Rhythm recognition Workshop Version: Jun 2016

Learning outcomes This workshop should enable you to: list the indications for ECG monitoring demonstrate how to monitor the ECG effectively explain the basic physiology of the ECG describe the 6-stage approach to rhythm recognition identify each of the common 12-lead ECG patterns of acute myocardial infarction

What are the indications for ECG monitoring?

How to monitor the ECG self-adhesive pads 3-lead monitoring 4

Self-adhesive pads 5

3-lead monitoring

Conducting system

QRS Complex

How to read a rhythm strip 1. Is there any electrical activity with a pulse?

How to read a rhythm strip 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad?

How to read a rhythm strip 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? Describe the rhythm on this basis. Continue further only if you are sure that you can see atrial activity.

How to read a rhythm strip 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity?

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Sinus rhythm

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Asystole

Is there any electrical activity with a pulse? 1. Is there any electrical activity with a pulse? Asystole

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? VT

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? VT

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Sinus Brady

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? 1st Degree AV Block

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Mobitz I second degree AV Block

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Mobitz II second degree AV Block

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? 3rd degree AV Block/CHB

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Agonal Rhythm

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Narrow Complex Tachycardia

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Atrial Fibrillation

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Atrial Flutter

Is there any electrical activity with a pulse? 2. 1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity? Sinus Tachy + PVC

1. Is there any electrical activity with a pulse? 2. What is the ventricular (QRS) rate? 3. 4. Is the QRS width normal (narrow) or broad? 5. Is atrial activity present? (If so, what is it: P waves? Other atrial activity?) 6. How is atrial activity related to ventricular activity?

1. Is there any electrical activity with a pulse?

Any questions?

Summary know the indications for ECG monitoring know how to monitor the ECG effectively understand the basic physiology of the ECG Be able to use the 6-stage approach to rhythm recognition be able to recognise the common 12-lead ECG patterns of acute myocardial infarction

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