Post on 02-Mar-2018
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Basic EKG
for Nurses
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Outline
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(Electrocardiogram)
sA
node AV node
His bundlebundle branch Purkinje fibers ventricular myocardium
electrocardiograph electrocardiogram
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Heart Beat Anatomy
AV NODE
Sinus Node(SA Node)
AtrioventricularNode (AV Node)
Receives impulse from
SA Node
Delivers impulse to the His-Purkinje System
40-60 BPM if SA Node fails to
deliver an impulse
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Heart Beat Anatomy
AtrioventricularNode (AV Node)
Sinus Node(SA Node)
Bundle of His
Bundle Branches
Purkinje Fibers
Bundle Branches
Purkinje Fibers
Moves the impulse throughthe ventricles for contraction
Provides Escape Rhythm:
20-40 BPM
THE PURKINJE NETWORK
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Normal Sinus Rhythm
Click heart toview animation
*Animation
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Impulse Formation In SA Node
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Atrial Depolarization
P wave= depolarization of the atrium
2.5 mm 0.11 sec
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Delay At AV Node
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Conduction Through Bundle
Branches
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Conduction Through Purkinje
Fibers
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Ventricular Depolarization
QRS = depolarization of the Ventricle
0.08 0.12 sec.
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Plateau Phase of Repolarization
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Final Rapid (Phase 3)
Repolarization
T wave = repolarization of the Ventricle
T wave 5 mm
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Normal EKG Activation
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EKG Skin preparation:
Rub site briskly with alcohol pad.
electrode has adequate gel and is not dry.
EKG
EKG position position
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12 leads
12 leads
1. Unipolar lead :
1.1 Unipolar limb leads : aVR , aVL, aVF
1.2 Unipolar chest leads : Lead V1 V6
2. Bipolar lead :
Bipolar limb leads : I , II , III
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Lead I : ()
( )
Lead II : () ( )
Lead III: ()
( )
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.
1. Standard lead / Bipolar lead / Limb lead
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Bipolar Lead
Limb lead : lead I, II,III,aVR,AVL,aVF
I,II,III,aVR,aVF,aVL
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Precordial lead Unipolar Chest Lead
V1 4
V2 4
V3 V2 V4
V4 5
V5 5 V 6 5
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2.The Precordial (Chest) Leads
VI-V6
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Normal 12 ECG with Lead II Rhythm Strip CalibrationSpike
Paper Speed and Voltage Calibration
Lead II Rhythm Strip
12 LeadsLead Change Indicators
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.
12Lead EKG ?
P wave Lead II , aVF aVR
( aVR Dextrocardia, lead &
P wave SA node AT
Lead II Lead II 2.5 mm 0.12 sec
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Sinus rhythm: P wave upright in lead II, aVF
negative P wave in aVR
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Normal sinus rhythm
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EKGPaper Speed =25 mm / sec25 mm (25 ) = 1 sec1 mm (1 ) = 1 / 25
= 0.04 sec
= 40 msec
5 mm (5 =1) = 0.04 X 5= 0.2 sec = 200
msec
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Reading EKG Squares
Each square = 40 ms
Each interval = 200 ms
Intervals and Timing
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0.20 second
5mm = 0.5m
1mm = 0.04
second
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Reading EKGs
Normal Rangesin Milliseconds:
PR Interval 120
200 ms
QRS Complex 60 100 ms
QT Interval 360 440 ms
Intervals and Timing
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1.Most common method* Fine R wave on a heavy line ( large box) count off 300,150,100,75,60,50
Until the next R wave
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Normal rate SA node 60-100
< 60 bradycardia
> 100 Tachycardia
Atrial pacemaker 60-80
AV node 40-60
Ventricle pacer 20-40
Ectopic pacemakers faster at rate 150-250
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2.Mathematical method
-regular bradycardia : rate
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300 150 100 75 60 50 43
Rate = 1500number of small box
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The most useful if you have an irregular Rhythm [ like AF]
Count 30 large boxes, starting from the first Rwave. There are 8 R-R intervals within 30 boxes.
Multiply 8 x 10 = Rate 80
3.six-second method
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.
SA - node :
1.
2. 60 -100 /
3. Wave
4. P wave QRS Complex5. Interval
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Steps to rhythm interpretation
1. Estimate Heart Rate
2. Is the rhythm regular? 3. Are there P waves?
4. Is the QRS wide or narrow?
5. Is there a relationship between
P waves and QRS complexes?
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1. Estimate Heart Rate
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2. Is the rhythm regular?
Is it regular?
Is it irregular?
Are there any patterns to the
irregularity?
Are there any ectopic beats?
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2. Is the rhythm regular?
Is it regular?
Is it irregular?
Are there any patterns to the
irregularity?
Are there any ectopic beats?
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2. Is the rhythm regular?
Is it regular?
Is it irregular?
Are there any patterns to the
irregularity?
Are there any ectopic beats?
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3. Are there P waves?
Are the P waves regular?
Is there one P wave for every QRS?
What is the morphology? (upright
rounded and uniform)
Are the irregular P waves associated
with ectopic beats?
Is the P wave in front of the QRS
or behind it?
Are there more P waves thenQRSs?
Do all the P waves look alike?
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3. Are there P Waves?
Are the P waves regular?
Is there one P wave for every QRS?What is the morphology?
(upright,rounded and uniform)
Are the irregular P waves associated
with ectopic beats?
Is the P wave in front of the QRS
or behind it?
Are there more P waves then
QRSs?
Do all the P waves look alike?
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3. Are there P Waves?
Are the P waves regular?
Is there one P wave for every QRS?What is the morphology? (upright
rounded and uniform)
Are the irregular P waves associated
with ectopic beats?
Is the P wave in front of the
QRS or behind it?
Are there more P waves then
QRSs?
Do all the P waves look alike?
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3. Are there P waves?
Is the P wave in front of the QRS
or behind it?
Are there more P waves then
QRSs?
Do all the P waves look alike?
Are the P waves regular?
Is there one P wave for every QRS?
What is the morphology? (upright
rounded and uniform)
Are the irregular P waves associated
with ectopic beats?
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4. Is the QRS wide or narrow?
Normal range < 0.12
Are all the QRS
complexes of equal
duration?
What is the
measurement of the
QRS complexes?
Is the QRS
measurement within
normal limits?
Are the unusual QRS
complexes associated
with ectopic beats?
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4. Is the QRS wide or narrow?
Are all the QRS
complexes of equal
duration?
What is the
measurement of the
QRS complexes?
Is the QRS
measurement within
normal limits?
Are the unusual QRS
complexes associated
with ectopic beats?
Normal range < 0.12
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5. Is there a relationship between
P waves and QRS complexes?
Are all the PR
intervals constant?
Is the PR interval
measurement within
normal limits?
If the PR interval
varies, is there a
pattern to the change
in measurements?
Normal PR interval = 0.120.20
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5. Is there a relationship between
P waves and QRS complexes?
Are all the PR
intervals constant?
Is the PR interval
measurement within
normal limits?
If the PR interval
varies, is there a
pattern to the change
in measurements?
Normal PR interval = 0.120.20
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Thank you