basic ekg for nurse

7/26/2019 Basic EKG for Nurse

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Basic EKG

for Nurses


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Outline


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(Electrocardiogram)

sA

node AV node

His bundlebundle branch Purkinje fibers ventricular myocardium

electrocardiograph electrocardiogram


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Heart Beat Anatomy

AV NODE

Sinus Node(SA Node)

AtrioventricularNode (AV Node)

Receives impulse from

SA Node

Delivers impulse to the His-Purkinje System

40-60 BPM if SA Node fails to

deliver an impulse


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Heart Beat Anatomy

AtrioventricularNode (AV Node)

Sinus Node(SA Node)

Bundle of His

Bundle Branches

Purkinje Fibers

Bundle Branches

Purkinje Fibers

Moves the impulse throughthe ventricles for contraction

Provides Escape Rhythm:

20-40 BPM

THE PURKINJE NETWORK


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Normal Sinus Rhythm

Click heart toview animation

*Animation


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Impulse Formation In SA Node


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Atrial Depolarization

P wave= depolarization of the atrium

2.5 mm 0.11 sec


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Delay At AV Node


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Conduction Through Bundle

Branches


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Conduction Through Purkinje

Fibers


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Ventricular Depolarization

QRS = depolarization of the Ventricle

0.08 0.12 sec.


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Plateau Phase of Repolarization


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Final Rapid (Phase 3)

Repolarization

T wave = repolarization of the Ventricle

T wave 5 mm


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Normal EKG Activation


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EKG Skin preparation:

Rub site briskly with alcohol pad.

electrode has adequate gel and is not dry.

EKG

EKG position position


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12 leads

12 leads

1. Unipolar lead :

1.1 Unipolar limb leads : aVR , aVL, aVF

1.2 Unipolar chest leads : Lead V1 V6

2. Bipolar lead :

Bipolar limb leads : I , II , III


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Lead I : ()

( )

Lead II : () ( )

Lead III: ()

( )


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.

1. Standard lead / Bipolar lead / Limb lead


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Bipolar Lead

Limb lead : lead I, II,III,aVR,AVL,aVF

I,II,III,aVR,aVF,aVL


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Precordial lead Unipolar Chest Lead

V1 4

V2 4

V3 V2 V4

V4 5

V5 5 V 6 5


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2.The Precordial (Chest) Leads

VI-V6


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Normal 12 ECG with Lead II Rhythm Strip CalibrationSpike

Paper Speed and Voltage Calibration

Lead II Rhythm Strip

12 LeadsLead Change Indicators


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.

12Lead EKG ?

P wave Lead II , aVF aVR

( aVR Dextrocardia, lead &

P wave SA node AT

Lead II Lead II 2.5 mm 0.12 sec


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Sinus rhythm: P wave upright in lead II, aVF

negative P wave in aVR


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Normal sinus rhythm


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EKGPaper Speed =25 mm / sec25 mm (25 ) = 1 sec1 mm (1 ) = 1 / 25

= 0.04 sec

= 40 msec

5 mm (5 =1) = 0.04 X 5= 0.2 sec = 200

msec


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Reading EKG Squares

Each square = 40 ms

Each interval = 200 ms

Intervals and Timing


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0.20 second

5mm = 0.5m

1mm = 0.04

second


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Reading EKGs

Normal Rangesin Milliseconds:

PR Interval 120

200 ms

QRS Complex 60 100 ms

QT Interval 360 440 ms

Intervals and Timing


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1.Most common method* Fine R wave on a heavy line ( large box) count off 300,150,100,75,60,50

Until the next R wave


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Normal rate SA node 60-100

< 60 bradycardia

> 100 Tachycardia

Atrial pacemaker 60-80

AV node 40-60

Ventricle pacer 20-40

Ectopic pacemakers faster at rate 150-250


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2.Mathematical method

-regular bradycardia : rate


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300 150 100 75 60 50 43

Rate = 1500number of small box


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The most useful if you have an irregular Rhythm [ like AF]

Count 30 large boxes, starting from the first Rwave. There are 8 R-R intervals within 30 boxes.

Multiply 8 x 10 = Rate 80

3.six-second method


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.

SA - node :

1.

2. 60 -100 /

3. Wave

4. P wave QRS Complex5. Interval


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Steps to rhythm interpretation

1. Estimate Heart Rate

2. Is the rhythm regular? 3. Are there P waves?

4. Is the QRS wide or narrow?

5. Is there a relationship between

P waves and QRS complexes?


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1. Estimate Heart Rate


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2. Is the rhythm regular?

Is it regular?

Is it irregular?

Are there any patterns to the

irregularity?

Are there any ectopic beats?


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Is it regular?

Is it irregular?


irregularity?



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Is it regular?

Is it irregular?


irregularity?



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3. Are there P waves?

Are the P waves regular?

Is there one P wave for every QRS?

What is the morphology? (upright

rounded and uniform)

Are the irregular P waves associated

with ectopic beats?

Is the P wave in front of the QRS

or behind it?

Are there more P waves thenQRSs?

Do all the P waves look alike?


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3. Are there P Waves?


Is there one P wave for every QRS?What is the morphology?

(upright,rounded and uniform)


with ectopic beats?


or behind it?

Are there more P waves then

QRSs?



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3. Are there P Waves?


Is there one P wave for every QRS?What is the morphology? (upright



with ectopic beats?

Is the P wave in front of the

QRS or behind it?


QRSs?



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3. Are there P waves?


or behind it?


QRSs?



Is there one P wave for every QRS?

What is the morphology? (upright



with ectopic beats?


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Normal range < 0.12

Are all the QRS

complexes of equal

duration?

What is the

measurement of the

QRS complexes?

Is the QRS

measurement within

normal limits?

Are the unusual QRS

complexes associated

with ectopic beats?


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Are all the QRS

complexes of equal

duration?

What is the

measurement of the

QRS complexes?

Is the QRS

measurement within

normal limits?

Are the unusual QRS

complexes associated

with ectopic beats?

Normal range < 0.12


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Are all the PR

intervals constant?

Is the PR interval

measurement within

normal limits?

If the PR interval

varies, is there a

pattern to the change

in measurements?

Normal PR interval = 0.120.20


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Are all the PR

intervals constant?

Is the PR interval

measurement within

normal limits?

If the PR interval

varies, is there a

pattern to the change

in measurements?

Normal PR interval = 0.120.20


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Thank you

basic ekg for nurse

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