EKG Interpretation UNC School of Medicine医学心电图解释北卡罗来纳大学.pptVIP

EKG Interpretation UNC Emergency Medicine Medical Student Lecture Series Objectives The Basics Interpretation Clinical Pearls Practice Recognition The Normal Conduction System Lead Placement All Limb Leads Precordial Leads EKG Distributions Anteroseptal: V1, V2, V3, V4 Anterior: V1–V4 Anterolateral: V4–V6, I, aVL Lateral: I and aVL Inferior: II, III, and aVF Inferolateral: II, III, aVF, and V5 and V6 Waveforms Interpretation Develop a systematic approach to reading EKGs and use it every time The system we will practice is: Rate Rhythm (including intervals and blocks) Axis Hypertrophy Ischemia Rate Rule of 300- Divide 300 by the number of boxes between each QRS = rate Rate HR of 60-100 per minute is normal HR 100 = tachycardia HR 60 = bradycardia Differential Diagnosis of Tachycardia What is the heart rate? Rhythm Sinus Originating from SA node P wave before every QRS P wave in same direction as QRS What is this rhythm? Normal sinus rhythm Normal Intervals PR 0.20 sec (less than one large box) QRS 0.08 – 0.10 sec (1-2 small boxes) QT 450 ms in men, 460 ms in women Based on sex / heart rate Half the R-R interval with normal HR Prolonged QT Normal Men 450ms Women 460ms Corrected QT (QTc) QTm/√(R-R) Causes Drugs (Na channel blockers) Hypocalcemia, hypomagnesemia, hypokalemia Hypothermia AMI Congenital Increased ICP Blocks AV blocks First degree block PR interval fixed and 0.2 sec Second degree block, Mobitz type 1 PR gradually lengthened, then drop QRS Second degree block, Mobitz type 2 PR fixed, but drop QRS randomly Type 3 block PR and QRS dissociated What is this rhythm? First degree AV block PR is fixed and longer than 0.2 sec What is this rhythm? Type 1 second degree block (Wenckebach) What is this rhythm? Type 2 second degree AV block Dropped QRS What is this rhythm? 3rd degree heart block (complete) The QRS Axis The Quadrant Approach QRS up in I and up in aVF = Normal What is the axis? Normal-