EKG Interpretation

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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 ? (lt .20)
• Whats the QRS width? (lt .12)
• Whats 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
  ringelectrical message gets past the AV node
  quickeri.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 0.08-0.1 sec
• If QRS width gt 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 gt1mm implies infarction
• Depression of gt0.5mm implies ischemia
• Widespread ST elevation occurs in pericarditis

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Rates

• Sinus Rhythm...60-100/min
• Sinus Bradycardia..rate lt 60/min
• Sinus Tachycardia...rate gt 100/min
• Junctional...40-60/min
• Accelerated Junctional..rate gt 60/min
• Idioventricular20-40/min
• Accelerated Idioventricular..rate gt 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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Couldnt 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 ? (lt .20)
• Whats the QRS width? (lt .12)
• Whats 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 21 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 _at_ rate of 80 w/ capture
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ADVICE

• When youve think youve looked at
• enough EKG stripsLook at more!
• PracticePractice
• more Practice!

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