ekg 1,2,3 - skinbonescme.com
TRANSCRIPT
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EKGJennifer Carlquist PA-C, ER CAQ
1,2,3
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Disclosures
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Objectives
• Review normal cardiac conduction
• Rhythm review
• How to assess heart rate
• 10 step program to assess an EKG
• Normal EKG review
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It is as easy as this…
P – P wave? PR interval?
Q – QRS – wide? QT interval? Q Wave?
R – Rate? Rhythm? RR interval?
S – ST elevation?
T – T waves (shape, size, position)
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What makes this a normal EKG?
(
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(60-100)
(120-200 ms)
(<120)
(<460)
(0-90)Is it though?
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Normal conduction
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You have to know what normal is to know what abnormal is.
• Introducing…. NSR.
• When the president is in charge.
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When the president goes on vacation…
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You need 1 “man” in charge
60-100
40-60
20-400-20
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Pop Quiz
Name that tune…
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When everyone tries to overthrow the government
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The Waves
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Recap
• P
• QRS
• ST segment
• T
• Q waves
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Pathologic Q waves
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Q waves to worry about
¼ of the R wave
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The Normal
EKG
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1. Big sick or little sick?
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2. Rate (60-100)
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3. Rhythm (Reg v Irr? Fast v. slow, Narrow v. wide)
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These numbers……MATTER
•PR Interval - .12 - .20 (120 ms – 200 ms)
•QRS Complex - below .12 (120 ms)
•QT Interval – below 460 ms
A normal QRS should be no longer than ___ boxes
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4. Intervals.
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5. ST Segments
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6. Q waves. P/QRS Married?
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7. Axis
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8. Hypertrophy, voltage.
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9. T wave rules
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10. Chief complaint
based approach
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Priority Chief Complaints
•Palpitations – WPW, SVT, AF, VT
•Chest pain – MI, S1, q3, T3
•Dyspnea – MI, s1, q3, t3, R axis, LVH
•Dizzy light headed – Arrhythmia, QT, WPW
•Weakness – EVERYTHING
•Dialysis – peaked T, slow rate
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Which ones are “contiguous”?
AVLII
III
AVRLead I
AVF
VI
V2
V3
v4
v5
V6
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“Reciprocal changes”
Courtesy of EKGtools.com
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Where’s the STEMIMI
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Lets practice!
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36 y/o military wife with four kids
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Weakness in a 70 year old
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Patient dizzy. PMD put her on Metoprolol 100 mg for HTN.
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70 year old male with Palpitations
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19 year old with Palpitations
• WAVE
• PR interval (<120 ms)
• Wide QRS
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Take Home Points
•The president should always run the heart
•Don’t trust the EKG interpretation
•PQRST
•The EKG family should always be holding hands
•Memorize your intervals
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