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EKG Intermediate Tips Tricks Tools

This document provides an overview of an EKG interpretation training presented by Brian Gober. The training covers the basic steps and rules for EKG interpretation, including evaluating the rate, regularity, presence of P waves, PR interval, and QRS width. Specific cardiac rhythms like sinus, atrial, junctional, and ventricular rhythms as well as heart blocks are defined and examples provided. The objectives are to teach participants how to identify different rhythms using these interpretation rules.

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mayas bsharat
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56 views

EKG Intermediate Tips Tricks Tools

This document provides an overview of an EKG interpretation training presented by Brian Gober. The training covers the basic steps and rules for EKG interpretation, including evaluating the rate, regularity, presence of P waves, PR interval, and QRS width. Specific cardiac rhythms like sinus, atrial, junctional, and ventricular rhythms as well as heart blocks are defined and examples provided. The objectives are to teach participants how to identify different rhythms using these interpretation rules.

Uploaded by

mayas bsharat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Birmingham Regional Emergency Medical Services System

2018 ALCTE Summer Conference


EKG Intermediate
Tips, tricks, tools
Brian Gober, MAT, ATC, NRP, CSCS
Education Services Manager
ECC Training Center Coordinator
Birmingham Regional EMS System
Birmingham Regional EMS System
Address:
1114 16th Street South
Birmingham, AL 35205
Phone:
205-934-2595
Fax:
205-975-9038
Hours:
Monday-Friday
8:00 am - 5:00 pm
Birmingham Regional EMS System
Real-time EMS serving Blount, Chilton, Jefferson,
Shelby, St. Clair, Walker, & Winston counties in
North Central Alabama. BREMSS’s main goal is to
serve all providers of emergency care in the region
so patient life & limb are saved, to lead with vision
the EMSS of the region in development &
implementation of a system that delivers patient
care at the highest level, to educate the community
about emergency medical care, & continue the
education of healthcare personnel in the newest
lifesaving knowledge, techniques, & skills.
Objectives
• Explain each step in the EKG interpretation process.
• Using the rules of ECG Interpretation, identify sinus rhythms.
• Using the rules of ECG Interpretation, identify atrial rhythms.
• Using the rules of ECG Interpretation, identify junctional rhythms.
• Using the rules of ECG Interpretation, identify ventricular rhythms.
• Using the rules of ECG Interpretation, identify heart blocks.
• Using the rules of ECG Interpretation, identify cardiac arrest rhythms.
• Explain 12 lead EKG Interpretation.
# 1 Problem Students Have with
EKG Interpretation?
Memorization vs. Interpretation
EKG Waveforms
Rules of EKG Interpretation
5 Basic Steps
•Rate
•Is it Regular or Irregular?
•Is there a P wave Present?
•What is my PR Interval?
•How wide is my QRS complex?
Inherent Cardiac Rates
The frequency of impulse
formation attributed to a given
pacemaker location within the
heart.
- sinus node, 60 to 100
beats/min
- atrioventricular junction, 40 to
60beats/min
- ventricle, 15 to 40 beats/min.
Rate: 6 Second Method
The second method can be used with an irregular rhythm to estimate
the rate. Count the number of R waves in a 6 second strip and multiply
by 10
Rate: 300 rule
The square counting method is ideal for regular heart rates. Use the
sequence 300-150-100-75-60-50-43-37. Count from the first QRS
complex, the first thick line is 300, the next thick line 150 etc. Count the
number of QRS complexes that fit into 3 seconds
Rate: ECG Rate Ruler
Regularity

Determining regularity is the second step of analyzing an ECG rhythm.


Irregular rhythms are considered abnormal and can be caused by a
variety of conditions. If the distance of the R-R intervals or P-P intervals
is the same, the rhythm is regular – if the distance differs, the rhythm is
irregular.
Regularity: Calipers
P Waves

• Are they present?


• Upright or Inverted?

• The P Wave represents Atrial Depolarization.


• Absence of a P wave indicates that there is no conduction witin the
atria
• Absent or inverted P Waves with an associated narrow QRS complex
may indicate a Junctional origin
PR Interval
In electrocardiography, the PR
interval is the period, measured in
milliseconds, that extends from the
beginning of the P wave (the onset
of atrial depolarization) until the
beginning of the QRS complex (the
onset of ventricular depolarization);
it is normally between 120
and 200ms in duration.
Abnormal PR Interval
QRS Duration

The normal duration (interval) of the QRS


complex is between 0.08 and 0.10
seconds — that is, 80 and 100 milliseconds.
When the duration is between 0.10 and0.12
seconds, it is intermediate or slightly
prolonged. A QRS duration of greater
than 0.12 seconds is considered abnormal.
Terminology
• Sinus: Originates from the SA Node
• Atrial: Originates from the Atria but not specifically the SA Node
• Junctional: Originates in and around the AV Junction
• Ventricular: Originates in the Ventricles
• Asystole: No Electrical Activity
• Tachycardia: Fast Heart Rate
• Bradycardia: Slow Heart Rate
• Supraventricular: Above the Ventricles
Sinus Rhythms
•Normal Sinus Rhythm
•Sinus Bradycardia
•Sinus Tachycardia
•Sinus Arrhythmia
Atrial Rhythms
• Atrial Tachycardia
• Atrial Flutter
• Atrial Fibrillation
• Prematura Atrial Contraction
Atrial Tachycardia
Atrial Flutter
Atrial Fibrillation
Premature Atrial Contraction (PAC)
Junctional Rhythms
• Junctional Escape
• Accelerated Junctional
• Junctional Tachycardia
• Premature Junctional
Contraction
Junctional Escape
Accelerated Junctional
Junctional Tachycardia
Premature Junctional Contraction (PJC)
Ventricular Rhythms
• Ventricular Tachycardia
• Ventricular Fibrilation
• Idioventricular Rhythm
• Accelerated Idioventricular
Rhythm
• Polymorphic Ventricular
Tachycardia (Torsades de
Pointes)
• Premature Ventricular
Contraction
Ventricular Tachycardia
Ventricular Fibrillation
Idioventricular Rhythm
Accelerated Idioventricular Rhythm
Polymorphic Ventricular Tachycardia
(Torsades de Pointes)
Premature Ventricular Contraction (PVC)
Heart Blocks
• 1st Degree AV Block
• 2nd Degree AV Block Type I
• 2nd Degree AV Block Type II
• 3rd Degree AV Block
1 st Degree AV Block
2 nd Degree AV Block Type 1 (Wenkebach)
2 nd Degree AV Block Type 2 (Classical)
3 rd Degree AV Block (Complete Heart Block)
Asystole
12 Lead EKG
Rules of EKG Interpretation
5 Basic Steps
•Rate
•Is it Regular or Irregular?
•Is there a P wave Present?
•What is my PR Interval?
•How wide is my QRS complex?
Brian Gober, MAT, ATC, NRP, CSCS
Education Coordinator
ECC Training Center Coordinator
(205) 934-2595 Extension 3
(205) 790-7613
[email protected]

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