ST segment: Back to isoelectric PAGE 206 Slide 49 Rhythm: P wave: Second Degree (Mobitz 2) Irregular , sometimes bradycardic Present, WNL; more P s than QRS s Normal until it 'drops' a QRS ST segment: Back to isoelectric PAGE Slide 50 Third Degree (Complete Heart Block) Atrial Ventricular P wave: Present, normal more P s than QRS s No relationship between P QRS ; possibly >.20 ST segment: Back to isoelectric PAGE Slide 51 17

18 Ventricular Rhythms Slide 52 Ventricular Rhythms Premature Ventricular Complex (PVC) Ventricular Tachycardia Ventricular Fibrillation Idioventricular Rhythm Asystole PAGE 241 Slide 53 Premature Ventricular Complex (PVC) Rhythm: P wave: QRS: ST segment: What is the underlying rhythm? Underlying rhythm? Underlying rhythm? Underlying rhythm? Wider than QRS, comes early, No preceding P Wave Underlying rhythm PAGE 242 Slide 54 18

19 Premature Ventricular Complex (PVC) Bigeminy (PVC) Trigeminy (PVC) Quadgeminy (PVC) PAGE 249 Slide 55 Premature Ventricular Complex (PVC) Couplet (PVC) Triplet (PVC) PAGE 242 Slide 56 Ventricular Tachycardia (VT) P wave: Absent Normal; likely indiscernible QRS: Wider than.12 ST segment: Difficult to discern PAGE 254 Slide 57 19

20 Ventricular Fibrillation Rhythm: Irregular Incalculable P wave: None discernible None QRS: Bizarre ventricular conduction ST segment: Incalculable PAGE 253 Slide 58 Idioventricular BPM P wave: Absent There is no PRI QRS: Wide and bizarre, >.12 ST segment: May appear to be above/below isoelectric line PAGE Slide 59 Rhythm: P wave: QRS: ST segment: Asystole None Zero None None None None PAGE 258 Slide 60 20

21 Miscellaneous Rhythms Slide 61 Miscellaneous Rhythms FIL is the electrically filtered actual rhythm going on during CPR CPR is the artifact caused by compressions RAW is what comes across the screen when both are going on Slide 62 Questions? Slide 63 21

22 Terminal Learning Objective Action: Communicate knowledge of 3 Lead ECG interpretation Condition: Given a lecture in a classroom environment Standard: Receive minimum score of 84% on AHA standardized written exam Slide 64 Agenda Interpret ECG waves and measurements Identify the components of analyzing ECG rhythms Identify sinus rhythms Identify atrial rhythms Identify junctional rhythms Identify heart blocks Slide 65 Agenda Identify ventricular rhythms Identify miscellaneous rhythms Slide 66 22

23 Reason At some time, you will likely encounter the need to treat a critical cardiac patient. As the leader or a member of the medical team, a comprehensive understanding of cardiac arrhythmias will improve overall patient management. Slide 67 23