1. Rhythm recognition Workshop
Version: Jun 2016

2. Learning outcomes This workshop should enable you to:
list the indications for ECG monitoring
demonstrate how to monitor the ECG effectively
explain the basic physiology of the ECG
describe the 6-stage approach to rhythm recognition
identify each of the common 12-lead ECG patterns of acute myocardial infarction

3. What are the indications for ECG monitoring?

4. How to monitor the ECG self-adhesive pads 3-lead monitoring4

5. Self-adhesive pads 5

6. 3-lead monitoring

7. Conducting system

8. QRS Complex

9. How to read a rhythm strip1.
Is there any electrical activity with a pulse?

10. How to read a rhythm strip1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad?

11. How to read a rhythm strip1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad?
Describe the rhythm on this basis.
Continue further only if you are sure that you can see atrial activity.

12. How to read a rhythm strip1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?

13. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Sinus rhythm

14. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Asystole

15. Is there any electrical activity with a pulse?1.
Is there any electrical activity with a pulse?
Asystole

16. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity? VT

17. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? VT

18. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Sinus Brady

19. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
1st Degree AV Block

20. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Mobitz I second degree AV Block

21. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Mobitz II second degree AV Block

22. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
3rd degree AV Block/CHB

23. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Agonal Rhythm

24. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Narrow Complex Tachycardia

25. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Atrial Fibrillation

26. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Atrial Flutter

27. Is there any electrical activity with a pulse? 2. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?
Sinus Tachy + PVC

28. 1.
Is there any electrical activity with a pulse? 2.
What is the ventricular (QRS) rate? 3. 4.
Is the QRS width normal (narrow) or broad? 5.
Is atrial activity present?
(If so, what is it: P waves? Other atrial activity?) 6.
How is atrial activity related to ventricular activity?

29. 1.
Is there any electrical activity with a pulse?

30. Any questions?

31. Summary know the indications for ECG monitoring
know how to monitor the ECG effectively
understand the basic physiology of the ECG
Be able to use the 6-stage approach to rhythm recognition
be able to recognise the common 12-lead ECG patterns of acute myocardial infarction

32. Advanced Life Support Course Slide set
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© Australian Resuscitation Council (June 2016)