EKG ‘s Simplified: Understanding and Reading EKG Monitoring Strips : EKG ‘s Simplified: Understanding and Reading EKG Monitoring Strips By: Sherrie J. Bazin, BSN, RN
Outline of Course : Outline of Course Objectives of the course
Literature for review
Basic cardiac monitoring
Atrial arrhythmias
Junctional arrhythmias
Ventricular arrhythmias
Atrioventricular blocks
Pacemakers and electrolytes
Review and test
Objectives of the Course : Objectives of the Course Understand basic heart function.
Understand cardiac monitoring functions.
Recognize abnormal heart rhythms.
Understand basic causes of abnormal rhythms.
Obtain knowledge of treatment of abnormal rhythms.
Sinus Node Arrhythmias : Sinus Node Arrhythmias Sinus Arrhythmias are part of the basic cardiac monitoring section-these are the more common waveforms.
The SA Node is the pacemaker.
Usually changes in blood supply or the autonomic nervous system (ANS) would produce these waves.
Types of Sinus Node Arrhythmias : Types of Sinus Node Arrhythmias Sinus Arrhythmia
Bradycardia
Tachycardia
Sinus Arrest
Sinus Arrhythmia : Sinus Arrhythmia Note the somewhat even pattern but the complex is not a defined complex. The timing is consistent and even.
Sinus Arrhythmias : Sinus Arrhythmias Rate is usually within normal limits.
Rhythm is irregular and corresponds with respiratory cycle.
May be normal in athletes, children and older adults.
Rate increases during inspiration and decreases during exhalation.
Drugs such as Digoxin and Morphine can cause arrhythmias.
Sinus Arrhythmias : Sinus Arrhythmias Watch for dizziness or syncope.
Can develop suddenly in Digoxin patients.
Notify MD if patient is symptomatic or taking the medications Digoxin or Morphine.
Bradycardia : Bradycardia Notice the slow but even pattern of the complex.
Bradycardia : Bradycardia Rate is less than normal (60 bpm)
Regular Rhythm, looks like NSR but slow
P and T waves are present
If patients cannot compensate for the slower rate symptoms can include: AMS, blurred vision, chest pain, cool-clammy skin, dizziness, hypotension, dyspnea, and syncope.
Bradycardia : Bradycardia Notify MD if symptoms are present.
If symptoms are present treatments include: atropine, dopamine, epinephrine, pacing or a permanent pacemaker.
Remember stroke volume needs to compensate decreased rate-the body may not be able to compensate.
Tachycardia : Tachycardia Notice the even but fast pattern of the complex
Tachycardia : Tachycardia Rate is faster than normal (100-160 bpm)
Regular Rhythm, looks like NSR but fast.
P and T waves are present-but T waves may be hard to see due to the fast repeat of the complex
Tachycardia : Tachycardia Triggers: Alcohol, Nicotine, and Caffeine.
Causes can include: Heart Failure, Pericarditis, Hypovolemia, Hemorrhage, Pulmonary Embolism, Sepsis, Drug Induced, Pain, Fever and Stress.
Typically no symptoms but watch for anxiety, blurred vision, chest pain, hypotension, palpitations or syncope.
Tachycardia : Tachycardia Notify MD of rate and symptoms.
If heart failure is developing sign to watch for are jugular vein distention and crackles.
Treatment is to correct underlying cause: beta blockers and/or calcium channel blockers.
Stop trigger agents.
Sinus Arrest : Sinus Arrest Note prolonged lapse in impulse-this is a missing complex.
Sinus Arrest : Sinus Arrest Regular rhythm except for the missing complex.
P waves can be missing, but normal when present.
QRS complexes are normal when present.
Watch for absent heart sounds and pulse, low BP, AMS, cool-clammy skin, syncope, dizziness or blurred vision.
Sinus Arrest : Sinus Arrest Causes: Acute Inferior MI, myocarditis, CAD, HTN, infection, sick sinus syndrome, and drugs-amiodarone, beta-blockers, calcium channel blockers, digoxin, procainamide and salicylate toxicity.
Notify MD and protect patient from risk of injury from falls, discontinue blockers and digoxin.
References : References Template by: www.presentationmagazine.com
http://www.unm.edu
http://ems12lead.com
http://www.valuemd.com
http://www.dearnurses.com/ (excellent illustrations of problems)
http://www.rnceus.com (great resource for EKG practice)
http://www.emedu.org/ (excellent 12 lead EKG’s)