ecg 101

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/