SlideShare uma empresa Scribd logo
1 de 80
Baixar para ler offline
ACLS CE
Part I of III
ECG STRIP INTERPRETATION
Prepared and presented by
Marc Imhotep Cray, M.D.
Graphic from: http://ekgenius.net/Fundamentals/nsr.html
Features include:
•Regular rhythm at 60-100 bpm
•Normal P wave morphology and
axis (upright in I and II, inverted in
aVR)
•Narrow QRS complexes (< 100 ms
wide)
•Each P wave is followed by a QRS
complex
•The PR interval is constant
2
Review of ECG Basics
Normal ECG Morphology
EKG Paper
3
From: EKG - Practical Clinical Skills (Website).EKG Paper
ECG tracings are recorded on grid
paper. The horizontal axis of the
EKG paper records time, with black
marks at the top indicating 3 second
intervals.
Each second is marked by 5 large
grid blocks. Thus each large block
equals 0.2 second. The vertical axis
records EKG amplitude (voltage).
Two large blocks equal 1 millivolt
(mV). Each small block equals 0.1
mV.
Within the large blocks are 5 small
blocks, each representing 0.04
seconds.
Normal Sinus Rhythm
12 lead ECG in sinus rhythm
Source: http://upload.wikimedia.org/wikipedia/commons/f/f0/12_lead_generated_sinus_rhythm.JPG
4
Analyzing a Rhythm
5
Component Characteristics
Rate The bpm is commonly the ventricular rate.
If atrial and ventricular rates differ, as in a
3rd-degree block, measure both rates.
Normal: 60–100 bpm
Slow (bradycardia): <60 bpm
Fast (tachycardia): >100 bpm
Regularity Measure R-R intervals and P-P intervals.
Regular: Intervals consistent
Regularly irregular: Repeating pattern
Irregular: No pattern
P Waves If present: Same in size, shape, position?
Does each QRS have a P wave?
Normal: Upright (positive) and uniform
PR Interval Constant: Intervals are the same.
Variable: Intervals differ.
Normal: 0.12–0.20 sec and constant
QRS Interval Normal: 0.06–0.10 sec
Wide: >0.10 sec
None: Absent
QT Interval Beginning of R wave to end of T wave Varies with
HR. Normal: Less than half the R-R interval
Dropped beats Occur in AV blocks. Occur in sinus arrest.
Thaler MS. The Only EKG Book you'll Ever Need - 5th ed., 117-20
Basic Rhythm Analysis
• Rate – too fast or too slow?
• Rhythm – regular or irregular?
• Is there a normal looking QRS? Is it wide or
narrow?
• Are P waves present?
• What is the relationship of the P waves to the
QRS complex?
6
ACLS Rhythm Analysis
Lethal vs non-lethal?
Shockable vs. non-shockable? Too fast vs too slow?
Symptomatic vs. asymptomatic?
or
Unstable vs. stable?
7
Hemodynamically Significant Rhythm
=Symptomatic or Unstable
8
•Clinically, most important parameter to assess in any
patient with a cardiac dysrhythmia is rhythm
hemodynamically "significant"
•This holds true regardless of whether rhythm in
question is slow or fast
•A rhythm is "hemodynamically" significant
IF it produces signs or symptoms of concern as a direct
result of the rate
N.B. Is the Patient Stable? How to Assess:
Signs and Symptoms of Concern
(“Think hypoperfusion of heart-brains-kidneys”)
9
•Signs of Concern --include hypotension (i.e.,
systolic BP ≤80-90 mm Hg); shock; heart
failure/pulmonary edema; and/or acute infarction
•Symptoms of Concern -- include chest pain;
shortness of breath; and/or impaired mental
status
Hemodynamic stability
VT or SVT
10
•The definition of hemodynamic stability is equally
applicable for supraventricular tachyarrhythmias (SVT) as
it is for ventricular tachycardia (VT)
•patient with tachycardia who is symptomatic
(i.e., hypotensive; short of breath; confused) is in
need of immediate synchronized cardioversion —
regardless of whether rhythm is VT or SVT
•In contrast – a trial of medical therapy is justified
IF the patient is stable!
See SVT and Tachycardia Notes.pdf
TO SUMMARIZE
“Symptomatic = unstable”
• Any abnormal rhythm that produces signs or
symptoms of hypoperfusion
– Chest Pain/ischemic EKG changes
– Shortness of Breath
– Decreased level of consciousness
– Syncope/pre-syncope
– Hypotension
– Shock - decreased Urine output, cool extremities,
etc.
– Pulmonary Congestion/CHF
11
Treat the patient not the monitor!!!!!!
“Sometimes you just have to be there"
12
For example
• despite a systolic BP of 75 mm Hg-we would not
necessarily cardiovert a patient with tachycardia who was
otherwise tolerating the rhythm well (i.e., without chest
pain, dyspnea, or confusion).
•Some patients may remain stable for hours (or even
days) despite being in sustained VT
Again Treat the patient not the monitor!!!!
Lethal Rhythms
• Shockable (Defibrillation)
–Ventricular fibrillation
–Pulseless ventricular tachycardia
• Non-shockable
–Asystole
–Pulseless electrical activity (PEA)
13
Non-Lethal Rhythms
• Too fast (tachycardias)
– Sinus
– Supraventricular (including a-fib/flutter)
– Ventricular
• Too slow (bradycardias)
– Sinus
– Heart block (1°, 2°, 3° AV block)
14
N.B. May have the potential to become lethal rhythms if
not treated appropriately
The following outlined ECG strips will be reviewed
OUTLINE:
• SINUS RHYTHMS
SINUS RHYTHM
SINUS BRADYCARDIA
SINUS ARREST
SINUS TACHYCARDIA
• ATRIAL RHYTHMS
SUPRAVENTRICULAR TACHYCARDIA
ATRIAL FIBRILLATION
ATRIAL FLUTTER
• VENTRICULAR RHYTHM
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
• ATRIOVENTRICULAR BLOCKS
FIRST DEGREE HEART BLOCK
SECOND DEGREE HEART BLOCK TYPE 1
SECOND DEGREE HEART BLOCK TYPE 2
THIRD DEGREE HEART BLOCK
For full rationale see respective disorders at
http://emedicine.medscape.com/cardiology
15
SINUS RHYTHMS (1)
SINUS RHYTHM
•VENTRICULAR RATE/RHYTHM 60 BPM/REGULAR
•ATRIAL RATE/RHYTHM 60 BPM/REGULAR
•PR INTERVAL 0.20 SEC
•QRS DURATION 0.06 SEC
•IDENTIFICATION SINUS RHYTHM
16
SINUS RHYTHMS (2)
SINUS BRADYCARDIA
•VENTRICULAR RATE/RHYTHM 58 BPM/REGULAR
•ATRIAL RATE/RHYTHM 58 BPM/REGULAR
•PR INTERVAL 0.20 SEC
•QRS DURATION 0.08 SEC
•IDENTIFICATION SINUS BRADYCARDIA
17
SINUS RHYTHMS (3)
SINUS TACHYCARDIA
• VENTRICULAR RATE/RHYTHM 130 BPM/REGULAR
•ATRIAL RATE/RHYTHM 130 BPM/REGULAR
•PR INTERVAL 0.14 – 0.16 SEC
•QRS DURATION 0.06 – 0.08 SEC
•IDENTIFICATION SINUS TACHYCARDIA
18
SINUS RHYTHMS (4)
SINUS ARREST
•VENTRICULAR RATE/RHYTHM NONE
•ATRIAL RATE/RHYTHM NONE
•PR INTERVAL NONE
•QRS DURATION NONE
•IDENTIFICATION ASYSTOLE
19
ATRIAL RHYTHMS(1)
SUPRAVENTRICULAR TACHYCARDIA
•VENTRICULAR RATE/RHYTHM 188 BPM/REGULAR
•ATRIAL RATE/RHYTHM UNABLE TO DETERMINE
•PR INTERVAL UNABLE TO DETERMINE
•QRS DURATION 0.06 SEC
•IDENTIFICATION SUPRAVENTRICULAR TACHYCARDIA (SVT)
20
ATRIAL RHYTHMS(2)
ATRIAL FLUTTER
•VENTRICULAR RATE/RHYTHM 88 BPM/REGULAR
•ATRIAL RATE/RHYTHM UNABLE TO DETERMINE
•PR INTERVAL UNABLE TO DETERMINE
•QRS DURATION 0.06 SEC
•IDENTIFICATION ATRIAL FLUTTER
21
ATRIAL RHYTHMS(3)
ATRIAL FIBRILLATION
•VENTRICULAR RATE/RHYTHM 55-94 BPM/IRREGULAR
•ATRIAL RATE/RHYTHM UNABLE TO DETERMINE
•PR INTERVAL UNABLE TO DETERMINE
•QRS DURATION 0.10 SEC
•IDENTIFICATION ATRIAL FIBRILLATION
22
VENTRICULAR RHYTHMS(1)
VENTRICULAR TACHYCARDIA
•VENTRICULAR RATE/RHYTHM 214 BPM/REGULAR
•ATRIAL RATE/RHYTHM UNABLE TO DETERMINE
•PR INTERVAL UNABLE TO DETERMINE
•QRS DURATION 0.14 SEC
•IDENTIFICATION VENTRICULAR TACHYCARDIA, MONOMORPHIC
23
VENTRICULAR RHYTHMS(2)
VENTRICULAR FIBRILLATION
•VENTRICULAR RATE/RHYTHM UNABLE TO DETERMINE
•ATRIAL RATE/RHYTHM UNABLE TO DETERMINE
•PR INTERVAL UNABLE TO DETERMINE
•QRS DURATION UNABLE TO DETERMINE
•IDENTIFICATION VENTRICULAR FIBRILLATION
24
ATRIOVENTRICULAR BLOCKS(1)
FIRST DEGREE HEART BLOCK
•VENTRICULAR RATE/RHYTHM 68 BPM/REGULAR
•ATRIAL RATE/RHYTHM 68 BPM/REGULAR
•PR INTERVAL 0.28 SEC
•QRS DURATION 0.06 SEC
•IDENTIFICATION FIRST-DEGREE AV BLOCK
25
ATRIOVENTRICULAR BLOCKS(2)
SECOND DEGREE HEART BLOCK TYPE 1
•VENTRICULAR RATE/RHYTHM 38-75 BPM/IRREGULAR
•ATRIAL RATE/RHYTHM 75 BPM/REGULAR
•PR INTERVAL LENGTHENING
•QRS DURATION 0.06 – 0.08 SEC
•IDENTIFICATION SECOND-DEGREE AV BLOCK, TYPE 1
26
ATRIOVENTRICULAR BLOCKS(3)
SECOND DEGREE HEART BLOCK TYPE 2
•VENTRICULAR RATE/RHYTHM 48 - 83 BPM/IRREGULAR
•ATRIAL RATE/RHYTHM 167 BPM/REGULAR
•PR INTERVAL 0.24 SEC
•QRS DURATION 0.12 SEC
•IDENTIFICATION SECOND-DEGREE AV BLOCK, TYPE 2
27
ATRIOVENTRICULAR BLOCKS(4)
THIRD DEGREE HEART BLOCK
•VENTRICULAR RATE/RHYTHM 45 BPM/REGULAR
•ATRIAL RATE/RHYTHM 115 BPM/REGULAR
•PR INTERVAL VARIES
•QRS DURATION 0.16 SEC
•IDENTIFICATION THIRD-DEGREE AV BLOCK
28
Name the rhythm & its
management …
ACLS Case Scenarios
Supplement to Part I- ECG STRIP INTERPRETATION
63 yo man with a witnessed collapse
while mowing the lawn
What is the rhythm?
What is the management?
30
NB: Go through step-by-step analysis of rhythm – rate, rhythm,
qrs, p waves, intervals etc.
Ventricular Fibrillation
• Rapid and irregular
• No normal P waves or QRS complexes
31
VF / Pulseless VT
Primary Survey - ABC
Secondary Survey - ABC
32
ACLS Algorithm
• Primary Survey
• Shock – 360 J
• Secondary Survey
• Vasopressor - Epi or Vasopressin IV
• Shock 360J
• Antiarrhythmic – Amiodarone, Lidocaine or
Magnesium Sulfate IV
• Shock 360J
33
NB: Don’t forget CPR in between shocks – don’t stop CPR for anything
except to assess patient (no longer than 10 seconds) or shock resume CPR
*immediately* after the shock for 5 cycles *without* checking a rhythm until
after 5 cycles of 30/2 CPR
79yo man s/p NSTEMI
What is the rhythm?
What is the management?
34
Ventricular Tachycardia (1)
• Rapid and regular
• No P waves
• Wide QRS complexes
35
Ventricular Tachycardia (2)
• Monomorphic VT
• Polymorphic VT
36
Note: Polymorphic is often associated with electrolyte
abnormalities or toxicities
http://www.txai.org/edu/irregular/ventricular_tachyarrhythmias.htm
http://www.txai.org/edu/irregular/ventricular_tachyarrhythmias.htm
Ventricular Tachycardia (3)
• Assume any wide complex tachycardia is VT
until proven otherwise
– SVT with aberrant conduction may also have wide
QRS complexes
• Attempt to establish the diagnosis
– Ischemia risk and VT go together
37
Treatment of VT (1)
• If pulseless - follow VF algorithm
• If stable try anti-arrhythmics
– Amiodarone
– Lidocaine
– Procainamide?
• If patient has a pulse, but is unstable or not
responding to meds - shock
38
Treatment of VT (2)
• Anti-arrhythmics are also pro-arrhythmic
• One antiarrhythmic may help, more than one
may harm
• Anti-arrhythmics can impair an already
impaired heart
• Electrical cardioversion should be the second
intervention of choice
39
60yo diabetic man with chest pain
What is the rhythm?
What is the management?
40
Normal Sinus Rhythm
• Regular rate and rhythm
• Normal P waves and QRS
• Evaluate for cause of chest pain and monitor for
change in rhythm
41
40 yo woman found down, pulseless and
apneic
What is the rhythm?
What is the management?
42
Pulseless Electrical Activity (PEA)
• Any organized (or semi-organized) electrical
activity in a patient without a detectable pulse
• Non-perfusing
• Treat the patient NOT the monitor
• Find and treat the cause!!!!!
43
PEA and Asystole
Secondary Survey - ABCD
Primary Survey - ABC
44
PEA
Atropine 1 mg IVP
if PEA is slow
Epinephrine 1 mg IVP
repeat every 3-5 minutes
Search for and Treat Causes
Secondary Survey
Primary Survey
45
Find and Treat the Cause
• Remember Non-shockable rhythms include:
–Asystole
–Pulseless electrical activity (PEA)
– The most effective treatment is to find and fix
the underlying problem
46
Causes of PEA?
• #1 cause of PEA in adults is hypovolemia
• #1 cause in children is hypoxia/respiratory
arrest
• Other causes? The H’s and T’s (Next Slide)
47
The H’s and T’s
• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hyper-/hypokalemia
• Hypothermia
• Hypoglycemia (rare)
• Toxins
• Tamponade
• Tension pneumothorax
• Thrombosis (coronary
or pulmonary)
• Trauma
48
N.B. There are now actually 6 H’s – hypoglycemia added on AHA
guidelines BUT only a few anecdotal reports of actually causing PEA
and usually in association with underlying chronic cardiac dysfunction
(severe heart failure)
Treat the H’s and T’s
• Hypovolemia
– Volume – IVF, PRBC’s
• Hypoxia
– Oxygenate/Ventilate
• Hydrogen ion (acidosis)
– Sodium bicarbonate
– Hyperventilation
• Hyper-/hypokalemia
– Sodium bicarbonate
– Insulin/glucose
– Calcium
• Hypothermia
– Warm -- invasive
• Hypoglycemia
– Dextrose
• Toxins
– Check levels
– Charcoal
– Antidotes
• Tamponade
– pericardiocentesis
• Tension pneumothorax
– Needle decompression
– Tube thoracostomy
• Thrombosis (coronary or
pulmonary)
– Thrombolytics
– OR/cath lab
• Trauma
49
Busy slide – the point is to TREAT whatever the problem is
19 yo man with palpitations
What is the rhythm?
What is the management?
50
Supraventricular Tachycardia
• Rapid (usually 150-250 bpm) and regular
• P waves cannot be positively identified
• QRS narrow
51
Note: P waves either merge with preceding T waves or are buried in QRS
complexes so the differentiation between atrial and junctional
tachycardia is impossible.
P waves buried in T wave or QRS or not present – can’t differentiate
supraventricular from junctional – most are supraventricular
Treatment of Stable SVT (1)
• Consider vagal maneuvers
– Carotid sinus massage
– Valsalva
– Eyeball massage
– Ice water to face
– Digital rectal exam
• Adenosine
– 6 mg, 12 mg, 12 mg
52
NB: Carotid massage - Turn head, Locate maximal impulse of carotid
artery. Massage up and down massage for 5-10 seconds.
One side at a time. Do not do in someone you suspect carotid disease
Treatment of Unstable SVT (2)
• Electrical Cardioversion
• Cardioversion is not defibrillation
• Use defibrillator in “sync” mode
– prevents delivering energy in the wrong part of
the cardiac cycle (R on T phenomenon)
53
NB: Heart is not fibrillating
Electrical Cardioversion (1)
• Energy level – somewhat controversial
• 100 J→200J→300J→360J
• Atrial flutter may convert with lower energy
– 50J
• For polymorphic VT – start with 200J
54
Electrical Cardioversion (2)
• Be prepared
– Patient on monitor, IV, Oxygen
– Suction ready and working
– Airway supplies ready
• Pre-medicate whenever possible
– Conscious sedation
– Electrical shocks are painful!
55
Tachycardia
Lots of options
based on rhythm
Stable?
Shock
Unstable?
Evaluate Patient
• Treat the patient NOT the monitor!!!
56
Stable Tachycardias
• Narrow complex?
– Regular rhythm
• Sinus tachycardia
• SVT
• AV nodal reentry
– Irregular rhythm
• Atrial fibrillation
• Atrial flutter
• Wide complex?
– Uncertain rhythm –
assume VT
– Narrow complex
tachycardia with
aberrancy
– Ventricular tachycardia
• Monomorphic or
polymorphic
57
56 yo woman with shortness of breath and
chest pain
What is the rhythm?
What is the management?
58
Atrial fibrillation/flutter
• May be rapid
• Irregular (fib) or more regular (flutter)
• No P waves, narrow QRS
59
Atrial fibrillation/flutter
• Treatment based on patient’s clinical picture
– Unstable = Immediate electrical cardioversion
– Stable
• Control the rate
– Diltiazem
– Esmolol (not if EF < 40%)
– Digoxin
• Provide anticoagulation
• Treat the patient NOT the monitor!!!
60
78yo man found down, pulseless and
apneic, unknown duration
What is the rhythm?
What is the management?
61
Asystole
• Is it really asystole?
• Check lead and cable connections.
• Is everything turned on?
• Verify asystole in another lead.
• Maybe it is really fine v-fib?
62
68 yo woman with h/o hypertension
presents with dizziness
What is the rhythm?
What is the treatment?
63
Sinus Bradycardia
• Slow and regular
• Normal P waves and QRS complexes
64
Bradycardias (1)
• Many possible causes
– Enhanced parasympathetic tone
– Increased ICP.
– Hypothyroidism
– Hypothermia
– Hyperkalemia
– Hypoglycemia
– Drug therapy
65
Bradycardias (2)
• Treat only symptomatic bradycardias
– Ask if the bradycardia causing the symptoms
• Recognize the red flag bradycardias
– Second degree type II block
– Third degree block
66
Transcutaneous pacing (1)
• Class I for all symptomatic bradycardias
• Always appropriate
• Doesn’t always work
• Technique
– Attach pacer pads
– Set a rate to 80 bpm
– Turn up the juice (amps) until you get capture
• Painful – may need sedation / analgesia
67
Transvenous Pacing (2)
• Invasive
• Time-consuming to establish
• Skilled procedure
• Better long-term than transcutaneous
• May have better capture than transcutaneous
pacing
68
Bradycardia Treatment
• Medications
–Vagolytic
• Atropine
–Adrenergic
• Epinephrine
• Dopamine
69
29 yo asymptomatic female
What is the rhythm?
What is the management?
70
1° AV block
• Regular rate and rhythm
• Normal P wave with long PR interval (>0.2msec/1 big
box)
• Normal QRS
71
Note: No emergent treatment needed (asymptomatic)
Follow bradycardia algorhitm if unstable
58yo asymptomatic woman
72
What is the rhythm?
What is the management?
2° AV Block - Type I
• aka Wenckebach
• Regular rate and rhythm
• Normal P waves and QRS complexes
• Increasing PR interval until QRS dropped
73
May be bradycardic. No ACLS interventions indicated
(asymptomatic)
80 yo man with syncope
74
What is the rhythm?
What is the management?
2° AV Block – Mobitz Type II
75
• Regular atrial rate with normal P wave
• Consistent PR interval
• Random QRS dropped
Note: Follow bradycardia algorithm – prepare for pacing even if
asymptomatic as this block can worsen
Another 80 yo man with syncope
What is the rhythm?
What is the management?
76
3° AV Block
• Normal P waves
• Normal QRS
• No relationship between P and QRS
• aka complete heart block
77
NB: Follow bradycardia algorithm. Will need to be paced.
May also have wide complexes if escape rhythm is present
Know When To Stop
• With return of spontaneous circulation
• No ROSC during or after 20 minutes of
resuscitative efforts
– Possible exceptions include near-drowning, severe
hypothermia, known reversible cause, some
overdoses
• DNR orders presented
• Obvious signs of irreversible death
78
N.B. For out-of-hospital providers also include
transfer of care, danger to providers, etc
Take Home Points
• Assess and manage at every step before
moving on to the next step
• Rapid defibrillation is the ONLY effective
treatment for VF/VT
• Search for and treat the cause
• Treat the patient not the monitor
• Reassess frequently
• Minimize interruptions to chest compressions
79
80
End of ACLS CE Part I
THANK YOU FOR YOUR ATTENTION
To follow:
Part II
ACLS in Acute Coronary Syndromes / Cardiac Arrest
•Importance of CPR / BLS in most current (2010) AHA ACLS
•Relationship of the chain of survival to successful resuscitation of the
cardiac arrest patient
•Discuss the interventions required to ensure good outcomes with
Return of Spontaneous Circulation (ROSC)
Part III
•Defibrillation and ACLS Drug Therapy
Reference resources and further study:
ACLS Study Guide - ECG STRIP INTERPRETATION.pdf
ACLS Rhythms for the ACLS Algorithms.pdf
http://acls-algorithms.com/ Website, including Megacode simulator

Mais conteúdo relacionado

Mais procurados (20)

Ventricular tachycardia
Ventricular tachycardiaVentricular tachycardia
Ventricular tachycardia
 
Basic ECG &rhythm interpretation
Basic ECG &rhythm interpretationBasic ECG &rhythm interpretation
Basic ECG &rhythm interpretation
 
The Basics of ECG Interpretation
The Basics of ECG InterpretationThe Basics of ECG Interpretation
The Basics of ECG Interpretation
 
Electrophysiology study basics
Electrophysiology study basicsElectrophysiology study basics
Electrophysiology study basics
 
Left Bundle Branch Block (LBBB)
Left Bundle Branch Block (LBBB)Left Bundle Branch Block (LBBB)
Left Bundle Branch Block (LBBB)
 
Cardiac arrythmias
Cardiac arrythmiasCardiac arrythmias
Cardiac arrythmias
 
Tachyarrhythmias
TachyarrhythmiasTachyarrhythmias
Tachyarrhythmias
 
ECG
ECGECG
ECG
 
Cardiac Arrhythmias
Cardiac ArrhythmiasCardiac Arrhythmias
Cardiac Arrhythmias
 
Defibrillation, cardioversion and pacing
Defibrillation, cardioversion and pacingDefibrillation, cardioversion and pacing
Defibrillation, cardioversion and pacing
 
Vpcs
VpcsVpcs
Vpcs
 
Cardioversion
CardioversionCardioversion
Cardioversion
 
Cardiac arrythmias
Cardiac arrythmiasCardiac arrythmias
Cardiac arrythmias
 
Junctional arrhythmias
Junctional arrhythmiasJunctional arrhythmias
Junctional arrhythmias
 
Normal sinus rhythm
Normal sinus rhythmNormal sinus rhythm
Normal sinus rhythm
 
ECG emergencies
ECG emergenciesECG emergencies
ECG emergencies
 
Ecg in emergency room
Ecg in emergency roomEcg in emergency room
Ecg in emergency room
 
Ecg rhythms charex
Ecg rhythms charexEcg rhythms charex
Ecg rhythms charex
 
ECG BASICS IN DETAIL
ECG BASICS IN DETAILECG BASICS IN DETAIL
ECG BASICS IN DETAIL
 
Ecg for acls
Ecg for aclsEcg for acls
Ecg for acls
 

Destaque

ACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w Arrest
ACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w ArrestACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w Arrest
ACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w ArrestImhotep Virtual Medical School
 
ACLS CE -Part III of III -Defibrillation and ACLS Drug Therpy
ACLS CE -Part III of III -Defibrillation and ACLS Drug TherpyACLS CE -Part III of III -Defibrillation and ACLS Drug Therpy
ACLS CE -Part III of III -Defibrillation and ACLS Drug TherpyImhotep Virtual Medical School
 
ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.
ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.
ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.SMSRAZA
 
Ecg or ekg sample strips (MS Cardiovascular)
Ecg or ekg sample strips (MS Cardiovascular)Ecg or ekg sample strips (MS Cardiovascular)
Ecg or ekg sample strips (MS Cardiovascular)biancadune
 
CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16
CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16
CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16Imelda Wijaya
 
Cardiac arrhythmias
Cardiac arrhythmiasCardiac arrhythmias
Cardiac arrhythmiasangleel
 
IVMS-Respiratory Anatomy and Physiology Global Overview / Review
IVMS-Respiratory  Anatomy and Physiology Global Overview / ReviewIVMS-Respiratory  Anatomy and Physiology Global Overview / Review
IVMS-Respiratory Anatomy and Physiology Global Overview / ReviewImhotep Virtual Medical School
 
Sodium and potassium
Sodium and potassiumSodium and potassium
Sodium and potassium101010101965
 
30 years of CPR in Saudi Arabia (Presentation)
30 years of CPR in Saudi Arabia (Presentation)30 years of CPR in Saudi Arabia (Presentation)
30 years of CPR in Saudi Arabia (Presentation)prof-mohamed-seraj
 
BLS instructor course
BLS instructor courseBLS instructor course
BLS instructor courseLisardo Duran
 
THE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITY
THE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITYTHE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITY
THE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITYmandar haval
 

Destaque (20)

ACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w Arrest
ACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w ArrestACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w Arrest
ACLS CE -Part II of III -BLS-CPR-ACLS in Acute Coronary Syndrome w Arrest
 
ACLS CE -Part III of III -Defibrillation and ACLS Drug Therpy
ACLS CE -Part III of III -Defibrillation and ACLS Drug TherpyACLS CE -Part III of III -Defibrillation and ACLS Drug Therpy
ACLS CE -Part III of III -Defibrillation and ACLS Drug Therpy
 
ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.
ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.
ARRHYTHMIA - WHAT YOU NEED TO KNOW FOR ACLS.
 
Ecg or ekg sample strips (MS Cardiovascular)
Ecg or ekg sample strips (MS Cardiovascular)Ecg or ekg sample strips (MS Cardiovascular)
Ecg or ekg sample strips (MS Cardiovascular)
 
Acls update class 2015
Acls update class 2015Acls update class 2015
Acls update class 2015
 
CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16
CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16
CPR 2015 oleh Bram, MD, Anesthesiologist 20.01.16
 
Ped medhandbook
Ped medhandbookPed medhandbook
Ped medhandbook
 
ACLS 2015
ACLS 2015ACLS 2015
ACLS 2015
 
Cardiac arrhythmias
Cardiac arrhythmiasCardiac arrhythmias
Cardiac arrhythmias
 
IVMS Endocrine Secretion and Action I
IVMS Endocrine Secretion and Action IIVMS Endocrine Secretion and Action I
IVMS Endocrine Secretion and Action I
 
IVMS-Gen Path-Inflammation
IVMS-Gen Path-InflammationIVMS-Gen Path-Inflammation
IVMS-Gen Path-Inflammation
 
Arrhythmia: ECG--- Tachycardia_20120902_北區
Arrhythmia: ECG--- Tachycardia_20120902_北區Arrhythmia: ECG--- Tachycardia_20120902_北區
Arrhythmia: ECG--- Tachycardia_20120902_北區
 
Pharmacodynamics II Dose-Response Relationships
Pharmacodynamics II Dose-Response RelationshipsPharmacodynamics II Dose-Response Relationships
Pharmacodynamics II Dose-Response Relationships
 
Ecg 4
Ecg 4Ecg 4
Ecg 4
 
Pulseless algorithm
Pulseless algorithmPulseless algorithm
Pulseless algorithm
 
IVMS-Respiratory Anatomy and Physiology Global Overview / Review
IVMS-Respiratory  Anatomy and Physiology Global Overview / ReviewIVMS-Respiratory  Anatomy and Physiology Global Overview / Review
IVMS-Respiratory Anatomy and Physiology Global Overview / Review
 
Sodium and potassium
Sodium and potassiumSodium and potassium
Sodium and potassium
 
30 years of CPR in Saudi Arabia (Presentation)
30 years of CPR in Saudi Arabia (Presentation)30 years of CPR in Saudi Arabia (Presentation)
30 years of CPR in Saudi Arabia (Presentation)
 
BLS instructor course
BLS instructor courseBLS instructor course
BLS instructor course
 
THE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITY
THE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITYTHE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITY
THE ROLE OF PEDIATRICIAN IN PRIMARY PREVENTION OF OBISITY
 

Semelhante a ACLS CE -Part I of III -ECG STRIP INTERPRETATION w Case Scenarios Supplemental

ECG REview.pdf
ECG REview.pdfECG REview.pdf
ECG REview.pdfJagan53828
 
Ecg 5th year 2016
Ecg 5th year 2016Ecg 5th year 2016
Ecg 5th year 2016Yousef Biuk
 
Cardiac Arrest Rhythm.pdf
Cardiac Arrest Rhythm.pdfCardiac Arrest Rhythm.pdf
Cardiac Arrest Rhythm.pdfssuser76f7cb
 
Its all about ECG..from A to Z.its so easy to understand
Its all about ECG..from A to Z.its so easy to understandIts all about ECG..from A to Z.its so easy to understand
Its all about ECG..from A to Z.its so easy to understandharavenkatdoddi
 
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationBasic EKG and Rhythm Interpretation Symposia - The CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationThe CRUDEM Foundation
 
Final introtocardiac pdf
Final introtocardiac pdfFinal introtocardiac pdf
Final introtocardiac pdfErikaLVN
 
Final Introto Cardiac Pdf
Final Introto Cardiac PdfFinal Introto Cardiac Pdf
Final Introto Cardiac PdfErikaLVN
 
Speedy ECG for medical student
Speedy ECG for medical studentSpeedy ECG for medical student
Speedy ECG for medical studentPatinya Yutchawit
 
1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx
1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx
1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptxPeruguMuniPrathiba
 
Basic of ECG Referesher Course
Basic of ECG Referesher CourseBasic of ECG Referesher Course
Basic of ECG Referesher CourseAme Mehadi
 
Stable & Unstabe Tachycardia.pptx
Stable & Unstabe Tachycardia.pptxStable & Unstabe Tachycardia.pptx
Stable & Unstabe Tachycardia.pptxjosepholamide247
 
Module 3 peri arrest and arrest rhythm -1
Module 3   peri arrest and arrest rhythm -1Module 3   peri arrest and arrest rhythm -1
Module 3 peri arrest and arrest rhythm -1Ewei Voon
 
Cardiac Rhythmdysrhythmia
Cardiac Rhythmdysrhythmia Cardiac Rhythmdysrhythmia
Cardiac Rhythmdysrhythmia NorthTec
 

Semelhante a ACLS CE -Part I of III -ECG STRIP INTERPRETATION w Case Scenarios Supplemental (20)

Ecg presentation1
Ecg presentation1Ecg presentation1
Ecg presentation1
 
ECG REview.pdf
ECG REview.pdfECG REview.pdf
ECG REview.pdf
 
Ecg 5th year 2016
Ecg 5th year 2016Ecg 5th year 2016
Ecg 5th year 2016
 
Cardiac Arrest Rhythm.pdf
Cardiac Arrest Rhythm.pdfCardiac Arrest Rhythm.pdf
Cardiac Arrest Rhythm.pdf
 
Basics of ECG.pptx
Basics of ECG.pptxBasics of ECG.pptx
Basics of ECG.pptx
 
Its all about ECG..from A to Z.its so easy to understand
Its all about ECG..from A to Z.its so easy to understandIts all about ECG..from A to Z.its so easy to understand
Its all about ECG..from A to Z.its so easy to understand
 
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationBasic EKG and Rhythm Interpretation Symposia - The CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM Foundation
 
ECG BASICS.pptx
ECG BASICS.pptxECG BASICS.pptx
ECG BASICS.pptx
 
Final introtocardiac pdf
Final introtocardiac pdfFinal introtocardiac pdf
Final introtocardiac pdf
 
Final Introto Cardiac Pdf
Final Introto Cardiac PdfFinal Introto Cardiac Pdf
Final Introto Cardiac Pdf
 
Speedy ECG for medical student
Speedy ECG for medical studentSpeedy ECG for medical student
Speedy ECG for medical student
 
Basic ecg
Basic ecgBasic ecg
Basic ecg
 
Basic ecg
Basic ecgBasic ecg
Basic ecg
 
1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx
1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx
1 CARDIAC DYSARHYTHMIAS - INTERPRETATION.pptx
 
Basic ecg
Basic ecgBasic ecg
Basic ecg
 
Basic of ECG Referesher Course
Basic of ECG Referesher CourseBasic of ECG Referesher Course
Basic of ECG Referesher Course
 
Stable & Unstabe Tachycardia.pptx
Stable & Unstabe Tachycardia.pptxStable & Unstabe Tachycardia.pptx
Stable & Unstabe Tachycardia.pptx
 
4- ECG.ppt
4- ECG.ppt4- ECG.ppt
4- ECG.ppt
 
Module 3 peri arrest and arrest rhythm -1
Module 3   peri arrest and arrest rhythm -1Module 3   peri arrest and arrest rhythm -1
Module 3 peri arrest and arrest rhythm -1
 
Cardiac Rhythmdysrhythmia
Cardiac Rhythmdysrhythmia Cardiac Rhythmdysrhythmia
Cardiac Rhythmdysrhythmia
 

Mais de Imhotep Virtual Medical School

Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)
Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)
Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)Imhotep Virtual Medical School
 
Reproductive System Pathology_FM Breast and FM Reproductive Systems
Reproductive System Pathology_FM Breast and FM Reproductive SystemsReproductive System Pathology_FM Breast and FM Reproductive Systems
Reproductive System Pathology_FM Breast and FM Reproductive SystemsImhotep Virtual Medical School
 
Reproductive System Pathology_Male Reproductive Systems
Reproductive System Pathology_Male Reproductive SystemsReproductive System Pathology_Male Reproductive Systems
Reproductive System Pathology_Male Reproductive SystemsImhotep Virtual Medical School
 
Nervous System Pathology_A Case-based Learning Approach
Nervous System Pathology_A Case-based Learning ApproachNervous System Pathology_A Case-based Learning Approach
Nervous System Pathology_A Case-based Learning ApproachImhotep Virtual Medical School
 
CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...
CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...
CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...Imhotep Virtual Medical School
 
Cardiovascular Pathology Case-based_Gross and Microscopic
Cardiovascular Pathology Case-based_Gross and MicroscopicCardiovascular Pathology Case-based_Gross and Microscopic
Cardiovascular Pathology Case-based_Gross and MicroscopicImhotep Virtual Medical School
 
Clinical Pharmacology for Medical Students_USMLE Step 1 & 2 Review
Clinical Pharmacology for Medical Students_USMLE Step 1 & 2 ReviewClinical Pharmacology for Medical Students_USMLE Step 1 & 2 Review
Clinical Pharmacology for Medical Students_USMLE Step 1 & 2 ReviewImhotep Virtual Medical School
 
Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...
Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...
Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...Imhotep Virtual Medical School
 
Myocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and Pathology
Myocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and PathologyMyocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and Pathology
Myocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and PathologyImhotep Virtual Medical School
 
Autonomic Nervous System Physiology and Pharmacology_Overview| Review of ANS
Autonomic Nervous System Physiology and Pharmacology_Overview| Review of ANSAutonomic Nervous System Physiology and Pharmacology_Overview| Review of ANS
Autonomic Nervous System Physiology and Pharmacology_Overview| Review of ANSImhotep Virtual Medical School
 

Mais de Imhotep Virtual Medical School (20)

Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)
Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)
Oncologic Pathology_A Case-based Organ Systems Review (USMLE Step 1)
 
Pathology and Pathophysiology of Shock
Pathology and Pathophysiology of ShockPathology and Pathophysiology of Shock
Pathology and Pathophysiology of Shock
 
Drugs Used In Disorders of the Reproductive System
Drugs Used In Disorders of the Reproductive SystemDrugs Used In Disorders of the Reproductive System
Drugs Used In Disorders of the Reproductive System
 
Reproductive System Pathology_FM Breast and FM Reproductive Systems
Reproductive System Pathology_FM Breast and FM Reproductive SystemsReproductive System Pathology_FM Breast and FM Reproductive Systems
Reproductive System Pathology_FM Breast and FM Reproductive Systems
 
Reproductive System Pathology_Male Reproductive Systems
Reproductive System Pathology_Male Reproductive SystemsReproductive System Pathology_Male Reproductive Systems
Reproductive System Pathology_Male Reproductive Systems
 
Nervous System Pathology_A Case-based Learning Approach
Nervous System Pathology_A Case-based Learning ApproachNervous System Pathology_A Case-based Learning Approach
Nervous System Pathology_A Case-based Learning Approach
 
CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...
CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...
CVS Function, Regulation of the Heart and Overview of Therapeutic Goals in CV...
 
Cardiovascular Pathology Case-based_Gross and Microscopic
Cardiovascular Pathology Case-based_Gross and MicroscopicCardiovascular Pathology Case-based_Gross and Microscopic
Cardiovascular Pathology Case-based_Gross and Microscopic
 
HIV / AIDS Pathology
HIV / AIDS PathologyHIV / AIDS Pathology
HIV / AIDS Pathology
 
Sepsis & Septic Shock
Sepsis & Septic ShockSepsis & Septic Shock
Sepsis & Septic Shock
 
Drugs Used in infectious Disease_Antibiotics
Drugs Used in infectious Disease_AntibioticsDrugs Used in infectious Disease_Antibiotics
Drugs Used in infectious Disease_Antibiotics
 
Hematopoietic and Lymphoid Systems Pathology
Hematopoietic and Lymphoid Systems  PathologyHematopoietic and Lymphoid Systems  Pathology
Hematopoietic and Lymphoid Systems Pathology
 
Drugs Used in Neoplastic Disorders
Drugs Used in Neoplastic DisordersDrugs Used in Neoplastic Disorders
Drugs Used in Neoplastic Disorders
 
Neoplasia & Oncologic Pathology
Neoplasia & Oncologic PathologyNeoplasia & Oncologic Pathology
Neoplasia & Oncologic Pathology
 
Clinical Pharmacology for Medical Students_USMLE Step 1 & 2 Review
Clinical Pharmacology for Medical Students_USMLE Step 1 & 2 ReviewClinical Pharmacology for Medical Students_USMLE Step 1 & 2 Review
Clinical Pharmacology for Medical Students_USMLE Step 1 & 2 Review
 
Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...
Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...
Make the Dx_ A Case-based Intro to Select Cardiovascular and Respiratory Dise...
 
Myocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and Pathology
Myocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and PathologyMyocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and Pathology
Myocardial infarction_ Causes, Symptoms, Diagnosis, Treatment, and Pathology
 
Basic CXR Interpretation_Diagnostic Radiographs
Basic CXR Interpretation_Diagnostic RadiographsBasic CXR Interpretation_Diagnostic Radiographs
Basic CXR Interpretation_Diagnostic Radiographs
 
Electrocardiogram (ECG) Interpretation_Module 1 of 2
Electrocardiogram (ECG) Interpretation_Module 1 of 2Electrocardiogram (ECG) Interpretation_Module 1 of 2
Electrocardiogram (ECG) Interpretation_Module 1 of 2
 
Autonomic Nervous System Physiology and Pharmacology_Overview| Review of ANS
Autonomic Nervous System Physiology and Pharmacology_Overview| Review of ANSAutonomic Nervous System Physiology and Pharmacology_Overview| Review of ANS
Autonomic Nervous System Physiology and Pharmacology_Overview| Review of ANS
 

Último

5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...CaraSkikne1
 
How to Solve Singleton Error in the Odoo 17
How to Solve Singleton Error in the  Odoo 17How to Solve Singleton Error in the  Odoo 17
How to Solve Singleton Error in the Odoo 17Celine George
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationMJDuyan
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and stepobaje godwin sunday
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptxmary850239
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRADUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRATanmoy Mishra
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxSaurabhParmar42
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxMYDA ANGELICA SUAN
 
How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17Celine George
 
How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17Celine George
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17Celine George
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational PhilosophyShuvankar Madhu
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICESayali Powar
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxDr. Santhosh Kumar. N
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?TechSoup
 

Último (20)

5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...
 
How to Solve Singleton Error in the Odoo 17
How to Solve Singleton Error in the  Odoo 17How to Solve Singleton Error in the  Odoo 17
How to Solve Singleton Error in the Odoo 17
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive Education
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and step
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptx
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRADUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptx
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptx
 
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdfPersonal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
 
How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17
 
How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational Philosophy
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICE
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptx
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?
 

ACLS CE -Part I of III -ECG STRIP INTERPRETATION w Case Scenarios Supplemental

  • 1. ACLS CE Part I of III ECG STRIP INTERPRETATION Prepared and presented by Marc Imhotep Cray, M.D.
  • 2. Graphic from: http://ekgenius.net/Fundamentals/nsr.html Features include: •Regular rhythm at 60-100 bpm •Normal P wave morphology and axis (upright in I and II, inverted in aVR) •Narrow QRS complexes (< 100 ms wide) •Each P wave is followed by a QRS complex •The PR interval is constant 2 Review of ECG Basics Normal ECG Morphology
  • 3. EKG Paper 3 From: EKG - Practical Clinical Skills (Website).EKG Paper ECG tracings are recorded on grid paper. The horizontal axis of the EKG paper records time, with black marks at the top indicating 3 second intervals. Each second is marked by 5 large grid blocks. Thus each large block equals 0.2 second. The vertical axis records EKG amplitude (voltage). Two large blocks equal 1 millivolt (mV). Each small block equals 0.1 mV. Within the large blocks are 5 small blocks, each representing 0.04 seconds.
  • 4. Normal Sinus Rhythm 12 lead ECG in sinus rhythm Source: http://upload.wikimedia.org/wikipedia/commons/f/f0/12_lead_generated_sinus_rhythm.JPG 4
  • 5. Analyzing a Rhythm 5 Component Characteristics Rate The bpm is commonly the ventricular rate. If atrial and ventricular rates differ, as in a 3rd-degree block, measure both rates. Normal: 60–100 bpm Slow (bradycardia): <60 bpm Fast (tachycardia): >100 bpm Regularity Measure R-R intervals and P-P intervals. Regular: Intervals consistent Regularly irregular: Repeating pattern Irregular: No pattern P Waves If present: Same in size, shape, position? Does each QRS have a P wave? Normal: Upright (positive) and uniform PR Interval Constant: Intervals are the same. Variable: Intervals differ. Normal: 0.12–0.20 sec and constant QRS Interval Normal: 0.06–0.10 sec Wide: >0.10 sec None: Absent QT Interval Beginning of R wave to end of T wave Varies with HR. Normal: Less than half the R-R interval Dropped beats Occur in AV blocks. Occur in sinus arrest. Thaler MS. The Only EKG Book you'll Ever Need - 5th ed., 117-20
  • 6. Basic Rhythm Analysis • Rate – too fast or too slow? • Rhythm – regular or irregular? • Is there a normal looking QRS? Is it wide or narrow? • Are P waves present? • What is the relationship of the P waves to the QRS complex? 6
  • 7. ACLS Rhythm Analysis Lethal vs non-lethal? Shockable vs. non-shockable? Too fast vs too slow? Symptomatic vs. asymptomatic? or Unstable vs. stable? 7
  • 8. Hemodynamically Significant Rhythm =Symptomatic or Unstable 8 •Clinically, most important parameter to assess in any patient with a cardiac dysrhythmia is rhythm hemodynamically "significant" •This holds true regardless of whether rhythm in question is slow or fast •A rhythm is "hemodynamically" significant IF it produces signs or symptoms of concern as a direct result of the rate N.B. Is the Patient Stable? How to Assess:
  • 9. Signs and Symptoms of Concern (“Think hypoperfusion of heart-brains-kidneys”) 9 •Signs of Concern --include hypotension (i.e., systolic BP ≤80-90 mm Hg); shock; heart failure/pulmonary edema; and/or acute infarction •Symptoms of Concern -- include chest pain; shortness of breath; and/or impaired mental status
  • 10. Hemodynamic stability VT or SVT 10 •The definition of hemodynamic stability is equally applicable for supraventricular tachyarrhythmias (SVT) as it is for ventricular tachycardia (VT) •patient with tachycardia who is symptomatic (i.e., hypotensive; short of breath; confused) is in need of immediate synchronized cardioversion — regardless of whether rhythm is VT or SVT •In contrast – a trial of medical therapy is justified IF the patient is stable! See SVT and Tachycardia Notes.pdf
  • 11. TO SUMMARIZE “Symptomatic = unstable” • Any abnormal rhythm that produces signs or symptoms of hypoperfusion – Chest Pain/ischemic EKG changes – Shortness of Breath – Decreased level of consciousness – Syncope/pre-syncope – Hypotension – Shock - decreased Urine output, cool extremities, etc. – Pulmonary Congestion/CHF 11 Treat the patient not the monitor!!!!!!
  • 12. “Sometimes you just have to be there" 12 For example • despite a systolic BP of 75 mm Hg-we would not necessarily cardiovert a patient with tachycardia who was otherwise tolerating the rhythm well (i.e., without chest pain, dyspnea, or confusion). •Some patients may remain stable for hours (or even days) despite being in sustained VT Again Treat the patient not the monitor!!!!
  • 13. Lethal Rhythms • Shockable (Defibrillation) –Ventricular fibrillation –Pulseless ventricular tachycardia • Non-shockable –Asystole –Pulseless electrical activity (PEA) 13
  • 14. Non-Lethal Rhythms • Too fast (tachycardias) – Sinus – Supraventricular (including a-fib/flutter) – Ventricular • Too slow (bradycardias) – Sinus – Heart block (1°, 2°, 3° AV block) 14 N.B. May have the potential to become lethal rhythms if not treated appropriately
  • 15. The following outlined ECG strips will be reviewed OUTLINE: • SINUS RHYTHMS SINUS RHYTHM SINUS BRADYCARDIA SINUS ARREST SINUS TACHYCARDIA • ATRIAL RHYTHMS SUPRAVENTRICULAR TACHYCARDIA ATRIAL FIBRILLATION ATRIAL FLUTTER • VENTRICULAR RHYTHM VENTRICULAR TACHYCARDIA VENTRICULAR FIBRILLATION • ATRIOVENTRICULAR BLOCKS FIRST DEGREE HEART BLOCK SECOND DEGREE HEART BLOCK TYPE 1 SECOND DEGREE HEART BLOCK TYPE 2 THIRD DEGREE HEART BLOCK For full rationale see respective disorders at http://emedicine.medscape.com/cardiology 15
  • 16. SINUS RHYTHMS (1) SINUS RHYTHM •VENTRICULAR RATE/RHYTHM 60 BPM/REGULAR •ATRIAL RATE/RHYTHM 60 BPM/REGULAR •PR INTERVAL 0.20 SEC •QRS DURATION 0.06 SEC •IDENTIFICATION SINUS RHYTHM 16
  • 17. SINUS RHYTHMS (2) SINUS BRADYCARDIA •VENTRICULAR RATE/RHYTHM 58 BPM/REGULAR •ATRIAL RATE/RHYTHM 58 BPM/REGULAR •PR INTERVAL 0.20 SEC •QRS DURATION 0.08 SEC •IDENTIFICATION SINUS BRADYCARDIA 17
  • 18. SINUS RHYTHMS (3) SINUS TACHYCARDIA • VENTRICULAR RATE/RHYTHM 130 BPM/REGULAR •ATRIAL RATE/RHYTHM 130 BPM/REGULAR •PR INTERVAL 0.14 – 0.16 SEC •QRS DURATION 0.06 – 0.08 SEC •IDENTIFICATION SINUS TACHYCARDIA 18
  • 19. SINUS RHYTHMS (4) SINUS ARREST •VENTRICULAR RATE/RHYTHM NONE •ATRIAL RATE/RHYTHM NONE •PR INTERVAL NONE •QRS DURATION NONE •IDENTIFICATION ASYSTOLE 19
  • 20. ATRIAL RHYTHMS(1) SUPRAVENTRICULAR TACHYCARDIA •VENTRICULAR RATE/RHYTHM 188 BPM/REGULAR •ATRIAL RATE/RHYTHM UNABLE TO DETERMINE •PR INTERVAL UNABLE TO DETERMINE •QRS DURATION 0.06 SEC •IDENTIFICATION SUPRAVENTRICULAR TACHYCARDIA (SVT) 20
  • 21. ATRIAL RHYTHMS(2) ATRIAL FLUTTER •VENTRICULAR RATE/RHYTHM 88 BPM/REGULAR •ATRIAL RATE/RHYTHM UNABLE TO DETERMINE •PR INTERVAL UNABLE TO DETERMINE •QRS DURATION 0.06 SEC •IDENTIFICATION ATRIAL FLUTTER 21
  • 22. ATRIAL RHYTHMS(3) ATRIAL FIBRILLATION •VENTRICULAR RATE/RHYTHM 55-94 BPM/IRREGULAR •ATRIAL RATE/RHYTHM UNABLE TO DETERMINE •PR INTERVAL UNABLE TO DETERMINE •QRS DURATION 0.10 SEC •IDENTIFICATION ATRIAL FIBRILLATION 22
  • 23. VENTRICULAR RHYTHMS(1) VENTRICULAR TACHYCARDIA •VENTRICULAR RATE/RHYTHM 214 BPM/REGULAR •ATRIAL RATE/RHYTHM UNABLE TO DETERMINE •PR INTERVAL UNABLE TO DETERMINE •QRS DURATION 0.14 SEC •IDENTIFICATION VENTRICULAR TACHYCARDIA, MONOMORPHIC 23
  • 24. VENTRICULAR RHYTHMS(2) VENTRICULAR FIBRILLATION •VENTRICULAR RATE/RHYTHM UNABLE TO DETERMINE •ATRIAL RATE/RHYTHM UNABLE TO DETERMINE •PR INTERVAL UNABLE TO DETERMINE •QRS DURATION UNABLE TO DETERMINE •IDENTIFICATION VENTRICULAR FIBRILLATION 24
  • 25. ATRIOVENTRICULAR BLOCKS(1) FIRST DEGREE HEART BLOCK •VENTRICULAR RATE/RHYTHM 68 BPM/REGULAR •ATRIAL RATE/RHYTHM 68 BPM/REGULAR •PR INTERVAL 0.28 SEC •QRS DURATION 0.06 SEC •IDENTIFICATION FIRST-DEGREE AV BLOCK 25
  • 26. ATRIOVENTRICULAR BLOCKS(2) SECOND DEGREE HEART BLOCK TYPE 1 •VENTRICULAR RATE/RHYTHM 38-75 BPM/IRREGULAR •ATRIAL RATE/RHYTHM 75 BPM/REGULAR •PR INTERVAL LENGTHENING •QRS DURATION 0.06 – 0.08 SEC •IDENTIFICATION SECOND-DEGREE AV BLOCK, TYPE 1 26
  • 27. ATRIOVENTRICULAR BLOCKS(3) SECOND DEGREE HEART BLOCK TYPE 2 •VENTRICULAR RATE/RHYTHM 48 - 83 BPM/IRREGULAR •ATRIAL RATE/RHYTHM 167 BPM/REGULAR •PR INTERVAL 0.24 SEC •QRS DURATION 0.12 SEC •IDENTIFICATION SECOND-DEGREE AV BLOCK, TYPE 2 27
  • 28. ATRIOVENTRICULAR BLOCKS(4) THIRD DEGREE HEART BLOCK •VENTRICULAR RATE/RHYTHM 45 BPM/REGULAR •ATRIAL RATE/RHYTHM 115 BPM/REGULAR •PR INTERVAL VARIES •QRS DURATION 0.16 SEC •IDENTIFICATION THIRD-DEGREE AV BLOCK 28
  • 29. Name the rhythm & its management … ACLS Case Scenarios Supplement to Part I- ECG STRIP INTERPRETATION
  • 30. 63 yo man with a witnessed collapse while mowing the lawn What is the rhythm? What is the management? 30 NB: Go through step-by-step analysis of rhythm – rate, rhythm, qrs, p waves, intervals etc.
  • 31. Ventricular Fibrillation • Rapid and irregular • No normal P waves or QRS complexes 31
  • 32. VF / Pulseless VT Primary Survey - ABC Secondary Survey - ABC 32
  • 33. ACLS Algorithm • Primary Survey • Shock – 360 J • Secondary Survey • Vasopressor - Epi or Vasopressin IV • Shock 360J • Antiarrhythmic – Amiodarone, Lidocaine or Magnesium Sulfate IV • Shock 360J 33 NB: Don’t forget CPR in between shocks – don’t stop CPR for anything except to assess patient (no longer than 10 seconds) or shock resume CPR *immediately* after the shock for 5 cycles *without* checking a rhythm until after 5 cycles of 30/2 CPR
  • 34. 79yo man s/p NSTEMI What is the rhythm? What is the management? 34
  • 35. Ventricular Tachycardia (1) • Rapid and regular • No P waves • Wide QRS complexes 35
  • 36. Ventricular Tachycardia (2) • Monomorphic VT • Polymorphic VT 36 Note: Polymorphic is often associated with electrolyte abnormalities or toxicities http://www.txai.org/edu/irregular/ventricular_tachyarrhythmias.htm http://www.txai.org/edu/irregular/ventricular_tachyarrhythmias.htm
  • 37. Ventricular Tachycardia (3) • Assume any wide complex tachycardia is VT until proven otherwise – SVT with aberrant conduction may also have wide QRS complexes • Attempt to establish the diagnosis – Ischemia risk and VT go together 37
  • 38. Treatment of VT (1) • If pulseless - follow VF algorithm • If stable try anti-arrhythmics – Amiodarone – Lidocaine – Procainamide? • If patient has a pulse, but is unstable or not responding to meds - shock 38
  • 39. Treatment of VT (2) • Anti-arrhythmics are also pro-arrhythmic • One antiarrhythmic may help, more than one may harm • Anti-arrhythmics can impair an already impaired heart • Electrical cardioversion should be the second intervention of choice 39
  • 40. 60yo diabetic man with chest pain What is the rhythm? What is the management? 40
  • 41. Normal Sinus Rhythm • Regular rate and rhythm • Normal P waves and QRS • Evaluate for cause of chest pain and monitor for change in rhythm 41
  • 42. 40 yo woman found down, pulseless and apneic What is the rhythm? What is the management? 42
  • 43. Pulseless Electrical Activity (PEA) • Any organized (or semi-organized) electrical activity in a patient without a detectable pulse • Non-perfusing • Treat the patient NOT the monitor • Find and treat the cause!!!!! 43
  • 44. PEA and Asystole Secondary Survey - ABCD Primary Survey - ABC 44
  • 45. PEA Atropine 1 mg IVP if PEA is slow Epinephrine 1 mg IVP repeat every 3-5 minutes Search for and Treat Causes Secondary Survey Primary Survey 45
  • 46. Find and Treat the Cause • Remember Non-shockable rhythms include: –Asystole –Pulseless electrical activity (PEA) – The most effective treatment is to find and fix the underlying problem 46
  • 47. Causes of PEA? • #1 cause of PEA in adults is hypovolemia • #1 cause in children is hypoxia/respiratory arrest • Other causes? The H’s and T’s (Next Slide) 47
  • 48. The H’s and T’s • Hypovolemia • Hypoxia • Hydrogen ion (acidosis) • Hyper-/hypokalemia • Hypothermia • Hypoglycemia (rare) • Toxins • Tamponade • Tension pneumothorax • Thrombosis (coronary or pulmonary) • Trauma 48 N.B. There are now actually 6 H’s – hypoglycemia added on AHA guidelines BUT only a few anecdotal reports of actually causing PEA and usually in association with underlying chronic cardiac dysfunction (severe heart failure)
  • 49. Treat the H’s and T’s • Hypovolemia – Volume – IVF, PRBC’s • Hypoxia – Oxygenate/Ventilate • Hydrogen ion (acidosis) – Sodium bicarbonate – Hyperventilation • Hyper-/hypokalemia – Sodium bicarbonate – Insulin/glucose – Calcium • Hypothermia – Warm -- invasive • Hypoglycemia – Dextrose • Toxins – Check levels – Charcoal – Antidotes • Tamponade – pericardiocentesis • Tension pneumothorax – Needle decompression – Tube thoracostomy • Thrombosis (coronary or pulmonary) – Thrombolytics – OR/cath lab • Trauma 49 Busy slide – the point is to TREAT whatever the problem is
  • 50. 19 yo man with palpitations What is the rhythm? What is the management? 50
  • 51. Supraventricular Tachycardia • Rapid (usually 150-250 bpm) and regular • P waves cannot be positively identified • QRS narrow 51 Note: P waves either merge with preceding T waves or are buried in QRS complexes so the differentiation between atrial and junctional tachycardia is impossible. P waves buried in T wave or QRS or not present – can’t differentiate supraventricular from junctional – most are supraventricular
  • 52. Treatment of Stable SVT (1) • Consider vagal maneuvers – Carotid sinus massage – Valsalva – Eyeball massage – Ice water to face – Digital rectal exam • Adenosine – 6 mg, 12 mg, 12 mg 52 NB: Carotid massage - Turn head, Locate maximal impulse of carotid artery. Massage up and down massage for 5-10 seconds. One side at a time. Do not do in someone you suspect carotid disease
  • 53. Treatment of Unstable SVT (2) • Electrical Cardioversion • Cardioversion is not defibrillation • Use defibrillator in “sync” mode – prevents delivering energy in the wrong part of the cardiac cycle (R on T phenomenon) 53 NB: Heart is not fibrillating
  • 54. Electrical Cardioversion (1) • Energy level – somewhat controversial • 100 J→200J→300J→360J • Atrial flutter may convert with lower energy – 50J • For polymorphic VT – start with 200J 54
  • 55. Electrical Cardioversion (2) • Be prepared – Patient on monitor, IV, Oxygen – Suction ready and working – Airway supplies ready • Pre-medicate whenever possible – Conscious sedation – Electrical shocks are painful! 55
  • 56. Tachycardia Lots of options based on rhythm Stable? Shock Unstable? Evaluate Patient • Treat the patient NOT the monitor!!! 56
  • 57. Stable Tachycardias • Narrow complex? – Regular rhythm • Sinus tachycardia • SVT • AV nodal reentry – Irregular rhythm • Atrial fibrillation • Atrial flutter • Wide complex? – Uncertain rhythm – assume VT – Narrow complex tachycardia with aberrancy – Ventricular tachycardia • Monomorphic or polymorphic 57
  • 58. 56 yo woman with shortness of breath and chest pain What is the rhythm? What is the management? 58
  • 59. Atrial fibrillation/flutter • May be rapid • Irregular (fib) or more regular (flutter) • No P waves, narrow QRS 59
  • 60. Atrial fibrillation/flutter • Treatment based on patient’s clinical picture – Unstable = Immediate electrical cardioversion – Stable • Control the rate – Diltiazem – Esmolol (not if EF < 40%) – Digoxin • Provide anticoagulation • Treat the patient NOT the monitor!!! 60
  • 61. 78yo man found down, pulseless and apneic, unknown duration What is the rhythm? What is the management? 61
  • 62. Asystole • Is it really asystole? • Check lead and cable connections. • Is everything turned on? • Verify asystole in another lead. • Maybe it is really fine v-fib? 62
  • 63. 68 yo woman with h/o hypertension presents with dizziness What is the rhythm? What is the treatment? 63
  • 64. Sinus Bradycardia • Slow and regular • Normal P waves and QRS complexes 64
  • 65. Bradycardias (1) • Many possible causes – Enhanced parasympathetic tone – Increased ICP. – Hypothyroidism – Hypothermia – Hyperkalemia – Hypoglycemia – Drug therapy 65
  • 66. Bradycardias (2) • Treat only symptomatic bradycardias – Ask if the bradycardia causing the symptoms • Recognize the red flag bradycardias – Second degree type II block – Third degree block 66
  • 67. Transcutaneous pacing (1) • Class I for all symptomatic bradycardias • Always appropriate • Doesn’t always work • Technique – Attach pacer pads – Set a rate to 80 bpm – Turn up the juice (amps) until you get capture • Painful – may need sedation / analgesia 67
  • 68. Transvenous Pacing (2) • Invasive • Time-consuming to establish • Skilled procedure • Better long-term than transcutaneous • May have better capture than transcutaneous pacing 68
  • 69. Bradycardia Treatment • Medications –Vagolytic • Atropine –Adrenergic • Epinephrine • Dopamine 69
  • 70. 29 yo asymptomatic female What is the rhythm? What is the management? 70
  • 71. 1° AV block • Regular rate and rhythm • Normal P wave with long PR interval (>0.2msec/1 big box) • Normal QRS 71 Note: No emergent treatment needed (asymptomatic) Follow bradycardia algorhitm if unstable
  • 72. 58yo asymptomatic woman 72 What is the rhythm? What is the management?
  • 73. 2° AV Block - Type I • aka Wenckebach • Regular rate and rhythm • Normal P waves and QRS complexes • Increasing PR interval until QRS dropped 73 May be bradycardic. No ACLS interventions indicated (asymptomatic)
  • 74. 80 yo man with syncope 74 What is the rhythm? What is the management?
  • 75. 2° AV Block – Mobitz Type II 75 • Regular atrial rate with normal P wave • Consistent PR interval • Random QRS dropped Note: Follow bradycardia algorithm – prepare for pacing even if asymptomatic as this block can worsen
  • 76. Another 80 yo man with syncope What is the rhythm? What is the management? 76
  • 77. 3° AV Block • Normal P waves • Normal QRS • No relationship between P and QRS • aka complete heart block 77 NB: Follow bradycardia algorithm. Will need to be paced. May also have wide complexes if escape rhythm is present
  • 78. Know When To Stop • With return of spontaneous circulation • No ROSC during or after 20 minutes of resuscitative efforts – Possible exceptions include near-drowning, severe hypothermia, known reversible cause, some overdoses • DNR orders presented • Obvious signs of irreversible death 78 N.B. For out-of-hospital providers also include transfer of care, danger to providers, etc
  • 79. Take Home Points • Assess and manage at every step before moving on to the next step • Rapid defibrillation is the ONLY effective treatment for VF/VT • Search for and treat the cause • Treat the patient not the monitor • Reassess frequently • Minimize interruptions to chest compressions 79
  • 80. 80 End of ACLS CE Part I THANK YOU FOR YOUR ATTENTION To follow: Part II ACLS in Acute Coronary Syndromes / Cardiac Arrest •Importance of CPR / BLS in most current (2010) AHA ACLS •Relationship of the chain of survival to successful resuscitation of the cardiac arrest patient •Discuss the interventions required to ensure good outcomes with Return of Spontaneous Circulation (ROSC) Part III •Defibrillation and ACLS Drug Therapy Reference resources and further study: ACLS Study Guide - ECG STRIP INTERPRETATION.pdf ACLS Rhythms for the ACLS Algorithms.pdf http://acls-algorithms.com/ Website, including Megacode simulator