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Basic dysrhythmia interpretation

easy way to learn how to interpret the basic dysrhythmia ECG

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Basic dysrhythmia interpretation

1. 1. Basic Dysrhythmia Interpretation Presented by : Rina Hadi Abdullah Lestari CRN/ACLS Instructor/Nursing Director Secretary
2. 2. Heart
3. 3. Recording of the ECG
4. 4. • P wave represents atrial activation (0.08 - 0.10s) • PR interval is the time from onset of atrial activation to onset of ventricular activation. (0.12 - 0.20s) • QRS complex represents ventricular activation (0.06 - 0.10s) • QT interval is the duration of ventricular activation and recovery (≤ 0.44 s)
5. 5. Calculating Heart Rate Several method can be used including: • 6-second interval X 10 method • 300,150,100,75,60,50 Method • 1500 method • Rate calculator
6. 6. Lets Have A Deal …!!!! • Normal P, normal P-R, normal QRS, normal P:QRS ratio = Sinus …… • Problem in the P wave = Atrial ……… • Problem in the QRS = Ventricular ……… • More P waves than QRS = 2nd or 3rd Degree AV Block. • Fibrillation = always irregular
7. 7. ECG - Analysis • Use a consistent method to analyze an ECG – Rate – Rhythm – Assess P wave – Assess P wave to QRS ratio 1=1 – Interval duration
8. 8. Sinus Rhythm 1- Sinus Rhythm ( the only normal one ) • Rate 60-100 bpm • Regular • Normal identical P waves • P-R interval Normal • Each P followed by a QRS • Normal QRS Normal QRS PR interval
9. 9. Normal Sinus Rhythm
10. 10. 2-Sinus Tachycardia • Same as SR but the rate is > 100 • Regular • Normal identical P waves • P-R interval Normal • Each P followed by a QRS
11. 11. 3- Sinus Bradycardia • Same as SR but the rate is < 60 • Regular • Normal identical P waves • P-R interval Normal • Each P followed by a QRS
13. 13. Atrial Arhythmias • General Characteristics 1. Abnormal P wave. 2. Multiple Foci. 3. Regular or Irregular 4. Fast most of the time
14. 14. 1- Atrial Fibrillation • Always irregular • No P wave ( can not be determined ) • Normal QRS Unequal R-R = irregular
15. 15. Atrial Fibrilation
16. 16. 2- Atrial Flutter • Mostly regular, but it can be irregular • No P wave but saw-toothed wave ( F wave ) • Normal QRS ٍSaw toothed Normal QRS
17. 17. Atrial Flutter
18. 18. 3- Atrial Tachycardia • Some times it is called Supraventricular Tachycardia ( SVT ). • Very fast rate > 150 bpm. • Narrow QRS. • No P wave.(Shaped like an umbrella ) No P wave Narrow QRS Very fast
19. 19. Atrial Tachycardia
20. 20. Ventricular Rhythms • General characteristics 1. Wide QRS. 2. NO P wave 3. Mostly very fast 4. Could be Lethal
21. 21. Idioventricular Rhythms • Regular • No P wave • Wide QRS • Rate 20-40 No P wave
22. 22. • Premature = comes early with bizarre shape. • Most of the time accompany sinus rhythm. 1- Premature Ventricular Contraction ( PVC ) PVCs ( early, wide and bizarre)
23. 23. PVCs … continued 2- unifocal vs. multifocal Unifocal multifocal
24. 24. PVCs … continued 3- Couplets 4. Bigeminy Couplets Every other beat is PVC
25. 25. PVCs…Continued 5- Trigeminy every second beat is PVC Every second beat is PVC
26. 26. 6- Ventricular Tachycardia ( V-tach.) • A whole strip with PVCs. (Wide QRS) • Rate :Rate • No P waves. • If there is no pulse, it is lethal • Always check the Pulse and BP
27. 27. Monomorphyc VT • The appearance of all the beats match each other in each lead of a surface ECG
28. 28. Polymorphic VT Torsade de pointes ( twisting of the point) has beat-to-beat variations in morphology
29. 29. 7- Ventricular Fibrillation • No P waves, No QRS, only electrical activity present. • Lethal, always check Pulse and BP
30. 30. AV Blocks • Prolonged P-R interval or more P waves than QRS • Block means DELAY.
31. 31. 1- 1st Degree AV Block • It looks like the sinus rhythm but with prolonged P-R interval.. • Normal and identical P waves. Each P is Followed by a QRS • Normal QRS. • P-R interval is > 0.20 sec. Prolonged P-R interval
32. 32. 2- 2nd Degree AV Block a- Mobitz I • Normal QRS. • Identical P waves. • P-R interval progressively prolongs until there is P not followed by a QRS P without QRS
33. 33. • Identical P waves, Not every P is followed by a QRS. • When there is a QRS, it has to be preceded by a P wave • Atrial rate is regular. • Check BP immediately. 2nd Degree AV Block a- Mobitz II Identical P waves Every QRS preceded by a P waves
34. 34. • No relationship between P waves and QRS complexes • Check the BP immediately 3rd Degree AV Block ( Complete Heart Block )
35. 35. Pulseless Electrical Activity
36. 36. No electrical Activity ( Asystole ) or Ventricular Standstill No QRS, no electrical activity, P waves may present
37. 37. Artifact Artifact occurs when something causes a disruption in monitoring. Some common causes are: • AC interference • Muscle tremors • Respiratory artifact-wandering baseline • Loose electrode • Broken lead wire
38. 38. Instant Feedback  1.Sinus tachycardia is a normal response to pain. True False 2. Sinus bradycardia is always abnormal and must be treated. True False
39. 39. 3. Instant Feedback  The hallmark sign of atrial fibrillation is: a. An irregulary rhythm b. A sawtooth pattern 4. In atrial flutter, instead of P waves there is commonly a "sawtooth" pattern seen. a. True b. False 5.Treatment is usually required if there are more than six PVCs per minute. a. True b. False
40. 40. Instant Feedback  6.In first degree AV block, the P-R interval is: a. Greater than 0.20 seconds b. Between 0.12 and 0.18 seconds 7. In a third degree heart block, the P waves are "married" to the QRS complexes. a. True b. False
41. 41. Instant feedback • 8. who am i?? • 9. give me a name please 
42. 42. Last