1. Stamford Emergency Medical Services
EKG Interpretation
Paramedic Instructor
Stamford Emergency Medical Services
Adam Cadan
Alex Cadan
09/18/00

2. Ask yourself the following:
Is the rate fast or slow?
Is there one P for every QRS?
Are the Ps upright and present?
Is the PR interval ? (< .20)
What’s the QRS width? (< .12)
What’s the rhythm?
Regular
Regularly Irregular
Irregularly Irregular
Any “funny” looking complexes?
PACs
PVCs
PJCs
Unifocal
Multifocal

3. Key facts about PR interval
Time it takes for the atria to depolarize and pass its “message” to the ventricles
From the beginning of the P-wave to the beginning of the QRS. Should be 0.12 to 0.21 sec (or three to five little squares)
Prolonged in heart block
Short PR, conditions where there is an abnormality in the fibrous insulating ring…electrical message gets past the AV node quicker—i.e. WPW

4. Key facts about QRS complex
Spread of depolarization from the AV node to all parts of the ventricles takes sec
If QRS width > 0.12sec (three small squares) it suggests a defect in the conduction system
Q wave pathological or physiological (Old MI signature)

5. Key facts about P-wave Initiated by the SA node
Travels inferiorly + Right to left
SA node normally determines the heart rate
P-waves should be upright in I, II, & V2 -V6

6. Key facts about ST segments
Elevation of >1mm implies infarction
Depression of >0.5mm implies ischemia
Widespread ST elevation occurs in pericarditis

7. Rates: Sinus Rhythm………………...60-100/min
Sinus Bradycardia…………..rate < 60/min
Sinus Tachycardia………...rate > 100/min
Junctional…………………… /min
Accelerated Junctional……..rate > 60/min
Idioventricular…………………20-40/min
Accelerated Idioventricular……..rate > 40

8. First item to look at is the "Time Markings".
Once your able to identify a six second time period, rate determination is easy!

9. Couldn’t think of a name for this slide!
1 small box is 40 milliseconds, or .04
2 small boxes is 80 milliseconds, or .08
3 small boxes is 120 milliseconds, or .12
4 small boxes is 160 milliseconds, or .16
5 small boxes is 200 milliseconds, or .20

10. Is the rate fast or slow?
Is there one P for every QRS?
Are the Ps upright and present?
Is the PR interval ? (< .20)
What’s the QRS width? (< .12)
What’s the rhythm?
Regular
Regularly Irregular
Irregularly Irregular
Any “funny” looking complexes?
PACs
PVCs
PJCs
Unifocal
Multifocal

11. 2nd Degree AV Block
Mobitz I or
Wenkebach

12. 3rd Degree AV Block

13. A-Fib Most common sustained arrhythmia. Arrhythmia Anatomy:
Multiple wavelets of re-entry swashing around the atria. The AV node is inundated with cascades of chaotic activity

14. Accelerated Junctional

15. Atrial Flutter 2:1 conduction

16. NSR w/ a 1st Degree AV Block

17. CHECK YOUR LEADS!!!
Asystole

18. Junctional

19. NSR w/ BBB

20. NSR w/ Multifocal PVCs

21. NSR w/ PAC

22. NSR w/ PJC

23. NSR w/ Unifocal Couplet PVCs

24. NSR w/ a Unifocal PVCs

25. Sinus Bradycardia

26. Sinus Tachycardia

27. SVT

28. Is someone moving the cables?
Could be artifact!
VFIB!

29. V-Tach

30. Paced Rhythm @ rate of 80 w/ capture

31. Practice…Practice & more Practice! ADVICE:
When you’ve think you’ve looked at
enough EKG strips…Look at more!
Practice…Practice
& more Practice!