EKG Interpretation Paramedic Instructor Stamford Emergency Medical Services Adam Cadan Alex Cadan 09/18/00.

EKG InterpretationEKG Interpretation

Paramedic InstructorParamedic Instructor

Stamford Emergency Medical Stamford Emergency Medical ServicesServices

Adam CadanAdam Cadan

Alex CadanAlex Cadan

09/18/0009/18/00

Ask yourself the following:Ask yourself the following:

1.1. Is the rate fast or slow?Is the rate fast or slow?2.2. Is there one P for every QRS?Is there one P for every QRS?3.3. Are the Ps upright and present?Are the Ps upright and present?4.4. Is the PR interval ? (< .20)Is the PR interval ? (< .20)5.5. What’s the QRS width? (< .12)What’s the QRS width? (< .12)6.6. What’s the rhythm?What’s the rhythm?

RegularRegular Regularly IrregularRegularly Irregular Irregularly IrregularIrregularly Irregular

7.7. Any “funny” looking complexes?Any “funny” looking complexes? PACsPACs PVCsPVCs PJCsPJCs UnifocalUnifocal MultifocalMultifocal

Key facts about PR intervalKey facts about PR interval

Time it takes for the atria to depolarize and pass Time it takes for the atria to depolarize and pass its “message” to the ventricles its “message” to the ventricles

From the beginning of the P-wave to the From the beginning of the P-wave to the beginning of the QRS. Should be 0.12 to 0.21 beginning of the QRS. Should be 0.12 to 0.21 sec (or three to five little squares) sec (or three to five little squares)

Prolonged in heart blockProlonged in heart block Short PR, conditions where there is an Short PR, conditions where there is an

abnormality in the fibrous insulating ring…abnormality in the fibrous insulating ring…electrical message gets past the AV node quickerelectrical message gets past the AV node quicker—i.e. WPW—i.e. WPW

Key facts about QRS complexKey facts about QRS complex

Spread of depolarization from the AV Spread of depolarization from the AV node to all parts of the ventricles takes node to all parts of the ventricles takes 0.08-0.1 sec 0.08-0.1 sec

If QRS width > 0.12sec (three small squares) If QRS width > 0.12sec (three small squares) it suggests a defect in the conduction system it suggests a defect in the conduction system

Q wave pathological or physiological (Old Q wave pathological or physiological (Old MI signature)MI signature)

Key facts about P-waveKey facts about P-wave

Initiated by the SA node Initiated by the SA node Travels inferiorly + Right to left Travels inferiorly + Right to left SA node SA node normallynormally determines the determines the

heart rate heart rate P-waves should be upright in I, II, & P-waves should be upright in I, II, &

V2 -V6 V2 -V6

Key facts about ST segmentsKey facts about ST segments

Elevation of >1mm implies infarction Elevation of >1mm implies infarction Depression of >0.5mm implies ischemiaDepression of >0.5mm implies ischemia Widespread ST elevation occurs in pericarditis Widespread ST elevation occurs in pericarditis

Rates:Rates:

Sinus Rhythm………………...60-100/minSinus Rhythm………………...60-100/min Sinus Bradycardia…………..rate < 60/minSinus Bradycardia…………..rate < 60/min Sinus Tachycardia………...rate > 100/minSinus Tachycardia………...rate > 100/min Junctional……………………...40-60/minJunctional……………………...40-60/min Accelerated Junctional……..rate > 60/minAccelerated Junctional……..rate > 60/min Idioventricular…………………20-40/minIdioventricular…………………20-40/min Accelerated Idioventricular……..rate > 40Accelerated Idioventricular……..rate > 40

First item to look at is the "Time Markings". First item to look at is the "Time Markings". Once your able to identify a six second time period, rate Once your able to identify a six second time period, rate

determination is easy! determination is easy!

1 small box is 1 small box is 4040 milliseconds, or .milliseconds, or .0404

2 small boxes is 2 small boxes is 8080

milliseconds, or milliseconds, or .08.08

3 small boxes is 3 small boxes is 120120 milliseconds, or milliseconds, or .12.12

4 small boxes is 4 small boxes is 160160

milliseconds, or milliseconds, or .16.16

5 small boxes is 5 small boxes is 200200 milliseconds, or milliseconds, or .20.20

Couldn’t think of a name for this slide!

Is the rate fast or slow?Is the rate fast or slow?Is there one P for every QRS?Is there one P for every QRS?Are the Ps upright and present?Are the Ps upright and present?Is the PR interval ? (< .20)Is the PR interval ? (< .20)What’s the QRS width? (< .12)What’s the QRS width? (< .12)What’s the rhythm?What’s the rhythm?

• RegularRegular• Regularly IrregularRegularly Irregular• Irregularly IrregularIrregularly Irregular

Any “funny” looking complexes?Any “funny” looking complexes?• PACsPACs• PVCsPVCs• PJCsPJCs• UnifocalUnifocal• MultifocalMultifocal

2nd Degree AV Block

Mobitz Ior

Wenkebach

3rd Degree AV Block

A-Fib

Most common sustained arrhythmia.

Arrhythmia Anatomy: Multiple wavelets of re-entry swashing around the atria. The AV node is inundated with cascades of chaotic activity

Accelerated Junctional

Atrial Flutter 2:1 conduction

NSR w/ a 1st Degree AV Block

CHECK YOUR LEADS!!!Asystole

Junctional

NSR w/ BBB

NSR w/ Multifocal PVCs

NSR w/ PAC

NSR w/ PJC

NSR w/ Unifocal Couplet PVCs

NSR w/ a Unifocal PVCs

Sinus Bradycardia

Sinus Tachycardia

SVT

Is someone moving the cables?Could be artifact!

VFIB!

V-Tach

Paced Rhythm @ rate of 80 w/ capture

ADVICE:ADVICE:

When you’ve think you’ve looked atWhen you’ve think you’ve looked atenough EKG strips…Look at more!enough EKG strips…Look at more!

Practice…PracticePractice…Practice& more Practice!& more Practice!