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EKG Interpretation

EKG Interpretation. Just the beginning. King County. Introduction Cardiac monitoring has been routinely used in the Fire Service for many years Not without some liability Intent of this course is to provide the basics in cardiac rhythm interpretation. Introduction cont.

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EKG Interpretation

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  1. EKG Interpretation Just the beginning

  2. King County • Introduction • Cardiac monitoring has been routinely used in the Fire Service for many years • Not without some liability • Intent of this course is to provide the basics in cardiac rhythm interpretation

  3. Introduction cont. • This course is not intended to teach diagnosis of heart disease • Lead II is not sufficient for EKG diagnosis • Recognition of the cardiac cycle will aid in the understanding of EKG’s • In order to remain proficient it is necessary to commit time to ongoing training in EKG interpretation

  4. Objectives • Understand basic cardiac terminology • Describe the anatomy of the heart • Identify the electrical conduction system • Identify abnormal electrical cardiac activity

  5. Objectives • Identify common cardiac rhythms • Identify and effect appropriate therapy for the patient on a monitor

  6. Course Completion • Participants are expected to pass a written exam and achieve a 70% score • Practical exam will include correct interpretation of static rhythms, 70% passing score

  7. Primary Obligation • It cannot be overemphasized that the primary obligation for non-cardiac arrest patients is: ABC’s & • Attention to the patient’s symptoms • Vital Signs, physical exam • Any necessary treatment with application of the monitor only when basic life support has been completed

  8. Anatomy & Physiology • Heart is a muscle • Divided into four chambers • Receives blood from the body via the inferior and superior vena cavae • Chambers separated by valves • Coronary arteries supply blood to the myocardium

  9. Electrical Conduction System • Specialized system of interconnected cells spread throughout the entire heart • Provides and conducts the signal to the heart muscle to contract in a coordinated fashion

  10. Sinoatrial (SA) Node • Collection of electrical tissue that is the normal point of origin of electrical activity • Named because it is located in the sinus part of the atria • Generates “P” waves

  11. Atrioventricular (AV) Node • A way station that receives the impulses from the atria • Named because it is located between the atria and the ventricles • Actually used to slow impulses from the atria to the ventricles

  12. Bundle of His • Receives impulses from the AV node and passes them through the left and right bundle branches in the ventricular septum

  13. Purkinje Fibers • Last receiving point of the electrical impulses • Fibers located in the ventricular musculature • Rapidly conducts impulses causing ventricular contraction

  14. Automaticity • Any portion of the conduction system or heart muscle may initiate an electrical impulse • When the AV Node fails to generate an impulse, another cell/area of the heart will initiate electrical activity

  15. Secondary Pacemakers • Any portion of the heart may initiate an electrical impulse and becomes a secondary pacemaker • Determining the location of a secondary pacemaker will become clearer as we proceed through this curriculum

  16. Electrocardiographic paper

  17. EKG paper • Grid of standard dimensions • Simply used as a measurement of time • Each small box represents 0.04 seconds • Larger bolded boxes are .20 seconds • Important to remember these values as they aid in the identification of virtually all EKG strips

  18. The Cardiac Cycle • P wave- indicates atrial “depolarization” • PR interval- the interval from the beginning of the P wave to the beginning of the QRS complex • PR interval represents the time from atrial depolarization to the beginning of ventricular repolarization

  19. Cardiac Cycle • Normal PR interval should not exceed 0.2 seconds or one large bolded square on the EKG paper • QRS complex- represents electrical depolarization of the ventricle • Normal duration of the QRS complex is from 0.08-0.10 seconds (2 to 3 small boxes on the EKG paper

  20. Cardiac Cycle • T wave- represents repolarization of the myocardium

  21. Normal Sinus Rhythm • Characteristics- • P wave for each QRS • PR interval normal, <0.20 seconds • QRS complex is normal, <0.10 seconds • Uniform in shape • Rate is regular and is between 60-100

  22. Normal Sinus Rhythm • Most common rhythm seen in acute MI • Does not indicate that the patient is stable or that there is an absence of heart disease • Indicates that the origin of the impulse is from the SA Node • Indicates normal function of the electrical system

  23. Normal Sinus Rhythm

  24. Normal Sinus Rhythm

  25. Sinus Tachycardia • Characteristics- • P wave for each QRS • PR interval is normal, < 0.20 seconds • QRS complex is narrow, < 0.10 seconds • Uniform in shape • Rate is regular, > 100/minute

  26. Sinus Tachycardia • Accelerated discharge of electrical impulses from the sinus node • Treatment is “attention to symptoms” • Underlying cause is the concern • Causes include; shock, stimulants, acute MI where decrease in cardiac output causes heart rate increase

  27. Sinus Tachycardia

  28. Sinus Tachycardia

  29. Supraventricular Tachycardia • P waves may not be seen due to accelerated rate • QRS complex is narrow, < 0.10 seconds • Uniform in shape • Rate is regular, > 150/ minute • Patient’s heart rate is too fast

  30. Supraventricular Tachycardia

  31. Supraventricular Tachycardia

  32. Sinus Bradycardia • Characteristics- • P wave for each QRS • PR interval is normal, < 0.20 seconds • QRS complex is normal, < 0.10 seconds • Uniform in shape • Rate is regular, < 60/ minute

  33. Sinus Bradycardia • Transmission of impulses from the SA node is slowed to < 60/ minute • Heart rates less than 50/ minute should never be considered to be normal • Beta blockers, digoxin, hypoxia, being athletic or with history of a slow heart rate can be the cause • Patient’s heart rate is too slow

  34. Sinus Bradycardia

  35. Sinus Bradycardia

  36. Premature Ventricular Contractions • Characteristics- • Early occurring beats that have a characteristic “compensatory pause” • Premature QRS complex that is wide and bizarre, conduction time > 0.10 seconds • Same shape except when from different focus in the heart

  37. Premature Ventricular Contractions • Can occur in a healthy individual • Viewed with caution in the patient who presents with cardiac symptoms • Significant if: occur in 2’s (couplets), 3’s (triplets),run of 4 is Ventricular Tachycardia • Frequent occurring with syncope be cautious

  38. Premature Ventricular Contractions

  39. Ventricular Tachycardia • Characteristics- • P waves are usually present but are obscured by wide, rapidly occurring QRS complex • QRS complex is wide > 0.10 and bizarre • Uniform in shape typically • Rate is regular and > 150/ minute

  40. Ventricular Tachycardia • Life threatening arrythmia • Rapid rate decreases cardiac output • Place patient supine, anticipating shock • Cause can be electrical and not always acute MI • If patient unconscious and pulseless is a a shockable rhythm

  41. Ventricular Tachycardia

  42. Ventricular Tachycardia

  43. Idioventricular Rhythm • Characteristics- • P waves typically obscured or follow the QRS complex • QRS complex is wide, > 0.10 seconds • Sometimes uniform in shape • Rate is irregular, most often seen with rate < 40/minute

  44. Idioventricular Rhythm • Observed after defibrillation & can be endpoint in arrest resuscitation attempt • Conduction system above the ventricles fails to generate an electricle impulse • Inherent rate of 30-40/minute • Will likely be in cardiac arrest • If unconscious and B/P <60, initiate CPR

  45. Idioventricular Rhythm

  46. Ventricular Fibrillation • Characteristics- • P waves are absent • QRS complex absent • Baseline wavy, chaotic and inconsistent • Rhythm irregular • Rate is not countable

  47. Ventricular Fibrillation • Sudden death & cardiac arrest immediately follow the onset • Immediately defibrillate with 200 joules and proceed with standing orders • Remember that we now do CPR for 2 minutes between shocks

  48. Asystole • Characteristics- • P waves are not present • QRS complex is not present • Absence of any complexes indicate complete cessation of electrical activity • The heart is motionless

  49. Asystole

  50. Pacemakers • Characteristics- • P waves sometimes are visible but are not associated • QRS complex of times is wide, > 0.10 seconds • Preceded by a small spike with either a negative or positive deflection

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