April 2012 Cardiac Review Handout - Advocate Health Care · Behavioral Objectives: Upon successful...
Transcript of April 2012 Cardiac Review Handout - Advocate Health Care · Behavioral Objectives: Upon successful...
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April 2012 CE
Site code # 107200E-1212
Cardiac Reivew – Rhythm Strips and 12 Lead EKG’s
Packet by Sharon Hopkins, RN, BSN, EMT-P
To view on the Advocate Condell website visit: www.advocatehealth.com/condell/body.cfm?id=422
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Date of CE presentation: April 2012 Topic: Cardiac Review – Rhythm Strips and 12 Lead EKG’s Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to:
1. Differentiate stable from unstable patients. 2. List criteria of the 2nd degree Type I, Type II and 3rd degree heart blocks. 3. Identify a variety of cardiac rhythms. 4. Identify ST elevation when presented with a variety of 12 lead EKG’s. 5. Describe treatment for the Acute Coronary Syndrome patient. 6. Given a rhythm, appropriately identify the rhythm and state treatment per Region X SOP’s. 7. Demonstrate placement of electrodes for obtaining a 12 lead EKG. 8. Successfully complete the post quiz with a score of 80% or better. Bibliography:
� Region X Advanced Life Support Standard Operating Procedures February 1, 2012
� Aehlert, B. ECG’s Made Easy 4th Edition. Elsevier. 2011. � American Heart Association. STEMI Professional Provider Manual. 2008. � Atwood, S., Stanton, C., Storey-Davenport, J. Introduction to Basic
Cardiac Dysrhythmia 3rd Edition. MosbyJems. 2003. � Beasley, B. Understanding EKGs – A Practical Approach 3rd Edition.
Brady. 2012. � Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices
Third Edition. Brady. 2009. � Limmer, D., O’Keefe, M. Emergency Care 12th Edition. Brady. 2012. � Page, B. 12 Lead ECG for Acute and Critical Care Providers. Brady. 2005. � Phalen, T., Aehlert, B. The 12 Lead ECG in Acute Coronary Syndromes
2nd Edition. Elsevier. 2006.
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Stable patient
� Condition not expected to deteriorate � Perfusion supports adequate level of consciousness
� Patient able to understand and obey commands � Evaluate level of consciousness � Evaluate blood pressure
Unstable patient
� Patient condition may be changing/deteriorating � Altered level of consciousness � Blood pressure less than 90 systolic
� This is abnormal for the patient � Not adequate to maintain perfusion to the vital organs
Cardiac Conduction System
Criteria for Heart Blocks First Degree Heart Block Regular rhythm Rate dependent on underlying rhythm PR interval >0.20 seconds QRS complex <0.12 seconds Not a true rhythm; a condition of a rhythm Symptoms dependent on the underlying rhythm
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Second Degree Heart block Type I – Wenckebach Atrial rhythm regular (P to P); ventricular rhythm irregular (dropped QRS) PR interval progressively lengthening until dropped QRS QRS complex <0.12 seconds Patients usually tolerate the slowed heart rate and are not symptomatic Considered a normal rhythm for some people Second Degree Heart Block Type II – Classical Atrial rhythm regular (P to P); ventricular rhythm regular (usually slow) PR interval (when present) – 0.12 – 0.20 seconds More P waves than QRS QRS complex <0.12 seconds Symptomatic usually due to the slow heart rate Consider the presence of an AMI until proven otherwise Third Degree Heart Block - Complete Atrial rate regular (P to P); ventricular rate based on pacemaker site P waves have no relationship with the QRS; no consistent PR intervals QRS complex < 0.12 seconds Often see the P waves marching through the QRS complex providing the different configurations noted sometimes form QRS to QRS Steps to Identify Cardiac Rhythms � Rhythm regular or irregular
� Can be off 2-3 little boxes � Overall rate � P waves and PR intervals (n=<0.20 sec) � QRS complex < 0.12 sec � Interpretation? � How is your patient doing/tolerating it?
Identify the Following Rhythms 1.
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2.
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6.
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Cardiac Blood Flow Coronary Blood Flow
Correlation of Coronary Arteries and Areas of Myocardium Supplied
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EKG Complex Wave Forms ST Segment Evolution
Views From the 12 Lead Perspective
Ischemia – ST depression
Injury – ST elevation
Infarct – Q wave development
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12 Lead Electrode Placement 12 Lead EKG Practice #1
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#2
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#5
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#7
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Identifying BBB
� Don’t always see “notching” � Important – QRS is widened (>0.20 sec) � Atrial activity (i.e.: P wave) precedes QRS � RBBB
� RSR’ pattern in V1 � End of QRS is a positive deflection
� LBBB � QS pattern in V1
� End of QRS is a negative deflection Can think of using your turn signal in the car to determine right from left bundle branch blocks: To make a right turn, you lift the turn signal up so get a positive deflection in V1. To make a left turn, you pull the turn signal down and get a negative deflection in V1. File: CE, EMS; CE Packets; 2012; April; Cardiac Review