EKG Monitoring

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EKG Monitoring
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Types of EKG Monitoring

• Critical Care
• 24 hours/day
• Immediate recognition of problems
• Cardiac stepdown
• 24 hours/day
• Immediate response
• 12 Lead EKG
• When needed
• Specific order or standing order

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Continuos Monitoring

• 3 to 5 electrodes are placed on chest
• Must change pads prevent irritation according to
  policy
• Monitor tech watches for changes
• Can determine rate, rhythm and changes

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12 Lead EKG

• Used to determine both new and old heart problems
• Electricity is conducted differently over injured
  heart muscle
• Determines rate, rhythm and changes from previous
  EKG
• Looks at heart in 12 directions
• Usually done by trained personnel
• Current flows from a negative to a positive lead
• The lead placement determines the direction of
  the deflection of the QRS complex

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Lead Placement
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Interpretation of an EKG

• Graph paper divided into small and large squares
• Each small square represents 0.04 seconds on the
  horizontal axis and I mm on the vertical axis
• Each large square contains 5 small squares and
  represents 0.20 seconds and 5 mm
• The electrical activity is recognized by upward
  and downward deflections of the wave forms
• The baseline is called the isoelectric line

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EKG Graph
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Interpretation of an EKG, cont.

• P Wave- represents atrial depolarization and is
  the 1st deflection and indicates the results of
  the SA node firing
• PR interval represents time required for atrial
  repolarization and the time it takes for the
  impulse to travel from the atria to the
  ventricles (normal is 0-.12 to 0.20 seconds)
• QRS complex represents ventricular
  depolarization (normal is 0.06 to 0.10 seconds)
• T Wave represents ventricular repolarization

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Interpretation of an EKG, cont

• EKG is evaluated for
• Rate done on EKG by using the 6 second strip
  from R wave to R wave (normal is 60-100)
• Regularity measure for consistency
• P waves look for a P wave before each QRS
  complex
• PR interval must fall in the normal range
• QRS complexes must be normal or may be problem
  in the conduction system
• T waves should be rounded, upright and same
  shape and size (not inverted )

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Systematic Review of EKG Strip

• Determine rate and regularity
• Is there a P wave before each QRS complex
• Are P waves rounded and upright
• Measure the QRS and do they look alike
• Look at the T wave. Is it upright or inverted

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Normal Strip
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Common Dysrhythmias

• Sinus dysrhythmias
• Sinus tachycardia greater than 100
• Sinus bradycardia less than 60
• Sinus arrest
• Atrial dysrhythmias
• PAC
• SVT
• Atrial fibrillation
• Atrial flutter

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Common Dysrhythmias, cont.

• Atrioventricular blocks
• 1st degree, 2nd degree, and 3rd degree AV block
• Ventricular dysrhythmias
• V-tache
• V-fib
• PVCs
• Idioventricular
• Ventricular asystole

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PVC
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V-Tache
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SVT
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Mobitz II
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Treatment

• Based on severity of the problem
• Lethal dysrhythmias are treated immediately
• Asystole Atropine, Epinephrine
• V-tache lidocaine, Pronestyl, mag sulfate,
  amiodarone
• V-fib defibrillation with drugs
• Some may cause severe symptoms while others do
  not

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Drug Treatment of Dysrhythmias

• Quinidine
• Pronestyl
• Lidocaine
• Mexitil
• Tonocard
• Tambocor
• Rythmol
• Adenocard
• Magnesium sulfate

• Inderal
• Brevibloc
• Betapace
• Cordarone
• Covert
• Verapamil
• Cardizem
• Lanoxin
• Atropine

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Pacemakers

• Used to restore regular rhythm and improve
  cardiac output
• Types
• Temporary
• Permanent
• Transcutaneous
• Transvenous
• Implantable

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Modes of Delivery

• Single chamber
• Duel chamber
• Fixed rate
• Demand rate
• AV sequential

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Care of Pacemaker

• Vitals on return from OR
• Check insertion site and provide care as needed
• Monitor for
• rhythm
• pacemaker spike
• PVCs or other abnormal beats
• Usually on bedrest for 24 hours , off the side of
  insertion
• Gradually increase activities
• Patient must carry ID card
• Instruct patient to take pulse daily
• Notify physician both in hospital and after home
  of
• Dyspnea
• Syncope
• Dizziness
• Weakness
• Fatigue
• Chest pain

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Implantable Cardioverter/Defibrillator

• Used to treat life threatening rhythm problems
• Senses heart rate and wave form and delivers a
  shock to return heart function to a regular
  rhythm
• Recognizes V-tach and V-Fib
• If rhythm does not return to NSR, can continue
• Newer models can also recognize tachyarrhythmias
  and bradyarrhythmias
• Implanted in the sub-q tissue over the pectoralis
  muscle
• Causes some anxiety to patient when shock
  delivered
• Family and patient need education and support
• Wears ID bracelet
• Should avoid heavy magnetic fields (MRI, metal
  detectors)