ACLS高级心脏急救术.ppt

normal sinus rhythm each P wave is followed by a QRS P waves normal for the subject P wave rate 60 - 100 bpm with 10% variation rate 60 = sinus bradycardia rate 100 = sinus tachycardia variation 10% = sinus arrhythmia normal QRS axis normal P waves height 2.5 mm in lead II width 0.11 s in lead II for abnormal P waves see right atrial hypertrophy, left atrial hypertrophy, atrial premature beat, hyperkalaemia normal PR interval 0.12 to 0.20 s (3 - 5 small squares) for short PR segment consider Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome (other causes - Duchenne muscular dystrophy, type II glycogen storage disease (Pompes), HOCM) for long PR interval see first degree heart block and trifasicular block normal QRS complex 0.12 s duration (3 small squares) for abnormally wide QRS consider right or left bundle branch block, ventricular rhythm, hyperkalaemia, etc. no pathological Q waves no evidence of left or right ventricular hypertrophy normal QT interval Calculate the corrected QT interval (QTc) by dividing the QT interval by the square root of the preceeding R - R interval. Normal = 0.42 s. Causes of long QT interval myocardial infarction, myocarditis, diffuse myocardial disease hypocalcaemia, hypothyrodism subarachnoid haemorrhage, intracerebral haemorrhage drugs (e.g. sotalol, amiodarone) hereditary Romano Ward syndrome (autosomal dominant) Jervill + Lange Nielson syndrome (autosomal recessive) associated with sensorineural deafness normal ST segment no elevation or depression causes of elevation include acute MI (e.g. anterior, inferior), left bundle branch block, normal variants (e.g. athletic heart, Edeiken pattern, high-take off), acute pericarditis causes of depression include myocardial ischaemia, digoxin effect, ventricular hypertrophy, acute posterior MI, pulmonary embolus, left bundle branch block normal T wave causes of tall T waves include hyperkalaemia, hyperacute myocardial infarction and left