1. EKG Interpretation

2. EKG Interpretation Sequence
Regular or Irregular
Rate
P wave
PR interval (normal )
QRS (less than 0.12)
ST segment
T wave
Ectopic beats

3. Regularity of the QRS complexes

4. Images: http://www.emergencyekg.com/graphics/Interactive_06.gif
Heart rate (HR)
1500/small boxes= most precise HR calculation for regular rhythms
Countdown method:
300 – 150 – 100 – 75 –
6 second method (irregular rhythms):
Images:

5. Waveforms, Intervals, Segments, and Complexes (Lead II)
P wave:
PR interval:
sec
>5 boxes for PR is heart block
QRS complex:
<.12sec
ST segment:
T wave:
Ectopic Beats:

6. Sinus Tachycardia Sinus Bradycardia Regular rhythm Rate >100

7. Premature atrial contraction (PAC)
Usually has regular underlying rhythm
Early atrial contraction causes early P wave
P wave usually abnormal in size, shape or direction and can be hidden in preceding T wave
May initially have rate suppression after this beat

8. Premature atrial contraction (PAC)

9. Atrial Flutter Regular or irregular
Rate: atrial , ventricular varies
P waves: Sawtooth deflections

10. Atrial Fibrillation
Irregularly irregular, difficult to assess with tachycardia
Rate: Varies, Rapid Ventricular Rate (RVR) is > 100 bpm, Rate Control is < 100 bpm
P waves: fibrillatory

11. Premature Ventricular Contraction (PVC)
Underlying rhythm regular
No P wave associated with the PVC
Early wide QRS (>0.12)
May be in sequence (ex: couplet, triplet, bigeminy, trigeminy)

12. Ventricular Tachycardia (VT)
Regular rhythm
Rate
No P wave associated with VT
QRS wide (>0.12)

13. Ventricular Fibrillation
No rhythm – P wave and QRS wave absent
No rate
Wavy irregular deflections of various sizes and shapes seen

14. Pacemakers Paced beat will have “pacer spike” on EKG Can be 100% paced
If underlying rate is greater then pacer maker settings the pace maker will be inhibited and you will only see the underlying rhythm on EKG
Can be mixed paced beats and native rhythm
A-V paced (both atria and ventricle are paced, will have two pacer spikes per QRS)

15. Pacemakers

16. CASE STUDIES