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Pre-Hospital ECG Interpretation Greg Cuculino

. . When to do it. Chest pain - Duh!Abdominal pain >55 y/oHx of DM,CAD,HTN, or increased cholesterolShortness of Breath(CHF). . . What to look for. RateRhythmST segment changesElevations or depressions. . . Rate. This one is easy Too fast or too slowRemember treatment is based not on the number but the clinical scenarioA heart rate of 40 is fine if the BP and mental status is good.

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Pre-Hospital ECG Interpretation Greg Cuculino

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    1. Pre-Hospital ECG Interpretation Greg Cuculino

    2. When to do it Chest pain - Duh! Abdominal pain >55 y/o Hx of DM,CAD,HTN, or increased cholesterol Shortness of Breath(CHF)

    3. What to look for Rate Rhythm ST segment changes Elevations or depressions

    4. Rate This one is easy Too fast or too slow Remember treatment is based not on the number but the clinical scenario A heart rate of 40 is fine if the BP and mental status is good

    5. Rhythm Normal sinus rhythm A p wave for every QRS and a QRS for every p

    6. 1 degree heart block PR interval longer than 0.2 No big deal

    7. Second Degree HB Type1 (Wenckebach) Progressive lengthening of the pr interval and then a dropped beat Grouped beats

    8. Second Degree Heart Block Type 2(Mobitz II) Constant pr interval but then dropped beat

    9. Third Degree heart Block This one is an issue No correlation between the p wave and the QRS Can have junctional or ventricular escape beats NO LIDOCAINE!!!!!

    10. Quiz time

    11. SVT Narrow complex tachycardia Regular Usually no p waves

    12. Afib You guys know this one No organized p wave activity Irregularly irregular

    13. Aflutter Saw-tooth pattern Usually around 150 Regular Treat like afib

    14. Vfib This one sucks Shouldnt catch this one on ECG

    15. Vtach Wide complex tachycardia No p waves Treat based on symptoms

    16. Torsades Some magnesium please

    17. ST segment changes Measure from the TP segment Depression is ischemia Elevation is infarction

    18. How much is enough? At least 1 mm (one little box) in 2 anatomically contiguous leads Across the precordial leads :V1-V6 II,III,aVF I,aVL

    19. Location, location, location I,AVL,V5,V6 - LATERAL V1-V2 - SEPTAL V3-V4 - ANTERIOR V5-V6 - LATERAL II,III, AVF - INFERIOR IT DOESNT REALLY MATTER Except that inferior MIs are more dependent on volume status Can quickly drop BP with NTG if the patient is dehydrated

    20. Reciprocal Changes Areas opposite the heart will experience ST depressions when the other side is experiencing elevations Common to see ischemia opposite infarction Not necessary but helps confirm the diagnosis Inferior is opposite anterior and lateral

    21. Reciprocal Changes

    22. Bundle Branch Blocks The Rabbit ears V1-V2 is a RBBB V5-V6 is a LBBB QRS is>120 ms (3 little blocks) Will change the ST segments

    23. RBBB

    24. LBBB

    25. LBBB with an AMI CONCORDANT ST segment changes Usually if QRS is up, ST segment is down If QRS and ST segments are in the same direction, think MI ST segment elevations > 5mm Always a tough distinction

    26. Ant MI

    27. Inferior MI

    28. Posterior MI ST depressions and a tall R wave in V2 (flip the ECG) Associated with inferior MIs

    29. Other things to notice ECG findings that are not infarctions, but will make you look good (and possibly save a life)

    30. Hyperkalemia Like pulling on the T wave Peaked t waves Then first degree block The lose p waves and QRS widens Sine wave

    31. Hyperkalemia again..

    32. Hyperacute Ts When you see really big T waves, think of 2 things Potassium (increased) and pre-infarction

    33. Pericarditis Diffuse ST segment elevations and PR segment depression No reciprocal changes

    34. Quiz time

    35. ECGs

    36. First Degree

    37. Wenckebach

    38. Mobitz

    39. Third Degree (please dont give )

    40. SVT

    41. Afib

    42. Aflutter

    43. V Tach

    44. VFib

    45. Torsades

    46. LBBB

    47. RBBB

    48. Hyperkalemia

    49. Hyperkalemia

    50. Hyperacture Ts

    51. Ant MI

    52. Ant MI

    53. Post MI

    54. Inferior MI

    55. Pericarditis

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