ecg 101
DESCRIPTION
Introduction to reading ECGs in EDTRANSCRIPT
ECG 101
The eyes may be the window to the soul
But the ECG is the window to the heart, lungs, toxicology, electrolytes, body temperature and sometimes even the brain
Pattern recognition
An ECG is put under your nose
Immediately
InterpretTime
Name stamp
Covers nurse/HCA’s arseMakes you read it
We know who to educate if it’s wrong
Be systematic
One system
Patient’s name
Presenting complaint
ECG machine RR interval big squares: 300, 150, 100, 75, 60, 50
total number of complexes across the page x 6
Rate
Rhythm
Same patient after treatment for sepsis
Frontal axis
Why else do we care about axis?
CQC
Incomplete trifascilar blockRBBB, LAD and 1˚HB
1 myocyte away from complete heart blockDon’t send this post syncope patient home
Then proceed through the complexes
p waves
PR interval
QRS complex
QRS complex
QRS complex
Killer Qs
Pathological Qs
> 40 ms (1 mm) wide > 2 mm deep > 25% of depth of QRS complex Seen in leads V1-3
ST segment
ST segment
R
ST segment
ST segment
Original Sgarbossa Criteria
Concordant ST-segment elevation ≥ 1 mm in any lead (5 points) Concordant ST-segment depression ≥ 1 mm in lead V1 – V3 (3 points)
Discordant ST-segment elevation ≥ 5 mm in any lead (2 points)
ST segment
T waves
Repeat ECGs
13 minutes later, pain free:
T waves
T waves
T waves
QTc
Long QT syndrome (genetic)
Drugs incl amiodarone, digoxin, macrolides, antipsychotics, tricyclics, SSRIs, loratidine
HypothermiaHyperCaHypoK, hypoMag
Myocardial ischaemiaICH
+ others
> 440ms in men or > 460ms in women
Methodical readRecord your interpretationTimeName stampFurther actions esp repeat ECGs q10min x 3 for CP
eg Trodat Printy 4910 http://www.selfinkingstamps.co.nz/shop/trodat-4910-26x9mm/
$20 delivered
References and images
Most facts checked with and images obtained from
Life in The Fast Lanehttp://lifeinthefastlane.com/