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Basic EKG Interpretation A Precursor to 12 Lead Interpretation

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Title: Basic EKG Interpretation A Precursor to 12 Lead Interpretation


1
Basic EKG InterpretationA Precursor to 12 Lead
Interpretation
  • By Darryl Jamison, NREMT-P
  • Macon County EMS Training

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Basic Steps of EKG Interpretation
  • Rate
  • Rhythm
  • P waves
  • P-R interval
  • QRS complexes

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Analyze the Rate
  • First step
  • Six second method
  • R-R intervals

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Analyze the rhythm
  • Occasionally irregular
  • Regularly irregular
  • Irregularly irregular

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Analyze the P waves
  • Ask yourself these questions
  • Are P waves present?
  • Are the P waves regular?
  • Is there on P wave for each QRS?
  • Are the P waves upright or inverted (compared to
    the QRS?)
  • Do all of the P waves look alike?

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Analyze the P-R Interval
  • The time necessary for the atria to depolarize
    and the conduction of the impulse to the AV node
  • Normal0.12-0.20 seconds
  • Should be consistent across the strip

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Analyze the QRS Complex
  • Ventricular depolarization
  • Ask these questions?
  • Do all of the QRS complexes look alike?
  • What is the duration of the QRS complex?
  • Normal--lt0.12 seconds
  • If gt0.12 consider ventricular ectopy.

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Sinus Bradycardia
  • Etiologyresults from a slowing in the SA node.
  • Increased parasympathetic tone
  • Intrinsic disease of the SA node
  • Drug effects (digitalis, propanolol, quinidine)

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  • SINUS BRADYCARDIA
  • Rate--lt60 bpm
  • Rhythmregular
  • Pacemaker siteSA node
  • P wavesupright and normal morphology
  • PRI0.12-0.20 seconds and consistent
  • QRS0.04-0.12 seconds

Rules of Interpretation
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Sinus Tachycardia
  • Etiology
  • Exercise
  • Fever
  • Anxiety
  • Hypovolemia
  • Anemia
  • Pump failure
  • Increased sympathetic tone

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  • Rate-- gt100
  • RhythmRegular
  • Pacemaker siteSA node
  • P wavesupright and normal in morphology
  • PRI0.12-0.20 and constant
  • QRS0.04-0.12

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Wandering Pacemaker
  • Results from any of the following conditions
  • A variant of sinus dysrhythmias
  • A normal phenomenon in the very young or the aged
  • Ischemic heart disease
  • Atrial dilation

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  • Rateusually normal
  • Rhythm--Slightly irregular
  • Pacemakervaries between the SA node, atrial
    tissue, and the AV junction
  • P wavesmorphology changes from beat to beat, can
    disappear
  • PRIvaries may be less than 0.12 seconds, greater
    than 0.20
  • Normal QRS

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PAC's
  • Causes
  • Use of caffeine, tobacco, or alcohol
  • Sympathomimetic drugs
  • Ischemic heart disease
  • Hypoxia
  • Dig toxicity
  • Ratedepends on underlying rhythm
  • Pacerectopic focus in the atrium
  • P wavesoccurs earlier than the next anticipated
    p wave
  • PRIusually normal, but can vary depending on
    location
  • QRSnormal

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PVC's
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PSVT
  • Occurs when rapid atrial depolarization overrides
    the SA node. Can be caused by increased
    automaticity of a single atrial focus or by
    reentry phenomenon at the AV node.
  • Etiologystress, overexertion, smoking, or
    ingestion of caffeine.
  • Rate150-250
  • Rhythmregular
  • Paceroutside SA node
  • P-waveusually buried within the preceding T wave
  • PRInormal
  • QRS--normal

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Atrial Flutter
  • Caused by rapid atrial reentry circuit and an AV
    node that physiologically cannot conduct all
    impulses through the ventricles.
  • Caused by CHF due to atrial dilation. Rarely from
    an MI
  • Rateatrial 250-350 vent. Varies with ratio
  • Rhythmatrial regular, vent regular unless
    variable conduction
  • Flutter waves are present

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Atrial Fibrillation
  • Results from multiple areas of reentry within the
    atria or from multiple ectopic foci bombarding an
    AV node that cannot handle the impulses.
  • Rateatrial rate from 350-750.
  • Irregularly irregular
  • Numerous ectopic foci in the atria
  • No PRI
  • QRS normal

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  • Results when the rate of the primary pacemaker,
    usually the SA node, becomes less than that of
    the AV node.
  • 40-60 bpm
  • AV junction is the pacer site
  • P wave may be inverted either before or after
    the QRS
  • QRS can be anything

Junctional Rhythm
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Accelerated Junctional
  • Results from increased automaticity in the AV
    junction
  • 60-100 bpm
  • Regular rhythm
  • Inverted or absent p waves
  • QRS normal

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Junctional Tachycardia
  • Results from rapid AV junctional depolarization
    overrides the SA node
  • 100-180 bpm
  • Regular rhythm
  • Same as previous for everything else

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Ventricular Tachycardia
  • Three or more PVCs in a row at a rate of greater
    than 100 bpm
  • Causesmyocardial ischemia hypoxia acid-base
    disturbances electrolyte imbalances increased
    sympathetic tone idiopathic causes MI
  • 100-250 bpm
  • Usually regular but can be irregular
  • Ventricles is the pacer
  • QRS is greater than 0.12

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1st Degree AV Block
  • Actually a delay in conduction rather than actual
    block.
  • Could have other blocks associated with 1st
    degree, also known as bifascicular blocks which
    is a serious condition.
  • Rate depends on underlying
  • Normal p waves
  • PRI greater than 0.20
  • No danger in and of itself, but cannot tell other
    blocks with just a 3 lead. (12 LEAD!!!)

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2nd Degree Type I Wenkebach
  • PRI becomes progressively longer until it drops a
    beat, the QRS.
  • Ischemia is the most common cause. With increased
    parasympathetic tone and drugs as well.
  • Atrial rate is unaffected. Atrial rhythm is
    usually regular.
  • Can compromise cardiac output if QRSs are
    dropped often enough.

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Type II
2nd Degree
  • Characterized by p waves not associated with QRS.
  • Ventricular rate is usually bradycardic.
  • Pacemaker insertion is the definitive treatment.

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3rd Degree Block Complete Heart Block
  • Complete absence of conduction between the atria
    and ventricles.

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