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EKG Quick and Dirty - GD v3.0

EKG interpretation requires a systematic approach by looking at rate, rhythm, axis, and key features like QRS morphology, P waves, and relationships between P waves and QRS complexes. Important rhythms to identify include STEMI, various arrhythmias, and heart blocks. In emergency situations, it is crucial to determine the appropriate treatment which may involve cardioversion, defibrillation, or medications based on the underlying rhythm. History and clinical context are also essential for accurate EKG interpretation.

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Sheema Sh
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631 views2 pages

EKG Quick and Dirty - GD v3.0

EKG interpretation requires a systematic approach by looking at rate, rhythm, axis, and key features like QRS morphology, P waves, and relationships between P waves and QRS complexes. Important rhythms to identify include STEMI, various arrhythmias, and heart blocks. In emergency situations, it is crucial to determine the appropriate treatment which may involve cardioversion, defibrillation, or medications based on the underlying rhythm. History and clinical context are also essential for accurate EKG interpretation.

Uploaded by

Sheema Sh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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EKG Quick and Dirty Interpretation

by Dr. Greg DiCamillo

EKG Pearls: Key Extra Features:


• Develop a methodical system of
interpretation, look at each EKG the same QRS morphology
way according to your system • Narrow complex: sinus, atrial or junctional
• Always compare with an old EKG if possible origin, SVT (usually rate of 150+)
• Repetition leads to mastery -all about • Wide complex: usually means bundle
pattern recognition branch blocks; usually means ventricular
• EKG’s are a dynamic snap shot in time, they origin, beware if rapid and wide complex
can change quickly over a few minutes so (Vtach)
repeat it if you are concerned about any
cardiac badness
• Abnormal potassium levels (low or high) will P waves
cause all kinds of weird rhythms – common • Absent: atrial fibrillation, sinus arrest
problem so be wary • Present: morphology and PR interval may
suggest sinus, atrial, or junctional rhythm
1. History – the most important thing to
consider on any EKG. Remember, an EKG is just
like any other test, and should always be Relationship between P waves and QRS
interpreted in the clinical context, ie is pt having complexes: Heart Blocks
chest pain?

2. Rate – Big box method: 300 divided by


number of large boxes in between QRS
complexes -> rate
• Normal rate is 60-100 beats/min
• Tachycardia or bradycardia? (>100 or <60)

3. Rhythm: pattern of QRS complexes –


measure it using a marked piece of paper
• Regular or irregular QRS intervals? Regular =
sinus; irregular = afib, PAC’s, PVC’s
• If irregular: regularly irregular (Aflutter) or
• 1st Degree block: prolonged PR interval
irregularly irregular (Afib)
• 2nd Degree Type 1: increasing PR until
dropped QRS (Wenckebach)
4. Axis - can get very in depth but easy cheat is • 2nd Degree Type 2: randomly dropped QRS’s
to look at QRS direction in leads I and aVF: • 3rd Degree block: regular P-P and QRS-QRS
intervals but unrelated to each other

*2nd Degree Type 2 and 3rd degree blocks


are life threatening, so consult cardio
*Also cardio consult for any new heart
blocks
*Mark out the P’s and QRS’s on a separate
sheet of paper to see the relationship
Rhythms to identify quickly in codes: In rapid responses or code situations:

• If hemodynamically unstable, ie BP is
dangerously low or pt is not mentating
appropriately, consider promptly shocking
the patient
• If organized rhythm like SVT, Aflutter, Afib,
then must sync the shock to the current
rhythm- so hit the “Sync” button =
“cardioversion”
• If unorganized rhythm like Vfib, Vtach, or
sudden cardiac arrest then do an
unsynchronized shock = “defibrillation”
• Know your ACLS algorithms, meds, doses,
and decision trees! Keep pocket guides on
you or near you to avoid blanking in a
stressful situation
• Try modified vagal maneuvers as initial step
to break SVT (google REVERT trial) – it
works!
• Consider adenosine to differentiate between
SVT and Vtach – if rate slows then it’s SVT, if
it doesn’t then likely a bad rhythm

STEMI Recognition:

• STEMI is defined as ST elevation: • Not all ST elevation represents STEMI’s –


o In 2 contiguous leads consider pericarditis (pleuritic, positional,
o >1mm elevation in all leads except pericardial rub, effusion), prior MI’s
V2-V3 (compare to prior EKG’s), Aortic dissection,
o V2-V3 >1.5mm in women PE
. >2mm in men
• Be familiar with Sgarbossa criteria and
Benign Early Repolarization – higher level
but important to at least be aware of

• PCI better than tPA if can be done within 2


hours of the onset of chest pain

• tPa can be done up to 6 hours after onset of


chest pain (sometimes up to 12 hours), but
benefit rapidly declines after the 3 hr mark

• Finally - if in doubt, call cardiology! Always


better to be over cautious than cavalier

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