High-Functioning-CPR59 วิทยาลัยพยาบาล.ppt

Bringing Bench to Bedside the CPR Pit Crew: High-Functioning CPR Teams ECG part Dr. Wisit Wichitkosoom. MD. Cardiac Center Udonthani HospiatlACLS : WISIT 0

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ECG inteกrำpลังrโeหลtaด…tionsACLS : WISIT 0

Learning Modules∗ ECG Basics∗ How to Analyze a Rhythm∗ Normal Sinus Rhythm∗ Heart ArrhythmiasACLS : WISIT 0

Normal Impulse Conduction Sinoatrial node AV node Bundle ofกHำisลังโหลด…Bundle Branches Purkinje fibersACLS : WISIT 0

Impulse Conduction & the ECG Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibersACLS : WISIT 0

The ECG Paper∗ Horizontally∗ One small box - 0.04 s∗ One large box - 0.20 s∗ Vertically∗ One large box - 0.5 mVACLS : WISIT 0

The ECG Paper (cont) 3 sec 3 sec∗ Every 3 seconds (15 large boxes) is marked by a vertical line.∗ This helps when calculating the heart rate.ACLS : WISIT 0

ECG Rhythm Interpretation Really Very EasyHow to Analyze a RhythmACLS : WISIT 0

Rhythm Analysis➢Step 1: Calculate rate.➢Step 2: Determine regularity.➢Step 3: Assess the P waves.➢Step 4: Determine PR interval.➢Step 5: Determine QRS duration.ACLS : WISIT 0

Step 1: Calculate Rate 3 sec 3 sec∗Option 1 กำลังโหลด…∗ Count the # of R waves in a 6 second rhythm strip,then multiply by 10.∗ Reminder: all rhythm strips in the Modules are 6seconds in length.Interpretation? 9 x 10 = 90 bpmACLS : WISIT 0

Step 1: Calculate Rate 3 117 65 0 505 00 0 00∗ Option 2 (cont)∗ Memorize the sequence: 300 - 150 - 100 - 75 - 60 - 50Interpretation? Approx. 1 box less than 100 = 95 bpmACLS : WISIT 0

Step 2: Determine regularity RR∗ Look at the R-R distances (using a caliper or markings on a pen or paper).∗ Regular (are they equidistant apart)? Occasionally irregular? Regularly irregular? Irregularly irregular?Interpretation? RegularACLS : WISIT 0

Step 3: Assess the P waves∗ Are there P waves?∗ Do the P waves all look alike?∗ Do the P waves occur at a regular rate?∗ Is there one P wave before each QRS? Interpretation? Normal P waves with 1 P wave for every QRSACLS : WISIT 0

Step 4: Determine PR interval∗ Normal: 0.12 - 0.20 seconds. (3 - 5 boxes) Interpretation? 0.12 secondsACLS : WISIT 0

Step 5: QRS duration∗Normal: 0.04 - 0.12 seconds. (1 - 3 boxes)Interpretation? 0.08 secondsACLS : WISIT 0

Rhythm Summary∗ Rate 90-95 bpm∗ Regularity regular∗ P waves normal∗ PR interval 0.12 s∗ QRS duration 0.08 sInterpretation? Normal Sinus RhythmACLS : WISIT 0

Sinus Rhythms∗ Sinus Bradycardia∗ Sinus Tachycardia∗ Sinus Arrest∗ Normal Sinus RhythmACLS : WISIT 0

Sinus rhythm Sinus bradycardiaACLS : WISIT 0

Sinus tachycardia Sinus arrhythmiaACLS : WISIT 0

Junctional rhythm rate 40-60 bpm Idioventricular rhythm rate 20-40 bpmACLS : WISIT 0

Rhythm #1• Rate? 30 bpm•• PRewgauvlaersit?y? rneogrumlaarl• PR interval? 0.12 s• QRS duration? 0.10 sInterpretation? Sinus BradycardiaACLS : WISIT 0

Rhythm #2• Rate? 130 bpm• Regularity? regular• P waves? normal• PR interval? 0.16 s• QRS duration? 0.08 sInterpretation? Sinus TachycardiaACLS : WISIT 0

Sinus Arrest∗ Etiology: SA node fails to depolarize and no compensatory mechanisms take over∗ Sinus arrest is usually a transient pause in sinus node activityACLS : WISIT 0

Rhythm #3• Rate? 100 bpm• Regularity? irregularly irregular•• PPRwainvteesrv?al? none• QRS duration? none 0.06 sInterpretation? Atrial FibrillationACLS : WISIT 0

Rhythm #4• Rate? 70 bpm• Regularity? regular• P waves? flutter waves• PR interval? none• QRS duration? 0.06 sInterpretation? Atrial FlutterACLS : WISIT 0

Atrial FibrillationACLS : WISIT 0

Narrow Complex TachycardiaRegular Irregular P before QRS: No p wave: Irregularly Irregular: Regularly Irregular:Sinus tachy SVT Afib •Aflutter with variableAtach Atach Multifocal Atach responseAflutter with 1:1 AV ?very fast AFIB •Atach with var response P>QRS: AflutterACLS : WISIT 0

Rhythm #5• Rate? 74 →148 bpm• Regularityก?ำลังโหลดRe…gular → regular• P waves? Normal → none• PR interval? 00..1068 ss → none• QRS duration?Interpretation? Paroxysmal Supraventricular Tachycardia (PSVT)ACLS : WISIT 0

Maximal sinus tach∗ 220 – age = maximum HR∗ 220 - 80 = 140∗ Unlikey this is just sinus tachACLS : WISIT 0

AV Nodal Blocks∗ 1st Degree AV Block∗ 2nd Degree AV Block, Type I∗ 2nd Degree AV Block, Type II∗ 3rd Degree AV BlockACLS : WISIT 0

Rhythm #6• Rate? 60 bpm• Regularity? regular• P waves? normal• PR interval? 0.36 s•IntQerRpSredtautrioantio?n?1st 0.08 s Degree AV BlockACLS : WISIT 0

Rhythm #7• Rate? 50 bpm• Regularity? regularly irregular• P waves? nl, but 4th no QRS• PR interval? lengthens• QRS duration? 0.08 sInterpretation? 2nd Degree AV Block, Type IACLS : WISIT 0

Rhythm #8• Rate? 40 bpm• Regularity? regular• P waves? nl, 2 of 3 no QRS• PR interval? 0.14 s• QRS duration? 0.08 sInterpretation? 2nd Degree AV Block, Type IIACLS : WISIT 0

Rhythm #9• Rate? 40 bpm• Regularity? regular• P waves? no relation to QRS• PR interval? none• QRS duration? wide (> 0.12 s)Interpretation? 3rd Degree AV BlockACLS : WISIT 0

Wide Complex tachycardia Ventricular FibrillationACLS : WISIT 0

Ventricular FibrillationRhythm: irregular-coarse or fine, wave form varies in sizeand shapeFires continuously from multiple fociNo organized electrical activityNo cardiac outputCauses: MI, ischemia, untreated VT, underlying CAD, acidbase imbalance, electrolyte imbalance, hypothermia,ACLS : WISIT 0

Ventricular Tachycardia∗ Ventricular cells fire continuously due to a looping re-entrant circuit∗ Rate usually regular, 100 - 250 bpm∗ P wave: may be absent, inverted or retrograde∗ QRS: complexes bizarre, > .12∗ Rhythm: usually regularACLS : WISIT 0

Changing Ventricular WaveformsACLS : WISIT 0

Asystole∗ Ventricular standstill, no electrical activity, no cardiac output – no pulse!∗ Cardiac arrest, may follow VF or PEA∗ Remember! No defibrillation with Asystole∗ Rate: absent due to absence of ventricular activity. Occasional P wave may be identified.ACLS : WISIT 0