EKG
interpretation
What the EKG means
P wave:
Atrial depolarization
QRS complex:
Ventricular depolarization
T wave:
Ventricular repolarization
Measuring the EKG1 second
0.04 sec
5 Steps of EKG Interpretation
Yes
?
No
3 to 5 little boxes
Yes
No
Yes
No
HR: 7 x 10 = 70
Yes
No
P-wave: normal
PR Interval: 0.12-0.20
QRS: <0.12
Rate: 60-100
Regularity: Regular
Normal Sinus Rhythm
Dysrhythmias
Sinus dysrhythmias
P-wave: Normal
PR Interval: 0.12-0.20
QRS: <0.12
Rate: <60
Regularity: Regular
Sinus Bradycardia
Sinus Bradycardia
P-wave: Normal
PR Interval: 0.12-0.20
QRS: <0.12
Rate: >100
Regularity: Regular
Sinus Tachycardia
Sinus Tachycardia
Heart Blocks
P-wave: Normal
PR Interval: >.20
QRS: <0.12
Rate: 60-100
Regularity: Regular
First degree heart block
First-degree heart block
P-wave: Not a P for every QRS
PR Interval: longer, longer, longer….drop
QRS: <0.12
Rate: 60-100
Regularity: Regular
Second degree heart block - type 1
Second degree heart block - type 1
P-wave: Not a P for every QRS
PR Interval: 0.12-0.20
QRS: <0.12
Rate: >100
Regularity: Regular
Second degree heart block - type 2
Second degree heart block - type 2
P-wave: Normal
PR Interval: Variable
QRS: <0.12
Rate: <60
Regularity: Irregular
Third degree heart block
Third degree heart block
If the R is far from P, then you have a FIRST DEGREE.
Longer, longer, longer, drop- then you have a WENKEBACH.
If some Ps don’t go through, then you have a MOTIZ II.
If Ps and Qs disagree, then you have a THIRD DEGREE.
Pacemakers
Types:
Transcutaneous
Transvenous
Permanent
Education:
● Keep a pacemaker identification card in your wallet.
● Taking a bath and shower is not restricted for permanent pacemakers
● Do not apply pressure over the generator and do not wear any tight clothing
● Operating household appliances would be considered safe
● Notify airport security of pacemaker
● For temporary pacemakers ensure lead wires don’t get wet.
● Contraindication for MRI
Atrial Dysrhythmias
P-wave: “saw-tooth”
PR Interval: none
QRS: <0.12
Atrial Rate: 250-400
Ventricular Rate: Varies
Regularity: Regular or Irregular
Atrial Flutter
A-flutter
P-wave: ‘wavy’
PR Interval: none
QRS: <0.12
Atrial Rate: >400
Ventricular rate: Varies
Regularity: irregular
Atrial Fibrillation
A-fib
P-wave: hidden
PR Interval: immeasurable
QRS: <0.12
Rate: 150-250
Regularity: Regular
Supraventricular Tachycardia (SVT)
SVT
Ventricular Dysrhythmias
P-wave: none
PR Interval: none
QRS: >0.11 - ‘wide & bizarre’
Rate: 150-250
Regularity: Regular
Ventricular Tachycardia (V-Tach)
VTach
P-wave: none
PR Interval: none
QRS: none
Rate: none
Regularity: Irregular
Ventricular Fibrillation (V-fib)
VFib
Cardioversion vs. defibrillation
P-wave: none
PR Interval: none
QRS: none
Rate: none
Regularity: n/a
Asystole
Asystole
Practice scenario:
You are working in the ED when a call from EMS comes in. They report a
42 year old woman who fainted at home. She is unresponsive to voice,
but opens her eyes to pain. She is breathing and has a rapid pulse.
What do you do first?
Vitals
HR: 190 and regular
RR: 4
BP: 62/38
SpO2: 72% on RA
What do you do next
EKG
What rhythm is this client in? What
do you do now?
Action
1. Vagal maneuvers
2. Adenosine
3. Cardioversion
After cardioversion….
What is the first thing you need to check? For how long?
Vitals
HR: 168……NO PULSE!
RR: 0
BP: 58/24
SpO2: 62% on RA
What are your actions?
Actions
1. CPR
2. Defibrillation
3. Epinephrine
After 2 minutes...
Return of Spontaneous Circulation
(ROSC)
