normal ecg for paramedic
DESCRIPTION
ECG for ParamedicTRANSCRIPT
![Page 1: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/1.jpg)
Normal EKG untuk Paramedis
dr. Ahmad Handayanidr. Hasbi Murdhani
![Page 2: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/2.jpg)
THE HEARTAnatomi Jantung & Konsep dasar
elektrokardiografi
![Page 3: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/3.jpg)
Sistem Konduksi Jantung
• Nodus Sino-Atrial (SA) - pada pertemuan SVC dg atrium kanan - otomatis menghasilkan impuls - fungsi pacu jantung alamiah - normal = 60 - 100 x /mnt
• Nodus Atrioventrikular (AV) - di atas sinus coronarius / posterior RA - fungsi pacu jantung pengganti - laju 40 - 60 x /mnt
![Page 4: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/4.jpg)
• Berkas His
- didalam IAS dan IVS
- bercabang 2 : berkas kiri (LBB) -> 2 cabang
berkas kanan (RBB)
• Serabut Purkinye
- serabut sistem konduksi yang kecil
- dalam miokard ventrikel
- impuls 20 - 40 x / mnt
![Page 5: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/5.jpg)
SA Node Cabang antarnodus Nodus AV Bundle Hiss Serat Purkinje Kontraksi
![Page 6: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/6.jpg)
SA node
AV node
Bundle His LBB - fasikulus posterior
LBB - fasikulus anteriorRBB
Serabut Purkinye
ATRIUM KANAN
VENTRIKEL
![Page 7: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/7.jpg)
Potensial Aksi
![Page 8: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/8.jpg)
Potensial Aksi
4
0
12
3
![Page 9: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/9.jpg)
Potensial Aksi• Phase 0 ( depolarisasi ) Masuknya Na + secara
mendadak ke intra sel --> intra sel menjadi positif• Phase 1 ( repolarisasi awal ) Kanal Natrium tertutup --
> muatan positif intrasel berkurang sedikit• Phase 2 ( plateu ) Kalsium masuk lambat ke intrasel,
muatan stabil .• ]Disebut masa refrakter absolut• Phase 3 ( repolasrisasi ) Kalium keluar ke ekstra sel
sehingga intrasel menjadi lebih bermuatan negatif kembali
• Phase 4 ( istirahat ) terjadi polarisasi : intrasel negatif, ekstrasel positif
![Page 10: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/10.jpg)
Sandapan EKG (standar - 12 lead)• Sandapan bipolar - Merekam perbedaan potensial dari 2
elektroda I = lengan kanan (-) lengan kiri (+) II = lengan kanan (-) tungkai kiri (+)III = lengan kiri (-) tungkai kiri (+)
• Sandapan unipolar- Merekam potensial listrik pada satu elektroda yang lain sebagai elektroda indiferen (0) - Ada dua sandapan: ekstremitas & prekordial - Sandapan unipolar ekstremitas avR, avL, avF - Sandapan prekordial V1,V2,V3,V4,V5,V6
![Page 11: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/11.jpg)
PEMASANGAN ELEKTRODE
• PEMASANGAN ELEKTRODE EXTREMITAS• Lengan kanan dan lengan kiri• Kaki kanan dan kaki kiri
• PEMASANGAN ELEKTRODE DADA• V1 = Parasternal kanan di ICS-4• V2 = Parasternal kiri di ICS-4• V4 = MCL kiri di ICS-5• V3 = Median antara V2 dgn V4• V5 = Para Axillair Line kiri di ICS-5• V6 = Median Axillair kiri di ICS-5
![Page 12: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/12.jpg)
Linea Mid-Clavicularis
Linea Axilaris Anterior
Linea Axilaris Media
Chest Lead Lokasi Elektroda Gambaran JantungV1 ICR 4 parasternal dekstra SeptumV2 ICR 4 parasternal sinistra SeptumV3 Antara V2 dan V4 AnteriorV4 ICR 5 Linea Mid Clavicularis sinistra AnteriorV5 Setentang V4 Linea Axilaris Anterior Sinistra LateralV6 Setentang V4 Linea Axilaris Media Sinistra Lateral
![Page 13: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/13.jpg)
![Page 14: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/14.jpg)
![Page 15: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/15.jpg)
![Page 16: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/16.jpg)
Elektrokardiogram
• Gelombang P : depolarisasi atrium
• Kompleks QRS : depolarisasi ventrikel
• Gelombang T : repolarisasi ventrikel
• Repolarisasi atrium tertutupi oleh QRS
P
Q
R
S
T
![Page 17: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/17.jpg)
DEPOLARISASI DAN REPOLARISASI JANTUNG
Depolarisasi : Impuls listrik sel dapat berubah – ubah akibat pergeseran (pengeluaran) elektrolit pada membran sel. Perubahan ini meransang serat otot berkontraksi.
Repolarisasi: Pengeluaran tersebut akan meransang pompa kimiawi mengisi kembali dan sel masuk tahap istrirahat.
![Page 18: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/18.jpg)
![Page 19: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/19.jpg)
![Page 20: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/20.jpg)
![Page 21: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/21.jpg)
![Page 22: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/22.jpg)
![Page 23: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/23.jpg)
P Wave
![Page 24: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/24.jpg)
AXIS
![Page 25: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/25.jpg)
Right Axis Deviation Left Axis Deviation
RAD
LAD
![Page 26: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/26.jpg)
Nomenclature ECG
Repolarisasi ventrikelDepolarisasi
atrium
Depolarisasi ventrikel
P TU
QS
R
![Page 27: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/27.jpg)
Nomenclature ECG
Depolarisasiatrium
P TU
QS
R
Gelombang P• Depolarisasi Atrium • Diikuti kontraksi atrium• Sinus Ritme : + di II• Sinus Ritme : - di avR• N ; lebar < 0,12 dtk• N : tinggi < 0,3 mV
![Page 28: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/28.jpg)
P Pulmonale
![Page 29: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/29.jpg)
P Mitrale
![Page 30: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/30.jpg)
PR Interval
![Page 31: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/31.jpg)
Nomenclature ECG
QT intervalPR
interval
QRS duration
PST segmen
TU
QS
R
PR interval : 0,12 - 0,20 dtkQTc < 0,42 ( tergantung HR)
![Page 32: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/32.jpg)
QRS Complex
![Page 33: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/33.jpg)
Nomenclature ECG
QS
R
Gelombang QRS• Depolarisasi ventrikel• Diikuti kontraksi ventrikel• Lebar 0,06 - 0,12 dtk• Tinggi tergantung lead• Q patologis: tanda infark miokard• Transisisonal zone untuk gel. R
Depolarisasi ventrikel
![Page 34: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/34.jpg)
ST Segment
![Page 35: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/35.jpg)
Nomenclature ECG
Gelombang T• Repolarisasi ventrikel• Diikuti relaksasi ventrikel• + di lead : I,II,V3-V6• - di lead avR
T
Repolarisasi ventrikel
![Page 36: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/36.jpg)
T Wave
![Page 37: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/37.jpg)
Contoh EKG Normal
37
![Page 38: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/38.jpg)
CARA MENILAI EKG
1. Tentukan frekuensi (heart rate)2. Tentukan irama jantung (rhythm)3. Tentukan sumbu jantung (axis)4. Tentukan ada tidaknya tanda hipertrofi5. Tentukan ada tidaknya tanda iskemia / infark miokard (topik penyakit jantung koroner)6. Tentukan ada tidaknya tanda arritmia dll (topik arritmia)
![Page 39: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/39.jpg)
![Page 40: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/40.jpg)
![Page 41: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/41.jpg)
Cara menilai EKG (lanjutan)…
1. Menentukan frekuensi , dapat dilakukan dengan 3 cara :a. 300
jumlah kotak besar antara R – R
b. 1500 jumlah kotak kecil antara R – R
c. Jika iramanya irregular Ambil EKG strip sepanjang 6 detik, hitung jumlah QRS dan kalikan dengan 10Atau ambil EKG 10 detik , hitung jumlah QRS dankalikan dengan 6
![Page 42: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/42.jpg)
Cara menilai EKG (lanjutan)…
2. Menentukan irama jantungtentukan apakah denyut jantung berirama teratur atau tidaktentukan berapa frekuensi jantung tentukan gelombang P normal atau tidaktentukan interval PR normal atau tidaktentukan gel.QRS normal atau tidak
Irama jantung normal impulsnya berasal dari nodus SA disebut irama sinus (sinus rhythm=SR)
![Page 43: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/43.jpg)
Cara menilai EKG (lanjutan)…
Kriteria IRAMA SINUS :-irama teratur-frekuensi jantung antara 60 – 90 / 100 x/menit-gelombang P normal -setiap gel. P selalu diikuti gel.QRS dan T-interval PR normal (0.12 – 0.20 detik)-gel. QRS normal (0.06 – 0.12 detik)-semua gelombang sama
Irama EKG yg tdk memp.kriteria tsb DISRITMIA
![Page 44: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/44.jpg)
Normal cardiac rhythm : SINUS rhythm
Sinus rhythm characteristics :• Rate 60-100 bpm• Constant R – R interval• Negative P wave in aVR and positive di II• P wave is always followed by QRS complex
![Page 45: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/45.jpg)
Cara menilai EKG (lanjutan)…
3. Menentukan sumbu jantungmenghitung axis QRS rata-rata di bidang frontalnormal : -30 s/d +110 derajatdeviasi axis ke kiri (LAD) : -30 s/d –90 derajatdeviasi axis ke kanan (RAD) : +110 s/d –180 derajat
![Page 46: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/46.jpg)
Kelainan sumbu QRS pada bidang frontal
46
![Page 47: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/47.jpg)
Kelainan Sumbu QRS pada bidang frontal
• Normal : -30o hingga +90o
• Deviasi Sumbu Ke Kiri (DSKi) : -30o hingga -90o
• Deviasi Sumbu Ke Kanan(DSKa) : +90o hingga -180o
• Sumbu Superior : +180o hingga -90o
47
![Page 48: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/48.jpg)
![Page 49: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/49.jpg)
49
75
aVF -
I +
aVF +
I -
A) Lihat I – aVF :I : R = +4 S = - 2 + 2
aVF : R = +3 S = -10
- 72
-7
75
II +
aVL +
aVF
I
B) Lihat II – aVL : II : R = +2 S = -7
-5 aVL : R = +9 S = -1
+8
Menghitung sumbu QRSbidang Frontal
![Page 50: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/50.jpg)
Cara menilai EKG (lanjutan)…
4. Tanda-tanda hipertrofiA.Hipertrofi atrium
1.Hipertrofi atrium kanan (RAH)gel.P tinggi dan lancipjelas terlihat di lead I dan IIdisebut P-PULMONAL
2.Hipertrofi atrium kiri (LAH)gel.P lebar dan berlekukpaling jelas terlihat di lead I dan IIdisebut P-MITRAL
![Page 51: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/51.jpg)
![Page 52: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/52.jpg)
![Page 53: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/53.jpg)
53
P PulmonalHipertrofi atrium : (leads II and V1).
P Mitral
![Page 54: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/54.jpg)
Cara menilai EKG (lanjutan)…
B.Hipertrofi Ventrikel1.Hipertrofi ventrikel kanan (RVH)
gel.R > gel.S pada lead prekordial kananVAT > 0.03 detik di V1gel.S menetap di V5 / V6depresi segmen ST dan gel. T terbalik di V1-V3axis RAD
2.Hipertrofi ventrikel kiri (LVH)gel.R pada V5 / V6 > 27 mmatau gel.S di V1 + gel.R di V5 / V6 > 35 mmdepresi segmen ST dan gel.T terbalik di V5 / V6axis LAD
![Page 55: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/55.jpg)
![Page 56: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/56.jpg)
![Page 57: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/57.jpg)
L V H
![Page 58: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/58.jpg)
L V H
![Page 59: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/59.jpg)
L V H
![Page 60: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/60.jpg)
![Page 61: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/61.jpg)
![Page 62: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/62.jpg)
R V H
![Page 63: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/63.jpg)
R V H
![Page 64: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/64.jpg)
R V H
![Page 65: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/65.jpg)
R V H
![Page 66: Normal ECG for Paramedic](https://reader033.vdocument.in/reader033/viewer/2022061504/563db836550346aa9a91980e/html5/thumbnails/66.jpg)