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ECG

Transcript: ELECTRICAL CELLS pacemaker cells automaticity and conductivity generation and conduction of electrical impulses CARDIAC CELLS II (+) electrode V6 25 sm The limb electrodes RA - On the right arm, avoiding thick muscle LA – On the left arm this time. RL - On the right leg, lateral calf muscle LL- On the left leg this time. LL 5 Presented by: EMERGENCY ROOM DEPARTMENT Iligan Medical Center Hospital San Miguel Village, Pala-o, Iligan City Location: Right atrial wall inferior to the opening of SVC Function: Dominant pacemaker Physiologic heart rate Inherent rate: 60-100 beats/minute LEADS V1,V2,V3,V4,V5,V6 THEY ARE PLACED DIRECTLY ON THE CHEST. BECAUSE OF THEIR CLOSE PROXIMITY OF THE HEART, THEY DO NOT REQUIRE AUGMENTATION. Inferior to be continued... 25 sm HOW TO DO ELECTROCARDIOGRAPHY Sinus Node Standard Limb Leads Surface viewed Inferior 0.20s 1 The 6 chest electrodes V1 - Fourth intercostal space, right sternal border. V2 - Fourth intercostal space, left sternal border. V3 - Midway between V2 and V4. V4 - Fifth intercostal space, left midclavicular line. V5 - Level with V4, left anterior axillary line. V6 - Level with V4, left mid axillary line. The Electrocardiogram Analyzing a Rhythm Strip Atrial depolarization ANALYZING A RHYTHM STRIP Lead Left leg 1 The Electrical Conduction System Regularly Irregular V3 Right and Left (-) electrode Left arm Irregularly Irregular The Different Views Reflect The Angles At Which LEADS "LOOK" At The Heart And The Direction Of The Heart's Electrical Depolarization. Contraction of atria - P wave Ventricular depolarization - QRS complex Ventricular repolarization - T wave The ECG 12-lead system LA aVR aVL aVR aVF aVL LL Lateral RL V5 Note: Place the sensors on a smooth fleshy area of the upper arms and lower legs. Attach the limb leads. Left arm AV Node Assess the Rhythm 0.04 25 sm Left leg 25 sm MYOCARDIAL CELLS working cells mechanical cells contractility contraction and relaxation 4 Location: Interventricular septum Inherent rate: 20-40 beats/min Escape pacemaker 2 Records the hearts electrical activity The diagnostic tool of choice in order to investigate cardiac arrhythmias in most patients noninvasive and readily available THE SHAPE OF ECG V2 Time II 1 Record of electrical activity between 2 electrodes Has a negative (-) and positive (+) pole Types: 1. Standard limb leads 2. Augmented leads 3. Precordial leads (chest leads) 1. Place the patient in a supine or semi-Fowler's position. If the patient cannot tolerate being flat, you can do the ECG in a more upright position. 2. Instruct the patient to place their arms down by their side and to relax their shoulders. 3. Make sure the patient's legs are uncrossed. 4. Remove any electrical devices, such as cell phones, away from the patient as they may interfere with the machine. 5. If necessary shave the electrode areas before cleaning the exposed skin with alcohol for proper electrode adhesion. 6. If you're getting artifact in the limb leads, try having the patient sit on top of their hands. Causes of artifact: patient movement, loose/defective electrodes/apparatus, improper grounding. RA Sino-Atrial Node The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle. Each event has a distinctive waveform the study of waveform can lead to greater insight into a patient’s cardiac pathophysiology. Bundle Branches (right and left) ECG Paper PRECORDIAL LEADS AV Junction 1 1 small square = 0.04 sec = 1 mm = 0.1 mV 1 big square = 0.2 sec 5 big squares = 1 sec 300 big squares = 1 min Ventricular Muscle CARDIAC CELLS These leads help to determine heart’s electrical axis. The limb leads and the augmented limb leads form the frontal plane. The precordial leads form the horizontal plane. Surface viewed Bundle of His What is an ECG? III Right arm Network of conducting strands beneath the ventricular myocardium Inherent rate: 20-40 beats/min Escape pacemaker Provides information about: Orientation of the heart in the chest Conduction disturbances Electrical effects of medications and electrolytes Presence of ischemic changes The ECG Waveforms BASIC ECG 1 Left arm I Learning Objectives (+) electrode RA Inferior The Electrocardiogram Left leg Assess the Rhythm V4 Atrioventricular node Lead The ECG Waveforms III Purkinje Fibers 3 V1 Voltage 25 sm Sino-atrial node 1mm or 0.1mV Rate, Rhythm and Waveforms aVF Right arm Define ECG and its importance Familiarize the Anatomy and Mechanism of Heart and its Conduction system Define terms related to ECG Demonstrate the proper ECG procedure and its Nursing Considerations Identify basic steps in analyzing a rhythm Identify common rhythm disturbances. Placement of electrodes Ventricular repolarization Augmented Leads The ECG and the 12-lead system Ventricular depolarization ANALYZING A RHYTHM STRIP LA Bundle of His Assess the Rhythm Measure the distance between 2 consecutive R-R intervals and compare that distance with the other R-R intervals PACEMAKERS OF THE HEART

ECG Presentation

Transcript: Presented by Emerald Communications Group Advertise in the UDK, the LJWorld, and Lawrence.com Place flyers in businesses around Lawrence Top Tweeter and guest of their choice. Top Pinterest Pinner and guest of their choice. Night-goers Social event Mixologists Local chefs and food makers Goal #3: Increase engagement and interaction between makers and guests. Strengths: Innovative Creative Inspiring Day Attendance Live tweeter Feature prominent makers on Twitter Maker hashtags “Maker of the Week” Tweet 2 to 3 times each day Post on FB 2 to 3 times each day Mission Statement: Threats: Same weekend as Kanrocksas Perception that the term maker only applies to one category Finding a way to advertise to a broad audience Night Attendance SWOT Analysis: Twitter Increase social media presence Target Audiences Day-goers Engagement and interaction on Facebook and Instagram "The Greatest Show and Tell on Earth" Goal #2: Increase attendance at Maker Faire: Kansas City 2013 by at least 25 percent. Welcome to Maker Faire: Kansas City 2013 Opportunities: Create and establish relationships between prospective makers, makers and the community Connect with the community and makers through social media Connect Kansas City with the make movement Increase touch-points between both KU students and the Lawrence community Headliner Local record holder Lego Crown Center Sweepstakes We strive to bring innovation, inspiration and creativity to our clients. We aim to facilitate conversation and transform our clients' ideas into reality. Sweepstakes Weaknesses: Insufficient use of social media Perceived as a kids only event Lack of awareness Remind attendees to tag Maker Faire: Kansas City in pictures and posts Reinforce attendees to use the hashtag #makesomething when posting pictures Creative Message: Goal 1: Increase the general awareness of Maker Faire: Kansas City especially among the Lawrence community and KU campus.

ECG

Transcript: When T wave inversion is normal: Inversion in V1 is common--but compare with previous ECG Inversion after STEMI this is EXPECTED and is a sign of reperfusion ST Elevation V2-V6, lead 1 and aVL with reciprocal depression in lead 2, 3, aVF. Hyperacute T waves Normal Knowing which part of the heart each lead sees can help identify where a problem is occurring http://3.bp.blogspot.com/-d5LHPGVUKLU/TzBuiZ4uYTI/AAAAAAAABMY/vbLRI5oGN-4/s1600/Initial+ECG.jpg http://www.publicsafety.net/image/precord_view.gif http://cardiophile.org/wp-content/uploads/2009/02/lateral-wall-ischemia-small.jpg UP! Objectives Can appear horizontal, up or down slopping off of ST segment http://lifeinthefastlane.com/wp-content/uploads/2012/01/AMI-ST-elevation-3.png EITHER! Arrows show which direction the QRS should be pointing primarily if depolarization is normal Lead 1 through AVF: "Up, always, sometimes, never, either, up" Precordial leads should progress downward to upward Lead placement is important http://i.istockimg.com/file_thumbview_approve/2436356/2/stock-photo-2436356-pink-gerbera-flower-from-3-different-angles.jpg Represents supply and demand ischemia Slightly asymmetrical Upright V2-V6 ALWAYS subordinate to QRS BLUE: part of the heart each lead capture RED: vessels located in this area Contingent leads: same background color 12 Lead ECG Analysis ALWAYS! (up) This chart is located by the original monitors at the front desk for your reference Bundle Branch Block QRS 0.12 sec or greater Review V1 and V6 for differentiation RBBB- V1 up, V6 up LBBB- V1 down, V6 up T wave inversion Electrode placement is IMPORTANT! T Wave Review of PESI Healthcare course "ECG Interpretation: Essential Skills & Treatment Protocols" by Cynthia Webner DNP, RN, CCNS, CCRN-CMC and Karen M. Marzlin DNP, RN, CCNS, CCRN-CMC Elevation http://www.ecglibrary.com/ecgs/norm.gif Summary and Application ST depression can indicate: ischemia reciprocal change to ST elevation ST depression can be visible in reciprocal leads to those with ST elevation *If you see depression, double check reciprocal leads for elevation Normal http://www.emedu.org/ecg/images/cond_2a.jpg SOMETIMES! (up) Normal Sinus Rhythm UP! Use contingent leads to help confirm suspicions RBBB Anatomical placement of leads makes a difference in the picture you are taking. Example: You see ST depression in leads 1 and aVL. Look at leads 2,3, AVF for ST elevation. Abnormal LBBB ST Depression Associate correct lead placement with ECG accuracy Use provided chart to identify: each lead's view of the heart lead normals contingent leads Associate lead views with appropriate bedside monitor primary lead choice Analyze ECG by following given steps rSR' pattern example Same example as earlier, but note ST depression in leads 2, 3, aVF with ST elevation in the reciprocal leads of I and AVL. http://nl.ecgpedia.org/images/thumb/d/d4/12leadLBTB.png/800px-12leadLBTB.png Infarction http://emj.bmj.com/content/17/1/40/F10.medium.gif Reciprocal http://12leadecg.com/intro/images/ECG/12841_01_0561A.gif Break Down http://3.bp.blogspot.com/_ES0GyVWZYyw/SZb-xYqlM0I/AAAAAAAAAEU/6LZQ9zaIVZQ/s1600/Second%2BEKG%2Bnow%2Bwithout%2BST%2Bdepression.png Use these steps for thorough ECG analysis Familiarizing with norms can help with abnormal identification http://lifeinthefastlane.com/wp-content/uploads/2011/12/normal-sinus-rhythm.jpg Apply when choosing a primary lead on the bedside monitor that is most appropriate for your patient's condition Abnormal You can use this chart to identify: where in the heart the lead is showing contingent leads QRS norms leads to identify BBB http://ecg.utah.edu/img/items/ST%20segment%20depression%20morphologies.jpg http://static.memrise.com/uploads/mems/7914000110501182002.gif http://12leadecg.com/intro/images/ECG/12841_01_0559A.gif NEVER (up)! T wave inversion can signal NSTEMI with positive trops or unstable angina (ischemia) with negative trops QRS Hyperacute T waves (sharp angulation) can be an early sign of STEMI ST elevation requires immediate reperfusion Normal Sinus Rhythm Represents a need for reperfusion with a cath or lytic http://ars.els-cdn.com/content/image/1-s2.0-S0147956311005553-gr2.jpg 12 Lead ECG Evaluation http://ars.els-cdn.com/content/image/1-s2.0-S0147956311005553-gr2.jpg ST elevation V1-V5, slight lead 1 and aVL.

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