interpretasi ekg
DESCRIPTION
Menjelaskan cara menginterpretassikan EKG.TRANSCRIPT
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12 Lead ECG Interpretation
McHenry Western Lake CountyEMS System
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Topics
Anatomy revisitedThe 12 Lead ECG deviceThe 12 Lead ECG formatWaveform componentsLead views
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Anatomy Revisited
RCA (Right Coronary Artery)Right ventricleInferior wall of LVPosterior wall of LV (75%)SA Node (60%)AV Node (>80%)
LCA (Left Coronary Artery)Septal wall of LVAnterior wall of LVInferior wall of LVPosterior wall of LV (10%)
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Anatomy Revisited
SA nodeIntra-atrial pathwaysAV nodeBundle of HisLeft and Right bundle branches
Left anterior fascicleLeft posterior fascicle
Purkinje fibers
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12 Lead ECG Device
Device serves as a voltmeter-measures the flow of electricity
Unipolar vs. Bipolar Leads
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Bipolar Leads1 positive and 1 negative electrode
RA always negativeLL always positive
Traditional limb leads are examples of these
Lead ILead IILead III
View from a vertical plane
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Unipolar Leads1 positive electrode & 1 negative “reference point”
Calculated by using summation of 2 negative leads
Augmented limb leadsaVR, aFV, aVLView from a vertical plane
Precordial or chest leadsV1-V6View from a horizontal plane
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12 lead ECG Format
Leads that areproduced by devices used in the Pre Hospital setting
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12 Lead ECG Format
These typically are not seen Pre Hospital
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12 Lead ECG Format
Device prints out 2.5 sec of each lead.The device computer then analyzes all 10 sec of all 12 leads, but only prints 2.5 sec of each group
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12 Lead ECG Format
The computer diagnosis
is not always accurate!
Look at your ECG!
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12 Lead ECG Format
The computer is very
accurate at measuring intervals
and durations
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Waveform ComponentsR Wave
First positive deflectionR wave includes the down stroke returning to the baseline
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Waveform ComponentsQ Wave
First negative deflection before the R waveQ wave includes the negative down stroke and return to baseline
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Waveform ComponentsS Wave
Negative deflection following the R waveS wave includes departure from and return to baseline
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Waveform ComponentsQRS
Q wavesCan occur normally in several leads
Normal Q waves called physiologic
Physiologic Q waves< .04 sec (40ms)
Pathologic Q>.04 sec (40ms)
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Waveform ComponentsQRS
Q waveMeasure widthPathologic if greater than or equal to 0.04 seconds (1 small box)
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Waveform ComponentsQS Complex
Entire complex is negatively deflectedNo R wave is present
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Waveform ComponentsJ-Point
Junction between the end of QRS and beginning of ST segmentWhere QRS stops and makes a sudden sharp change in direction
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Waveform ComponentsST Segment
Segment between J-Point and beginning of T wave
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Waveform ComponentsST Segment
Need reference pointCompare to TP segmentDO NOT use PR segment as reference!
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Waveform ComponentsPractice
Find the J Point and ST segment
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Waveform ComponentsPractice
J POINTS ST SEGMENT
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Waveform ComponentsPractice
Find the J Point and ST segment
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Waveform ComponentsPractice
J POINTS ST SEGMENT
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Lead Views
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Lead Groups
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
Limb Leads Chest Leads
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Inferior Wall MI
II, III, aVFView from Left Leg ⊕inferior wall of left ventricle
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Inferior Wall MI
Posterior ViewPortion resting on diaphragmST elevation….suspect inferior injury
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Lateral Wall MI
1 and AVLView from Left Arm ⊕Lateral wall of left ventricle
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Lateral Wall MI
V5 and V6Left lateral chestLateral wall of left ventricle
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Lateral Wall MI
I, aVL, V5, V6ST elevation…suspect lateral wall injury
Lateral Wall
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Anterior Wall MI
V3, V4Lateral anterior chest+ electrode on anterior chest
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Anterior Wall MI
V3, V4ST segment elevation….suspect anterior wall injury
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Septal Wall MIV1, V2
Along sternal bordersLook through right ventricle and see septal wall
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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Septal Wall MI
V1, V2Septum is left ventricular tissue
I aVR VI V4
II aVL V2 V5
III aVF V3 V6
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ST Segment Analysis
For each complex, determine whether the ST segment is elevated one millimeter or more above the TP segment
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ST Segment Analysis
YES YES YES YES NO NO
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12 Lead ECG
AMI recognitionTwo things to know
What to look for Where you are looking
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AMI Recognition
What to look forST segment elevation
One millimeter or more (one small box)Present in two anatomically contiguous leads
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Summary
The key to 12 lead ECG interpretation for AMI are Q wave, R wave, S wave and pathologic Q wave, the J point and ST segment.Each lead looks at a specific portion of the heart through the + electrode
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Summary
Specific changes must appear in two contiguous leadsChanges seen in AMI are: tall, peaked T wave, elevated ST segment and a widened Q waveA normal 12 lead ECG does NOT rule out AMI
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Special Thanks!
To Acute Coronary Syndrome Consultants, Inc.
Tim Phalen, Gary Denton and Assoc.and Temple College for the use of their
materials in this presentation