ECGs Flashcards
1st Degree Heart Block
1st Degree Heart Block
- PR equal to or longer than 5 small boxes/1 large box
- Most straight forward - everything about the ECG will be completely normal
Asystole
Asystole
Dead, non shockable
Supra Ventricular Tachycardia (SVT)
Supra Ventricular Tachycardia
- No P wave, heart overworked, try val salva (to stimulate vagal nerve)
- HR above 150bpm
- Umbrella term for all tachycardia rhythms that originate above the ventricals
- Specific cause and diagnosis complex & the differentiation won’t change your pre-hospital treatment
Ventricular Fibrillation
Ventricular Fibrillation
- Quivering heart, no pulse/no rhythm - shockable
- Don’t need to check for a pulse
- 3 types - course, fine, very fine
Atrial Fibrillation
Atrial Fibrillation
- No P wave, atrium not firing properly, asymptomatic or symptomatic
- no pre-hospital drugs to correct
- may suffer from symptoms such as rate related chest pain if they present with Rapid Atrial Fibrillation (rates over 100bpm)
2nd Degree Heart Block Type 1
2nd Degree Heart Block Type 1
- Longer longer drop
- Prolonged PR interval over 5 small boxes/1 large box (0.20 secs) which gets longer and longer with each conduction until there is a ‘skipped’ or ‘missed’ QRS complex
Premature Ventricular Contraction
Premature Ventricular Contraction
‘Extra Heart Beat”, a concern if consistent
ECG - The 6 Second Method
ECG - The 6 Second Method
Get 6 seconds of ECG tracing (ie 30 big boxes) and count the number of R waves that appear within that 6 second period and multiply by 10
Right Bundle Branch Block
Right Bundle Branch Block
- Lead V1 Big ‘M’ shape (goes up/down twice)
- Do not require pre-hospital management
Pulseless Electrical Activity (PEA)
Pulseless Electrical Activity (PEA)
- Electrical activity, but no pulse, continue CPR
- Generally PEA rhythms will appear as Sinus Rhythm but can present as any rhythm
Shockable Rhythms
Shockable Rhythms Ventricular
- Fibrillation (VF)
- Pulseless Ventricular Tachycardia (Pulseless VT)
Sinus Tachycardia
Sinus Tachycardia
- ‘Normal’ fast heart rate, >100bpm
- Reassure pt to calm and decrease HR
- Unless SVT, no clinical way to improve HR
- Consider other symptoms linked to tachycardia that you can treat eg low BP
Reading the ECG
Reading the ECG
- Rate - HR (6 Second/300 or 1500 method) and strength (palpate radial or corotid pulse)
- Rhythm - regular, irregular regular (irregular rhythm on regular basis), irregularly irregular (all over the place)
- P Wave - present, before every QRS, smooth, upright, rounded
- PR Interval - 3-5 small boxes (short = electrical signal too fast)
- QRS Complex - upright, 1.5 - 3 small boxes
- T Wave - after every QRS, upright tall, no more than 1/3 height of R Wave
Left Bundle Branch Block
Left Bundle Branch Block
- V6 Bunny ears (double R wave)
- Do not require pre-hospital management
- A new presentation can be an indication of an Acute Myocardial Infarction
Atrial Flutter
Atrial Flutter
- ‘Shark Teeth’, stomach butterflies in the heart
- No treatment required pre-hospitalisation
ECG - The 1500 Method
ECG - The 1500 Method
Count how many small boxes there are between 2 R waves and divide that number into 1500 eg 1500/8 small boxes = 187.5bpm
3rd Degree Heart Block
3rd Degree Heart Block
- Random P wave and QRS complexes with no correlation between them
- No communication between atriams and ventricals
- Complete block through the AV node
Ventricular Tachycardia (Pulseless/with Pulse)
Ventricular Tachycardia (Pulseless/with Pulse)
- QRS complexes wide and bizarre
- ventricals running riot, can shock if pulseless
- In the ventricals so not SVT
2nd Degree Heart Block Type 2
2nd Degree Heart Block Type 2
- Dropped QRS
- PR interval always the same length which may vary from pt to pt, but will be consistent
ECG Lead Views
ECG Lead Views
NSTEMI
NSTEMI
- ‘ST Depression’
- Partial thickness infarction
Sinus Bradycardia
Sinus Bradycardia
- ‘Normal’ slow heart rate, <60bpm
- Requires close monitoring to ensure brain is receiving adequate blood supply
- No drugs in current scope to treat
STEMI
STEMI ‘ST Elevation’
- Sudden onset of crushing chest pain
- Full thickness infarction
Sinus Rhythm
Sinus Rhythm
‘Normal’
ECG - The 300 Method
ECG - The 300 Method
Count how many large boxes there are between 2 R waves and divide that number into 300 eg 300/3.5 large boxes = 85.71bpm
The ECG Times/Boxes
The ECG Times/Boxes
PR Interval = 0.12 - 0.2 secs (3-5 small boxes)
QRS Duration = 0.08 -0.10 secs (2-3 small boxes)
QT Interval = 0.4 - 0.43 secs (2 large boxes)
RR Interval = 0.6 - 1.0 secs (3-5 large boxes)
