Arrythmia recognition recently altered.ppt
- 1. Arrhythmia Recognition An Emergency View Dr Hari Hara Sudhan C
- 3. Normal Impulse Conduction Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers
- 4. The “PQRST” • P wave -Atrial depolarization • T wave - Ventricular repolarization • QRS - Ventricular depolarization
- 7. 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.
- 8. Step 1: Calculate Rate •Option 1 •Count the # of R waves in a 6 second rhythm strip, then multiply by 10. •Reminder: all rhythm strips in the Modules are 6 seconds in length. Interpretation? 9 x 10 = 90 bpm 3 sec 3 sec
- 9. Step 1: Calculate Rate •Option 2 •Find a R wave that lands on a bold line. •Count the # of large boxes to the next R wave. If the second R wave is 1 large box away the rate is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes - 75, etc. (cont) R wave
- 10. Step 1: Calculate Rate • Option 2 (cont) • Memorize the sequence: 300 - 150 - 100 - 75 - 60 - 50 Interpretation ? 3 0 0 1 5 0 1 0 0 7 5 6 0 5 0 Approx 1 box less than 100 = 95 bpm
- 11. Step 2: Determine regularity •Look at the R-R distances (using a caliper or markings on a pen or paper) •Regular ? •Occasionally irregular ? •Regularly irregular ? •Irregularly irregular ? Interpretation ? Regular R R
- 12. 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 QRS
- 13. Step 4: Determine PR interval • Normal : 0.12 - 0.20 seconds. (3 - 5 small boxes) Interpretation? 0.12 seconds
- 14. Step 5 : QRS duration • Normal : 0.04 - 0.12 seconds. (1 - 3 small boxes) Interpretation ? 0.08 seconds
- 15. Rhythm Summary •Rate 90-95 bpm •Regularity regular •P waves normal •PR interval 0.12 s •QRS duration 0.08 s Interpretation ? Normal Sinus Rhythm
- 16. ELECTROCARDIOGRAM “5” steps approach to arrhythmias Step1: Is there a “QRS” Step2: Is there a “P” Wave Step3: What is the relationship between the P waves and the QRS complexes? Step4: Calculate rate Step5:Miscellaneous
- 17. 3)What is the relationship between the P waves and the QRS complexes?
- 19. < 0.2 Normal > 0.2 Io AVB Constant ? Yes IIo AVB type 2 No RR interval Yes IIIoAVB No Type1 IIo PR interval PR interval HEART BLOCK n“P” = n“QRS” ? No Yes Constant?
- 20. 1st Degree block (AV Nodal Delay)
- 21. P-R Interval IST Degree heart block n“P” = n“QRS” ? P-R interval is >0.2 Sec
- 23. IIIrd Degree heart block n“P” is not equal to n“QRS”? PR intervals are not constant RR intervals are constant
- 25. n“P” is not equal to n“QRS”? PR interval is constant
- 28. 2nd Degree Type-II n“P” is not equal to n“QRS”? PR intervals are constant
- 38. Supraventricular Tachycardia • Narrow complex • Regular Rate 140 to 220 / minute
- 39. A&E(SRMC)
- 41. No “P” & Varying “RR” interval
- 43. 1) Is there a “QRS” (No pulse) YES NO CHAOTIC FLAT LINE WIDE NARROW PEA VF Asystole VT
- 44. No “QRS” & Chaotic
- 45. No QRS & Flat line
- 46. Wide QRS
- 47. Wide QRS
- 48. Wide QRS & Polymorphic
- 49. Thank You