7.1 monitoring, rhythm recognition, 12-lead ecg guidance 2010

8/13/2019 7.1 Monitoring, Rhythm Recognition, 12-Lead ECG Guidance 2010

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ALS course documents

Monitoring, rhythm recognition and 12-leadECG workshop

Key learning outcomes

By the end of this session the candidate will:

Understand the indications for ECG monitoring

Know how to monitor the ECG effectively

Understand the basic physiology of the ECG

Understand the 6-stage approach to rhythm recognition

Be able to recognise the common 1-lead ECG patterns of ac!te myocardial

infarction

Instructor information

Use of a rhythm sim!lator and real-time screen is essential"

#et the mood$ establish !sef!lness and state learning o!tcomes for the session"

%he following points sho!ld be covered:

Monitoring

Basic ECG monitoring

&ndications ' enco!rage candidates to disc!ss indications

(ow to monitor the ECG

)-lead monitoring and 1-lead monitoring

Use of self-adhesive pads

Electrocardiogram

Basic ECG physiology

#ino-atrial and atrio-ventric!lar nodes and intracardiac cond!ction

Generation of * waves$ the +,# comple and % waves

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.ormal morphology of these and normal limits for *+/*, interval$ +,# d!ration and

+% interval

Rhythm recognition

0efinitions of bradycardia and tachycardia"

0emonstration of the 6-stage approach to basic rhythm recognition !sing a vis!al aid

and real time rhythm sim!lator"

Use rhythm sim!lator/interactive disc!ssion to demonstrate 1st and nd degree and

complete heart bloc" B!ndle branch bloc" 2trial fibrillation and fl!tter"

0isc!ss significance of prolonged +% interval"

Emphasise the importance of recording an arrhythmia for later review and 1-lead

ECG recordings 3when possible4 for acc!rate rhythm recognition"

12-lead ECG

Common patterns of myocardial ischaemia and infarction" #ignificance of + waves$ #%

segment and % wave abnormalities" %he following 1-lead ECG patterns sho!ld be

demonstrated !sing the vis!al aids provided:

1. Normal 12-lead ECG

.ormal morphology in ) dimensions" &ntrod!ce concept of electrical ais"

2. Non-ST-segment-eleation myocardial infarction

% wave inversion" #% segment depression" Emphasise that these appearances are non-

specific and only provide evidence of .#%E5& in the appropriate clinical contet and with

biochemical evidence of myocardial damage"

!. "cute ST-segment-eleation anterolateral myocardial infarction

,elate to indication for immediate reperf!sion therapy" #tart to disc!ss relevance to

coronary anatomy 3)-dimensional role of ECG again4 and o!tcome ' anterior infarction

generally liely to have a worse prognosis than inferior infarction etc"

#. "cute ST-segment-eleation inferior myocardial infarction

,einforce #%-elevation 5& as indication for immediate reperf!sion therapy" !rther

ill!stration of )-dimensional !se of ECG" 7eads &&$ &&& and a8 reflect events/disease of



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the inferior 78 wall" 28 bloc more liely to complicate inferior infarction b!t !s!ally

recovers and does not always need temporary pacing" Beware: !se of modified lead

positions 3on tr!n rather than legs4 may alter the appearances"

$. "cute ST-segment-eleation %osterior myocardial infarction

2nother chance to emphasise the )-dimensional nat!re of the ECG" .ow introd!ce the

concept of reciprocal change: #% depression at the front act!ally means #% elevation at

the bac ' where the infarct is" Use the posterior leads to s!pport this point" 2ltho!gh

the conventional 1-lead ECG act!ally shows anterior #% depression$ this is an indication

for immediate reperf!sion therapy beca!se it act!ally represents #%E5& of the posterior

wall"

2llow candidates to as 9!estions and reflect on the session content before terminating

the session with a s!ccinct review of all the maor points covered"


7.1 monitoring, rhythm recognition, 12-lead ecg guidance 2010

Documents