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12 Lead EKG Interpretation. Essentially speaking. 12-lead EKG interpretation has been a lifelong partner of the Emergency Physician in patient assessment. Many EP’s, though, are not STARS at 12 lead EKG interpretation. X. WHY?????. Because most EKG courses are too long,

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12 Lead EKG Interpretation


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    1. 12 Lead EKG Interpretation Essentially speaking...

    2. 12-lead EKG interpretation has been a lifelong partner of the Emergency Physician in patient assessment

    3. Many EP’s, though, are not STARS at 12 lead EKG interpretation X

    4. WHY?????

    5. Because most EKG courses are too long, too boring, and teach absolutely unnecessary and unrememberable stuff in ways that make students just regurgitate the material

    6. What am I NOT talking about? • Advanced rhythm assessment • Ventricular tachycardia assessment • Vtach vs. SVT assessment • Block

    7. Augustus Waller

    8. Augustus Waller

    9. Einthoven Netherlands – ECG 1895

    10. Einthoven String Galvanometer

    11. Einthoven

    12. Fowler’s Prime Directive of Cardiac Emergencies: Some systole is better than no systole at all

    13. Pulseless Rhythms CPR, Shock, Intubate with CPR, Epi q 3, Shock, Amio or Lidocaine then ?? CPR, Shock, Intubate with CPR, Epi q 3, Shock, Amio or Lidocaine then ?? Intubate, IV, Epi q 3, Consider Atropine, Look for cause

    14. Second point: Much of what we call “12 lead interpretation” is in fact actually rhythm strip interpretation. …such as, for example, the evaluation of AV block, which can usually be done in one, or at most, two leads

    15. Third point: AXIS INTERPRETATION IS BORING!! Hence, I will make it VERY short!

    16. As the lead sees the impulse growing (or “coming toward it”), the machine records an upward deflection Positive

    17. As the lead sees the impulse coming then going (or “going by the lead”), the machine records an isoelectric deflection Positive

    18. As the lead sees the impulse coming then going (or “going by the lead”), the machine records an isoelectric deflection Positive

    19. + Lead I Lead II Lead III + +

    20. The EKG Basic Limb Leads + I II III + +

    21. Lead I is “horizontal”, and is arbitrarily established at “0 Degrees” + Lead III is 120 degrees from Lead I, and is arbitrarily established at “Positive 120 Degrees” Lead II is 60 degrees down from Lead 1 and is arbitrarily established at “Positive 60 Degrees” + +

    22. + Lead I Augmented Limb Leads avL avR Lead II Lead II avF Added by Goldberger in 1942 + +

    23. + Lead I + + Augmented Limb Leads Lead II Lead II + + + Frontal Plane

    24. V6 V5 V4 V1 V2 V3 Added by AHA and the Cardiac Society of Great Britain 1938

    25. The Leads may be moved to the center of the chest I + I + II III III II + + + +

    26. Axis is based on the direction of the heart’s depolarization + I II III + +

    27. I + I II II III III + +

    28. I + I II II III III + +

    29. I + I II II III III + +

    30. Rhythm strip interpretation has been a standard for emergency medicine since the inception of the monitor

    31. Basic Rhythm Strip Interpretation • Rate • Rhythm • P Waves • PR Interval • QRS Complex • ST Segment • T Wave • U Wave • Summary

    32. “Cherchez la P”

    33. Rate Rhythm P PR QRS ST T U Assessment Axis Hypertrophy Infarction

    34. Since serious rhythm disturbances are the most important issue (like VF, VT, asystole), then if you see a serious rhythm disturbance proceed with rhythm strip interpretation FIRST!!!

    35. Normal EKG?

    36. Understanding the Anatomy Is the Key

    37. The coronary circulation

    38. The coronary arteries supply the three main walls of the heart