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Stamford Emergency Medical Services
EKG Interpretation Paramedic Instructor Stamford Emergency Medical Services Adam Cadan Alex Cadan 09/18/00
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Ask yourself the following:
Is the rate fast or slow? Is there one P for every QRS? Are the Ps upright and present? Is the PR interval ? (< .20) What’s the QRS width? (< .12) What’s the rhythm? Regular Regularly Irregular Irregularly Irregular Any “funny” looking complexes? PACs PVCs PJCs Unifocal Multifocal
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Key facts about PR interval
Time it takes for the atria to depolarize and pass its “message” to the ventricles From the beginning of the P-wave to the beginning of the QRS. Should be 0.12 to 0.21 sec (or three to five little squares) Prolonged in heart block Short PR, conditions where there is an abnormality in the fibrous insulating ring…electrical message gets past the AV node quicker—i.e. WPW
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Key facts about QRS complex
Spread of depolarization from the AV node to all parts of the ventricles takes sec If QRS width > 0.12sec (three small squares) it suggests a defect in the conduction system Q wave pathological or physiological (Old MI signature)
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Key facts about P-wave Initiated by the SA node
Travels inferiorly + Right to left SA node normally determines the heart rate P-waves should be upright in I, II, & V2 -V6
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Key facts about ST segments
Elevation of >1mm implies infarction Depression of >0.5mm implies ischemia Widespread ST elevation occurs in pericarditis
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Rates: Sinus Rhythm………………...60-100/min
Sinus Bradycardia…………..rate < 60/min Sinus Tachycardia………...rate > 100/min Junctional…………………… /min Accelerated Junctional……..rate > 60/min Idioventricular…………………20-40/min Accelerated Idioventricular……..rate > 40
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First item to look at is the "Time Markings".
Once your able to identify a six second time period, rate determination is easy!
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Couldn’t think of a name for this slide!
1 small box is 40 milliseconds, or .04 2 small boxes is 80 milliseconds, or .08 3 small boxes is 120 milliseconds, or .12 4 small boxes is 160 milliseconds, or .16 5 small boxes is 200 milliseconds, or .20
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Is the rate fast or slow? Is there one P for every QRS? Are the Ps upright and present? Is the PR interval ? (< .20) What’s the QRS width? (< .12) What’s the rhythm? Regular Regularly Irregular Irregularly Irregular Any “funny” looking complexes? PACs PVCs PJCs Unifocal Multifocal
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2nd Degree AV Block Mobitz I or Wenkebach
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3rd Degree AV Block
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A-Fib Most common sustained arrhythmia. Arrhythmia Anatomy:
Multiple wavelets of re-entry swashing around the atria. The AV node is inundated with cascades of chaotic activity
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Accelerated Junctional
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Atrial Flutter 2:1 conduction
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NSR w/ a 1st Degree AV Block
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CHECK YOUR LEADS!!! Asystole
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Junctional
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NSR w/ BBB
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NSR w/ Multifocal PVCs
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NSR w/ PAC
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NSR w/ PJC
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NSR w/ Unifocal Couplet PVCs
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NSR w/ a Unifocal PVCs
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Sinus Bradycardia
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Sinus Tachycardia
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SVT
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Is someone moving the cables?
Could be artifact! VFIB!
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V-Tach
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Paced Rhythm @ rate of 80 w/ capture
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Practice…Practice & more Practice! ADVICE:
When you’ve think you’ve looked at enough EKG strips…Look at more! Practice…Practice & more Practice!
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