ECG strip boxes
1 Big Box = 5 small
boxes
1 Small box = 0.04secs
1 Big box = 0.20secs
ECG INTERPRETATION
6 Seconds Strip
+
Isoelectric Line
(Neutral/Baseline)
15 Boxes = 3 sec
Let’s Review!
What if there
are “defective”
myocytes?
Wave Representation
P wave (Atrial Depolarization) 2 Atria are contracting
QRS complex (Ventricular 2 Ventricles are contracting
Depolarization)
T wave (Ventricular Repolarization) Relaxation of ventricles
QRS complex (Atrial Repolarization) Relaxation of atrias
PR interval Includes the natural “delay” of impulse
transmission to AV Node (0.12 secs).
Measured from Start of P Wave to Start
of QRS Complex
6 steps
Identify and examine the P waves
Measure PR interval
Measure QRS complex
Identify the rhythm*
Determine the heart rate
Interpret the strip
6 steps
Identify and examine the P waves
Measure PR interval
Measure QRS complex
Identify the rhythm
Determine the heart rate
Interpret the strip
P-WAVES
Normal Findings
Present and Upright Absent or Inverted = Junctional Rhythm
Junctional Rhythm 40-60bpms
IDENTIFY THE P-WAVES
Atrial flutter (Saw-Toothed Pattern)
Atrial Fibrilliation (AFib)
6 steps
Identify and examine the P waves
Measure PR interval
Measure QRS complex
Identify the rhythm
Determine the heart rate
Interpret the strip
PR- Interval
Formula: Count the number of small boxes in between and x by
0.04secs
Normal 0.12-0.20secs anything more than = heart blocks
Blocks First Degree AV block
2nd Degree AV block Type I (Mobitz I Wenckebach)
Blocks
2nd Degree AV block Type I (Mobitz I Wenckebach)
2nd Degree AV block Type II Mobitz II
Block
3rd Degree AV block
6 steps
Identify and examine the P waves
Measure PR interval
Measure QRS complex
Identify the rhythm
Determine the heart rate
Interpret the strip
Supraventricular Tachycardia (SVT)
QRS complex: Normal is 0.06-0.12secs.
anything more than = Premature Ventricular Complex
Wide QRS complex
6 steps
Identify and examine the P waves
Measure PR interval
Measure QRS complex
Identify the rhythm
Determine the heart rate
Interpret the strip
Ventricular Tachycardia (VTach): Monomorphic
Torsades de pointe: (Vtach): Polymorphic
Ventricular Fibrillation
Asystole
R-R distance = rhythm analysis
Regular (Sinus) or Irregular
6 steps
Identify and examine the P waves
Measure PR interval
Measure QRS complex
Identify the rhythm
Determine the heart rate
Interpret the strip
Determine HR
6 Second method
Determine it if it is a 6 second ecg strip 3 lines
Formula: Count the number of R in between R x 10 = HR
RATE = Brady / Tachy
Works best for irregular rhythm
ECG INTERPRETATION
Big box method
Regular rhythms
Less than 6 secs ECG strips
300 / # of big boxes between 2 R`s
Example: 300 / 5 = 60bpms
Syntax
Injured Part + Description of the Problem
Sinus Tachycardia
Ventricular Fibrillation
Sinus Rhythms
Normal Sinus Rhythm (NSR)
Features Normal Observation
1. P Wave Present and Upright positive & precedes QRS
2. PR Interval 0.12 to 0.20 sec 0.12 to 0.20
3. QRS Complex 0.06 to 0.12 sec 0.06-0.12
4. Rhythm Regular Regular
5. Rate 60-100 bpm 60-100
Sinus Rhythms Sinus Bradycardia (SB)
Features Normal Observation
1. P Wave Present and Upright positive & precedes QRS
2. PR Interval 0.12 to 0.20 sec 0.12 to 0.20
3. QRS Complex 0.06 to 0.12 sec 0.06-0.12
4. Rhythm Regular Regular
5. Rate 60-100 bpm Slow (< 60 bpm)
Sinus Rhythms Sinus Tachycardia (ST)
Features Normal Observation
1. P Wave Present and Upright positive & precedes QRS
2. PR Interval 0.12 to 0.20 sec 0.12 to 0.20
3. QRS Complex 0.06 to 0.12 sec 0.06-0.12
4. Rhythm Regular Regular
5. Rate 60-100 bpm Fast (> 100 bpm)
Sinus Rhythms Sinus Arrhythmia (SA)
Features Normal Observation
1. P Wave Present and Upright positive & precedes QRS
2. PR Interval 0.12 to 0.20 sec 0.12 to 0.20
3. QRS Complex 0.06 to 0.12 sec 0.06-0.12
4. Rhythm Regular Irregular, varying with
respiration
5. Rate 60-100 bpm 60-100
ER
Asystole
Sinus Rhythms Sinus Pause
Features Normal Observation
1. P Wave Present and Upright positive & precedes QRS
2. PR Interval 0.12 to 0.20 sec 0.12 to 0.20
3. QRS Complex 0.06 to 0.12 sec 0.06-0.12
4. Rhythm Regular Irregular, missed beats
(±3 sec)
5. Rate 60-100 bpm 60-100
ER
Pulseless Electrical Activity (PEA)
ER
Ventricular Tachycardia
ER
Ventricular Fibrillation
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
GUIDE
P wave?
PR interval?
QRS complex?
Regular / Irregular?
Rate?
REMEMBER THIS
ST- Elevation Myocardial Infarction (STEMI) = start advanced cardiac life support
RN responsibilities
Start an I.V
Place the patient on a cardiac monitor and pulse
oximeter
Supply oxygen to maintain levels >90%
Follow advanced cardiac life support protocols.
Refer to cardiologist for reperfusion procedures
RHYTMS IDENTIFICATION
