1. MAKING ECG’S EASY EVALUATING THE ECG Dr Nick Robinson 01206 504320

2. Don’t PANIC
BASICS
RELAX
MAJOR POINTS ONLY
PATTERN RECOGNITION

3. You will be able to: Perform ECG correctly Describe ECG
Understand main features
Identify basic normal ECG
Distinguish between ECG arrhythmia and artefact

10. LATERAL
LATERAL

11. INFERIOR
INFERIOR
INFERIOR

12. RIGHT SIDE

14. Antero-Septal ANT & RV Lateral ANT & RV Lateral Antero-Septal
MAKING ECGS EASY - CDOCKX
Antero-Septal
ANT & RV
Lateral
ANT & RV
Lateral
Antero-Septal

17. RELATIONSHIP MAKING ECGS EASY - CDOCKX
Lets look at how the conduction system related to what we record on the ECG.
P wave: the sequential activation (depolarization) of the right and left atria
QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously)
ST-T wave ventricular repolarization
U wave: origin for this wave is not clear - but probably represents "afterdepolarizations" in the ventricles   PR interval: time interval from onset of atrial depolarization (P wave) to onset of ventricular depolarization (QRS complex) QRS duration: duration of ventricular muscle depolarization QT interval: duration of ventricular depolarization and repolarization RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate) PP interval: duration of atrial cycle (an indicator of atrial rate)

20. INFORMATION ON THE 12-LEAD ECG

21. WHAT YOU NEED TO LOOK FOR
Are the limb leads set up correctly?
Are the chest leads set up correctly?
Is the ECG free of artifact.

22. IS the ECG SET UP CORRECTLY?
LIMB LEADS
AVR – always negative
Lead I – always positive
CHEST LEADS
R wave progression
Small to Tall

23. MAKING ECGS EASY - CDOCKX
Is this ECG hooked up correctly for the limb leads?
Is it for the chest leads?

24. OTHER PROBLEMS WITH THE ECG
Artifact
Electrical interference
Muscle tremor
Wandering baseline

25. FIND THE ARTEFACT

26. MUSCLE TREMOR

27. ELECTRICAL INTERFERANCE

28. BASIC OBSERVATIONS Heart Rate Rhythm: regular? sinus?
Intervals: PR, QRS
ST segment

30. BOX METHOD MAKING ECGS EASY - CDOCKX
Look at the number of large boxes before two R waves and then using this method find the HR .
I just remember that 2 ½ large boxes or less is critical value for tachycardia
7 or more large boxes is critical for bradycardia

31. MAKING ECGS EASY - CDOCKX
Look at the rhythm strip is it regular or irregular.
How many large boxes are between two R waves = 5 = 60bpm

34. ECTOPIC BEATS

37. 40 y/o with chest pain & palpitations short PR/delta wave (WPW)

56. Atrial Flutter Saw tooth baseline Atrial rate 300 bpm

61. Rhythm
Sinus
Not sinus
Morphology
Supraventricular
Ventricular

62. The Normal ECG

63. Sinus rhythm (P before QRS)
The Normal ECG
Sinus rhythm (P before QRS)
Rate 50 – 100 bpm
Axis +90o to –30o
Intervals: PR sec
QRS <.12 sec

64. SUMMARY Correct electrode placement ? Regular ? Sinus/ ’p’ wave Rate
Recognize basic values

65. Dr Nick Robinson