THINGS TO REMEMBER...If you see a lethal arrhythmia(v-fib, asystole, v-tach without a pulse, etc.) call a CODE BLUE and Start your ACLS Protocol If you have a change in rhythm, notify

Cardiac Telemetry Self Study: Part One Cardiovascular Review 2017

Please review the above anatomy of the heart.

THINGS TO REMEMBER

There are 3 electrolytes that affect cardiac function

o Sodium, Potassium, and Calcium

When any of these electrolytes are out of the normal range you may see changes in

your cardiac rhythm and in your rhythm strip analysis

Normal contraction of the atria and ventricles is sequential

Automaticity - ability to automatically generate electrical impulse

o The SA node is normally in control and is called the pacemaker of the heart because it possesses the

highest level of automaticity. If the SA node fails to generate electrical impulses at its normal rate or

stops functioning entirely, or if the conduction of these impulses is blocked, pacemaker cells in

secondary pacemaker sites can assume control as pacemaker of the heart but at a much slower rate. In

general the farther away the impulse originates from the SA node, the slower the rate.

This does not apply to Sinus Bradycardia; which originates from the SA node at a slower pace

than normal


Cardiac Electrical Conduction

Sinus Atrial (SA) Node; High in the R atrium. Pacemaker of the heart. Rate of automaticity @ 60-

100bpm

Atrio-Ventricular (AV) Node; low R atrium near the Tricuspid valve.

o Slows conduction from atria-ventricles through Bundle of His, allowing time for atria to empty

blood into ventricles. Impulse rate of 40-60 bpm. Back up pacemaker to SA node

Bundle of His-Purkinje Fibers; Upper portion of the septum connects the AV node with the two bundle

branches. Purkinje fibers are hair like fibers along the endocardial surface of both ventricles. Impulse

rate 20-40 bpm.


Sequence of Excitation

Impulse passes from SA node ►AV node ► ventricles via the atrioventricular bundle (Bundle of

His) Bundle of His splits into two pathways in the interventricular septum (Bundle Branches, R & L)

R & L Bundle branches carry the impulse towards the apex of the heart

Purkinje fibers carry the impulse to the heart apex and ventricular walls

Segment Representation P wave: represents depolarization/spread of electrical impulse through R & L atria

PR interval: conduction of impulse through AV node, Bundle of His, R/L Bundle Branch

& Purkinje fibers

QRS: Depolarization of ventricles (Q, R & S waves)

ST segment: represents early repolarization of ventricles

J point: where QRS stops and ST segment begins T wave: represents ventricular repolarization

QT interval: Represents total Ventricular activity

Artifact: distortion of ECG tracing by non cardiac electrical activity like:- loose electrode, patient movement, muscle activity, interference

o Depolarization: cardiac cell is stimulated and positively charged. Greater Na/Ca in the cell o Repolarization: returning back to its resting state of negative charge.






The 6 Step Approach to strip interpretation

Rate? ( Tachy, Brady, normal SR)

Rhythm? (Regular or Irregular)

P-R Interval Normal? (0.12-0.20 sec)

QRS complex normal? (0.04-0.11sec or ≤ 0.11) (does

every QRS look the same?)

QT Interval (0.36 – 0.44) Usually gender/age dependent

P-wave upright & preceding every QRS? (one P-

wave for every QRS) (does every P wave look the same?)


Interventions

If you see a lethal arrhythmia(v-fib, asystole, v-tach

without a pulse, etc.) call a CODE BLUE and Start your

ACLS Protocol

If you have a change in rhythm, notify your supervisor,

gather pertinent data (i.e. history, recent labs, prior

rhythm, medications) and notify the physician if

applicable

Measurements


Let’s Review some rhythm strips









Let’s Practice!

For each practice strip, use the 6 step approach to identify: Rate, Rhythm,

P-R interval, QRS complex, QT interval, and P-wave characteristics

Rate_______________ Rhythm_______________ P-R Interval______________ Tachy/Brady/Normal? Regular/Irregular? 0.12-0.20 sec?

QRS complex______________________ QT Interval________________________ 0.04 – 0.10 sec or widened? 0.36 – 0.44 sec?

Every QRS looks the same?

P-Wave (upright? Precedes every QRS?)__________________________________ Interpretation: ______________________________________________________




P-Wave (upright? Precedes every QRS?)__________________________________ Interpretation:_______________________________________________________












QRS complex______________________ QT Interval________________________ 0.04 – 0.10 or widened? 0.36 – 0.44 sec?


P-Wave (upright? Precedes every QRS?)__________________________________

Interpretation:_______________________________________________________





Interpretation:_______________________________________________________
























Interpretation:_______________________________________________________























Resources

EKG Arrhythmia Practice Drill

https://www.practicalclinicalskills.com/ekg-practice-drill

https://www.practicalclinicalskills.com/ekg-practice-drill


EKG Academy

https://ekg.academy/

EMS Success, Education, Opportunity (SEO)

http://www.emsseo.com/2011/07/ekg-flash-chart/

Heart Blocks video

http://www.youtube.com/watch?v=3NgiiMHUrfQ

ECG Workout (workbook)

Huff, J. (1997). ECG workout: Exercises in arrhythmia interpretation. Philadelphia: Lippincott.

Aehlert, B. (2002). ECGs made easy (2nd

ed.). St. Louis: Mosby.

https://ekg.academy/

http://www.emsseo.com/2011/07/ekg-flash-chart/

http://www.youtube.com/watch?v=3NgiiMHUrfQ

THINGS TO REMEMBER...If you see a lethal arrhythmia(v-fib, asystole, v-tach without a pulse, etc.) call a CODE BLUE and Start your ACLS Protocol If you have a change in rhythm, notify

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