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    Waves and Intervals Heart Activity Normal/Abnormal (1 Small Box 0.04sec) (1 Big (5 Small) 0.2sec)

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    Eben Ezar Dela Cruz
    This document provides information on ECG placement, waves and intervals, heart blocks, tachycardias, and cardiac arrest rhythms. It defines the normal placement of ECG leads and describes each wave and interval seen on an ECG. It outlines various types of heart blocks, tachycardias including atrial and ventricular arrhythmias, and their corresponding ECG patterns. Treatment approaches for unstable bradycardias and tachycardias are also summarized. Finally, it identifies four cardiac arrest rhythms and their appearances on ECG.

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    Waves and Intervals Heart Activity Normal/Abnormal (1 Small Box 0.04sec) (1 Big (5 Small) 0.2sec)

    Uploaded by

    Eben Ezar Dela Cruz
    136 views6 pages
    This document provides information on ECG placement, waves and intervals, heart blocks, tachycardias, and cardiac arrest rhythms. It defines the normal placement of ECG leads and describes each wave and interval seen on an ECG. It outlines various types of heart blocks, tachycardias including atrial and ventricular arrhythmias, and their corresponding ECG patterns. Treatment approaches for unstable bradycardias and tachycardias are also summarized. Finally, it identifies four cardiac arrest rhythms and their appearances on ECG.

    Original Description:

    ECG, BLS, ACLS

    Original Title

    ECG BLS.ACLS

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    This document provides information on ECG placement, waves and intervals, heart blocks, tachycardias, and cardiac arrest rhythms. It defines the normal placement of ECG leads and describes each wave and interval seen on an ECG. It outlines various types of heart blocks, tachycardias including atrial and ventricular arrhythmias, and their corresponding ECG patterns. Treatment approaches for unstable bradycardias and tachycardias are also summarized. Finally, it identifies four cardiac arrest rhythms and their appearances on ECG.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    136 views6 pages

    Waves and Intervals Heart Activity Normal/Abnormal (1 Small Box 0.04sec) (1 Big (5 Small) 0.2sec)

    Uploaded by

    Eben Ezar Dela Cruz
    This document provides information on ECG placement, waves and intervals, heart blocks, tachycardias, and cardiac arrest rhythms. It defines the normal placement of ECG leads and describes each wave and interval seen on an ECG. It outlines various types of heart blocks, tachycardias including atrial and ventricular arrhythmias, and their corresponding ECG patterns. Treatment approaches for unstable bradycardias and tachycardias are also summarized. Finally, it identifies four cardiac arrest rhythms and their appearances on ECG.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 6

    V1- Right SB, 4th ICS

    ECG Placement V2- Left SB, 4th ICS


    RA-Salt (white) V3- Left MCL, 5th ICS
    LA- Pepper (Black) V4- Halfway b/n V2 and V4
    RL-Green V5- Left, MAxL, level of V4
    LL- Ketchup (red) V6- Left, AAxL, level of V4

    Waves and Intervals Heart Activity Normal/Abnormal


    De-Contract (1 small box=0.04sec)
    Re-Relax [1 big (5 small)= 0.2sec]
     P Wave (R&L) ATRIAL DEpolarization  Abnormal P wave indicates Artrial
    Arrythmias
     QRS Complex (R&L) VENTRICULAR DEpolarization  Abnormal QRS indicates Ventricular
    Arrhythmias
     T Wave (R&L) VENTRICULAR REpolarization  Abnormal T Wave indicates potassium
    imbalance.
     Tall is hyperkalemia- K+ is muscle RELaxant
     Flat or depressed is hypokalemia (U-wave
    present)
     PR Interval (PRI) Time interval from Onset of ATRIAL  N= 0.12-0.20 (3-5 small squares)
    Depo (P) to Onset of VENTRICULAR  >0.20= Heart Blocks
    Depo (QRS)
     QRS Complex Duration of Ventricular Depo (QRS)  N= 0.05-0.10
    Duration  <0.05sec (NARROW) -SVT, Afib/flutter)
     >0.10 (WIDE) (Vtach, Vfib)
     ST Segment Early ventricular repolarization  Slightly Elevated ST segment - ST Elevation
    Myocardial Infarction (STEMI)
     Super Elevated ST Segment- ACUTE
    Myocardial Infarction
     Slightly Depressed/Inverted ST segment-
    NONSTEMI
     U wave Origin for this wave is not clear - but Not usually observable if it becomes apparent
    probably represents "after suspect Hypokalemia.
    depolarizations" in the ventricles
     QT Interval Duration of ventricular  N= 0.36 - 0.44 sec.
    depolarization and repolarization  < 0.36 sec. indicates hypercalcemia
     > 0.44 sec. indicates hypocalcemia
    (Torsades de Pointes)
     RR Interval Duration of ventricular cardiac cycle  Narrow R-R is a tachycardia.
    (an indicator of ventricular rate)  Wide R-R is a bradycardia

    HEART RATE COMPUTATION


    A. IRREGULAR Rhythm= 6 second strips
    o Count the R’s in a 6 second strips x 10
    B. REGULAR Rhythm
    o A. Big Box Method
    -300/# of Big Box between 2 R’s
    o B. Small Box Method- Not recommended (1500/Small box between 2 R’s)
    HEARTBLOCKS (BRADYCARDIA)

    RHYTHMS DESCRIPTION
    ST -CONSISTENT PROLONGED PRI
    1 Degree Heart Block

    2ND Degree Heart Block -PROGRESSIVE BLOCK


    -Progressively Longer PRI then Dropped QRS
    -Long (PRI)->Longer (PRI)->DROP
    a. WENKEBACH
    Phenomenon (MOBITZ I)

    -Normal (PRI)-> Normal (PRI)->DROP


    b. MOBITZ II

    3rd Degree Heart Block -INTERMITTENT BLOCK


    -DROPS in QRS
    -Pwave and QRS march- No correlation
    -SUPER BRADYCARDIA

    UNSTABLE BRADY MANAGEMENT (A-T-D-E)


    Asess:
    -BP- < 90/60
    -LOC- Decreased
    -Chest pain - (+)
    -Signs of shock

     A-Atropine- 0.5mg bolus/3-5mins max: 3mg


     T-Transcutaneous pacing
     D-Dopa- 2-20mcg/kg/min
     E-Epi- 2-10mcg/min
    TACHYCARDIA
    ATRIAL TACHYCARDIA = HR-100bpm
    RHYTHMS DESCRIPTION
    1. PREMATURE ATRIAL CONTRACTION -Peaked, Biphasic (by 2) P wave
    (PAC) -Narrow QRS
    -Cause: Caffeine, stress- Usually No mgmt

    2. ATRIAL FLUTTER- SAWTOOTH -More P waves than QRS (P waves are Visible-> SAWTOOTH)
    -Cause: CHF, MI and Electrolyte Imbalance
    -Mgmt: Cardioversion and Procainamide

    3. ATRIAL FIBRILLATION -More P waves than QRS (P waves are Not Visible)
    -Irregular Narrow QRS

    VENTRICULAR TACHYCARDIA

    RHYTHMS DESCRIPTION
    1. PREMATURE VENTRICULAR -Wide QRS and inverted T wave
    CONTRACTION (PVC) -Cause: CHF, MI and electrolyte imbalance
    -Mgmt: Dx->Holter, stress test, Give Betablockers, calcium blockers
    Anti arrythmic

    UNIFOCAL

    MULTIFOCAL

    2. SUPRAVENTRICULAR TACHYCARDIA -More than 170 beats/min


    (SVT) -No P wave
    -Regular R to R interval
    -Management: Carotid massage for 10 sec.
    -Mx: Carotid massage 10 sec, Adenosine, Beta blockers, Calcium
    blockers
    -May progress to serious arrhythmia.

    3. VENTICULAR TACHYCARDIA -No P and T waves


    -Regular wide QRS
    -Non-sustained VT
    -Cause: CHF, MI and electrolyte imbalance
    -Management: give Adenosine

    MONOMORPHIC

    -Management: give Mg SO4 and consider defibrillation if unstable.

    POLYMORPHIC

    4. VENTRICULAR FIBRILLATION

    COARSE

    FINE

    TACHYCARDIA MANAGEMENT

    Unstable S/sx
    -BP- < 90/60
    -LOC- Decreased
    -Chest pain - (+)
    -Signs of shock

    RHYTHMS STABLE UNSTABLE


    1. ATRIAL FLUTTER/ATRIAL BCDH SYNCHORNIZE CARDIOVERSION
    FIBRILLATION B-Beta Blocker (METOPROLOL) (2.5-
    5mg-2min/5min) 120-200J
    C- Calcium Channel Blocker
    (VERAPAMIL) 5-10mg-2min then
    Maintain
    D- Digoxin
    H- Heparin
    2. SUPRAVENTICULAR CABC SYNCHRONIZE CARDIOVERSION
    TACHYCARDIA (SVT) C - Carotid Massage
    A - Adenosine: 1st dose: 6mg and
    2nd dose: 12mg rapid IV push 50-100J
    follow with NS flush
    B - Beta Blocker
    C- Calcium channel blocker
    3. VENTRICULAR TACHYCARDIA AA SYNCHRONIZE CARDIOVERSION
    MONOMORPHIC A-Adenosine- 1st dose: 6mg and
    100J
    2nd dose: 12mg rapid IV push follow
    with NS flush
    A-Anti Arrythmic Infusion or
    Amiodarone 150mg over 10mins
    4. VENTRICULAR TACHYCARDIA M-Magnesium Sulfate DEFIBRILLATION
    POLYMORPHIC
    Cardiac Arrest Rhythms

    RHYTMS ECG
    1. (PVT) Pulseless
    Ventricular Tachycardia

    2. (VF) Ventricular
    Fibrillation

    3. Asystole or Flat Line

    4. (PEA) Pulseless
    Electrical Activity-any
    organized rhythm
    without a pulse

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