ECG PT.1

P Wave

Atrial contraction

QRS COMPLEX

Ventricle contraction

T wave

Refilling with blood; relaxing; repolarizing

PR INTERVAL

Movement of electrical activity from atria to ventricles

ST SEGMENT

Time between ventricular depolarization and repolarization (ventricular contraction).

QR INTERVAL

Time to take from ventricles to depolarize, contract and repolarize.

• RA - Right Arm - White

• RL - Right Leg - Green

• LA - Left Arm - Black

• LL - Left Leg - Red

• V1 or C - Center of Chest - Brown

5 LEAD PLACEMENT

V1 - 4th intercostal space to the right of the sternum

V2 - 4th intercostal space to the left of the sternum

V3 - Directly between the leads V₂ and Va

V4 - 5th intercostal space at midclavicular line

V5 - Level with V, at left anterior axillary line

V6 - Level with Vs at midaxillary line (directly under the midpoint of the armpit)

12 LEAD ECG PLACEMENT

1. P WAVE

2. Measure PR Interval

3. QRS Wave

4. R-R

5. DETERMINE THE HEART RATE

6 STEPS IN INTERPRETING ECGs

• Should be present and upright.

• Comes before QRS complex

• One P wave for every QRS complex

Identify and examine the P waves:

0.12 – 0.2 seconds

Normal PR interval:

it should not be widened or shortened – this may indicate problems. Widen is often seen in PVCs. Electrolyte imbalances and drug toxicity.

Is every P wave followed by a QRS complex?

6 second method

Count the number of Rs in between the 6 second strips and multiply by 10.

Rate: 60 – 100 bpm
Rhythm : Regular
P wave: Upright and uniform before each QRS

PR interval: Normal

QRS complex: Normal

NORMAL SINUS RHYTHM Characteristics:

• RATE: <60 BPM

• RHYTHM:REGULAR

• P WAVE: UPRIGHT AND UNIFORM BEFORE EACH QRS

• PR INTERVAL: NORMAL

• QRS COMPLEX: NORMAL

SINUS BRADYCARDIA characteristics:

• Lower metabolic needs – sleep, athletic training, hypothyroidism

• Vagal stimulation

CAUSES OF SINUS BRADYCARDIA:

calcium channel blockers, beta blockers, AMIODARONE

Medications of Sinus Bradycardia:

AMIODARONE

golden standard to give people with bradycardia

AMIODARONE

medication to increase heart rate

• RATE: >100 bpm

• RHYTHM: Regular

• P WAVE: Upright and uniform before each QRS

• INTERVAL: Normal Q

• RS COMPLEX: Normal

SINUS TACHYCARDIA characteristics

• Physiologic or psychological stress – blood loss, fever, exercise, dehydration

• Certain medications: Stimulants- caffeine, nicotine ; Illicit drugs – cocaine, amphetamines; Stimulate sympathetic response – epinephrine

• Heart failure

• Cardiac tamponade

• Hyperthyroidism

CAUSES OF SINUS TACHYCARDIA

epinephrine

Stimulate sympathetic response

Decrease the heart rate to normal

TREATMENT OF SINUS TACHYCARDIA:

• RATE: 100 – 250 BPM

• RHYTHM:REGULAR

• P-WAVE:NOT VISIBLE

• PR INTERVAL: NONE

• QRS COMPLEX: WIDE (LIKE TOMBSTONES) >0.12 seconds

VENTRICULAR TACHYCARDIA characteristics:

• Myocardial ischemia/infarction

• Electrolyte imbalances

• Digoxin toxicity

• Stimulants: caffeine and methamphetamines

CAUSES OF VENTRICULAR TACHYCARDIA:

Patient is usually awake

Chest pain

Lethargy

Anxiety

Syncope

Palpitations

MANIFESTATIONS OF VTACH

•Oxygen

•Antidysrhythmics (eg. Amiodarone) – stabilizes the rhythm

•Synchronized Cardioversion – synchronized administration of shock (delivery in sync with the QRS wave).

TREATMENT FOR VTACH (STABLE CLIENT WITH A PULSE)

Synchronized Cardioversion

synchronized administration of shock (delivery in sync with the QRS wave)

•CPR

•Follow ACLS protocol for defibrillation – SHOCK

•Possible intubation

Drug therapy – Epinephrine, vasopressin, amiodarone

TREATMENT FOR VTACH (UNSTABLE CLIENT WITHOUT A PULSE)