ECG Interpretation - NURS 3000 student.pptx

ECG Interpretatio n NURS 3000 Conduction System SA node AV node Bundle of His (AV bundle) Bundle branches Purkinje fibres  Telemetry Used to measure HR, SpO2, and RR, while patient remains active and unrestricted Electrodes – attach to patients' skin and co...

ECG Interpretatio n NURS 3000 Conduction System SA node AV node Bundle of His (AV bundle) Bundle branches Purkinje fibres  Telemetry Used to measure HR, SpO2, and RR, while patient remains active and unrestricted Electrodes – attach to patients' skin and connects to the lead wire Lead wire – connects the electrode to the telemetry unit Preparation and accuracy of electrode and lead placement are essential for proper diagnosis 5-Lead Placement Remember this saying: “Snow over grass, smoke over fire, chocolate for the heart” Limb leads (I, II, III, aVR, aVL, and aVF) are recorded to find electrical activity across the vertical plane of the heart Lead II of the ECG is commonly used to determine heart rhythms 12-Lead ECG Records electrical activity using limb and chest leads across the vertical and horizontal plane V lead is divided into V1, V2, V3, V4, V5, V6, based on where the electrodes are placed across the chest Specifically used to diagnose heart conditions such as myocardial infarction and pericarditis 8-Step Interpretation Method 1. Rate 2. Rhythm 3. P Waves 4. PR Interval 5. QRS Complex 6. ST Segment, T Wave, and QT Interval 7. Interpret rhythm 8. Interventions/Treatment Telemetry/ECG Paper 1 small box = 0.04 seconds 5 small boxes/1 large box = 0.2 seconds 5 large boxes = 1 second 30 large boxes = 6 seconds **Helpful when finding the length and time of waves, segments, and intervals of the PQRST**  Two rates to interpret 1. Assess Rate Atrial – using P waves Ventricular – using R waves Count the number of P or R waves (or P-P and R-R intervals within a period of – 6 Second 6 seconds Multiple that number by 10 to find the number of complexes in 1 minute Method In this case, the atrial rate is 80bpm and the ventricular rate is 80bpm (8 x 10 = 80)  Also called the rule of 300 1. Assess To find the atrial rate, count the number of large boxes between the P-P interval; ventricular rate, count large Rate – Large boxes between R-R intervals Divide that number by 300 Box Method In this case, 300/4 large boxes = 75bpm  Also called the rule of 1500 To find the atrial rate, count the number of small boxes between the P- P interval; ventricular rate, count small boxes between R-R intervals Divide that number by 1500 1. Assess Method is helpful to find the most accurate rate Time consuming, not recommended Rate – Small Only can be used for regular rhythms In this case: 1500/20 small boxes = 75 bpm Box Method Remember – normal rate is 60-100bpm 100bpm = tachycardia 2. Assess Rhythm Use two consecutive R-R intervals to find ventricular rhythm Mark the points of the R-R on a piece of paper or the points of the calipers shown on the left Lift your paper across the strip and compare the distance of each R-R interval Regular ventricular rhythm = R-R intervals are equal; irregular ventricular rhythm = R-R intervals unequal Same method can be used to find atrial rhythm using P-P intervals – not common For accuracy – R-R and P-P should be evaluated across an entire 6 second strip 3. P Waves Represents the spread of electrical impulse through the atria, aka. atrial depolarization Atrial contraction Normal characteristics Upright (positive deflection above isometric line), smooth, rounded