Rekindle your enthusiasm for EMS: Your burnout repair guide
Rekindle your enthusiasm for EMS: Your burnout repair guide
From KARL STORZ Endoscopy-America, Inc.
Consistently following the process of analyzing a patient’s ECG will help you correctly identify their heart rhythm
The ECG interpretation uses a step-by-step process to ensure that we always provide the best patient care. Since no two emergencies or patients are the same, the call elements that we can control must be handled methodically.
Electrocardiography-a diagnostic tool that analyzes the electrical function of the heart and measures voltage (vertical measurement) and time (horizontal measurement)-can be confusing, so here are the ten steps I follow on each electrocardiogram (or electrocardiogram) To make sure I recognize the rhythm correctly.
1. Is the ECG rhythm regular or irregular?
When you look at the heart rhythm, you find the QRS segment that represents the depolarization (cell charging) of the ventricle. The ventricles are the two lower chambers of the heart that gather blood and drain it to the body and lungs. In QRS, the R wave is identified, which is the positive wave above the equipotential line (baseline). Using the 6-second bar, measure the R to R interval between QRS segments and determine whether the rhythm is regular or irregular.
If you find abnormalities or irregularities here-or in any subsequent findings on your ECG-ask your patients if it is normal to them and look for any related symptoms, such as CHAPS-chest pain, Low blood pressure, changes in mental status, poor perfusion, or shortness of breath.
Measure the radial artery pulse at the patient’s wrist, confirm with the number displayed on the heart monitor, or print a 6-second ECG chart, calculate the number of QRS complexes, and then multiply it by 10 to get the one-minute heart rate. From there, determine if the patient’s heart rate is bradycardia (less than 60 beats per minute); within the normal range (60-100 bpm); tachycardia (100-150 bpm) or a potentially dangerous rhythm above 150 bpm , Such as supraventricular tachycardia or pulsed ventricular tachycardia.
At this stage of ECG interpretation, be careful not to skip to quick interpretation. Instead, write down the information you found and continue with the next steps.
The P wave represents the depolarization of the atria, which are the two upper cavities of the heart that receive blood from the vena cava and the pulmonary vein. When searching for P waves: Ask yourself, is there a P wave? Are they upright in lead II on the heart monitor? Is the QRS segment behind? If the answer is all yes, the electrical impulse is likely to start in the sinoatrial node (SA), which is the normal pacemaker of the heart.
The PR interval is the time interval between the P wave (atrial depolarization) and the beginning of the QRS segment (ventricular depolarization). The normal PR interval is 0.12-0.20 seconds, which is 3-5 small boxes on the ECG drawing. The prolonged PR interval indicates a delay through the atrioventricular (AV) node, which is the relay system between the upper and lower chambers of the heart.
The normal QRS segment has three graphic deflections-the first negative wave (Q wave); the positive wave (R wave) above the equipotential line and the negative wave (S wave) after the positive wave-the normal duration is 0.04-0.10 second. If you notice a lengthening of the QRS segment, it may be due to a relatively benign bundle branch block or a sign of an underlying heart disease.
The T wave represents the repolarization (recovery) of the ventricle and should be upright in lead II and appear after the QRS segment. Any changes in the T wave require attention. The inverted T wave may be due to hypoxia in the heart; too much potassium (hyperkalemia) will cause the peak T wave; the flat T wave may be due to too low potassium content, and the elevated ST segment-the end of the QRS segment To the beginning of the T wave-possibly due to a heart attack.
Ectopic beating is a change in heart rhythm caused by beating caused by fibers outside the SA node (the heart's normal pulse generating system). If you notice ectopic beats, determine if they are atrial premature beats (PAC); borderline premature beats (PJC) or ventricular premature beats (PVC). In addition, please pay attention to how many ectopic beats are present in the ECG, the interval at which they appear, their shape, and whether they appear individually or in groups.
The last step before correctly identifying your ECG is to determine the source of the rhythm. Here are some key elements to look for:
Now that you have analyzed the rhythm methodically, you should be able to recognize it easily. Once you do this, consider your ECG interpretation in the context of the other information you flash on the phone—the patient’s chief complaint, mental state, OPQRST/sample history, and vital signs—and then decide on the correct treatment plan. When in doubt, always deal with the question you are evaluating, not the heart monitor.
If you are still studying or want to get an extra reference on the phone at 3 AM, when your mind is a little fuzzy, don't be afraid to create a job help on the note card that lists the key steps to analyze the rhythm of the ECG.
In addition, by using Skill Stat's free online ECG simulator, reading Life's clinical cases in Fast Lane's informative ECG library, and checking and trying these EKG challenges, you can always know your ECG skills.
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Kevin Grange works as a paramedic at Jackson Hole Fire/EMS and is the author of a new memoir about nursing schools, entitled "Lights and Alarms: Education for Nursing Staff."
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