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ECG Overview

This document provides an overview of ECG waveforms, intervals, and heart rates, including definitions and measurements for normal conduction, bradycardia, tachycardia, and various types of AV blocks. It outlines methods for calculating heart rate and distinguishes between shockable and non-shockable rhythms in cardiac arrest scenarios. Additionally, it emphasizes the importance of recognizing different heart rhythms and their characteristics.

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jamessulu622
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3 views27 pages

ECG Overview

This document provides an overview of ECG waveforms, intervals, and heart rates, including definitions and measurements for normal conduction, bradycardia, tachycardia, and various types of AV blocks. It outlines methods for calculating heart rate and distinguishes between shockable and non-shockable rhythms in cardiac arrest scenarios. Additionally, it emphasizes the importance of recognizing different heart rhythms and their characteristics.

Uploaded by

jamessulu622
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ECG Overview

Normal conduction system


Waveforms and Intervals
ECG intervals
P– Atrial depolarisation- atrial contraction

PR- From beginning atrial contraction, delay in AV


node until start of ventricular contraction (0.12-
0.2sec)

QRS- Ventricular depolarisation-ventricular


contraction (<0.9)

T- Ventricular repolarisation
Measuring time on ECG paper

• 1 “little box” = 0.04 seconds


• 1 “big box” = 0.2 seconds
• 5 “little boxes” = 1 “big box”
• 5 “big boxes” = 1 second
Normal QRS
• Normal QRS <0.09 seconds
• 1 small square= 0.04 seconds

• >0.09 wide complex


Wide or narrow complex?
Rate
• Rule of 300

Take the number of “big boxes” between QRS


complexes and divide this into 300
= approximation of rate

Quick method but only works for regular


rhythms.
What is the heart rate?

[Link]

(300 / 6) = 50 bpm
What is the heart rate?

(300 / 1.5) = 200 bpm


Normal Heart Rates Children
• Neonate: 100-205
• Infant: 100-180
• Toddler: 98-140
• Pre-schooler: 80-120
• School age: 75-118
• Adolescent: 60-100
Normal Sinus Rhythm

• Rate is age dependent


• Normal P
• Normal QRS
• Regular R-R
• P:QRS =1:1
Recognition Bradycardia
• Sinus Bradycardia
• AV block (atrioventricular block)

• HR: slow for age


• P may or may not be visible
• QRS may be narrow or wide
• P wave and QRS may not be related

• Check for poor perfusion


Sinus Bradycardia

•Lower than normal Heart rate for age


•Normal P
•Normal QRS
•Regular R-R
AV Nodal Blocks
•Delay conduction of impulses from
sinus node

• If AV node does not let impulse


through, no QRS complex is seen

• AV nodal block classes:


1st, 2nd, 3rd degree
AV Block

1st degree AV block

2nd degree AV block type1 Wenckebach

2nd degree AV block Mobitz type 2

3rd degree AV block


Sinus Tachycardia

•Higher than normal HR for age


•Normal P
•Normal QRS
•Regular R-R
SVT: Criteria (children)
• Rate>220 infants Usually >180 children

• P wave may be absent, may be buried in


QRS
• R-R often constant
• QRS usually narrow
• May be stable or unstable
Ventricular Tachycardia

• Rate is > than 120 bpm


• No P waves Wide QRS
• If pulseless- shockable
•If VT with a pulse consider cardioversion
Torsades de Pointes

• Occurs secondary to prolonged


QT interval
•Shockable
Ventricular Fibrillation

Disorganized activity of ventricle

Ventricular fibrillation = no cardiac output

Always shockable
Questions to ask
1. Is there a pulse?

[Link] the rate slow or fast?

3. Is the rhythm regular/irregular?

4. Is the QRS complex narrow or wide?

5. Are there P waves?

6. Relationship between the P waves and QRS


complexes?
Asystole

• No pulse (check leads)

• Begin CPR
PEA Pulseless electrical activity
• No palpable pulse

• Begin CPR
Shockable and non shockable rhythms
in cardiac arrest

Activate
emergency
response
Begin CPR
NON-
SHOCKABLE SHOCKABLE
VF Asystole
Pulseless VT PEA
Recognise
• Sinus rhythm
• Bradycardia
• SVT
• VT
• VF
• PEA

• Check pulse and perfusion


THANK YOU

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