Basic ECG 1
AO WONG Ning
Objective
基礎心臟生理 Narrow complex Rhythms
基本判讀 (Rate, P, PR I, QRS, Normal: Sinus
QT I, J point, ST)
Tachy: Afib, A flutter, SVT
Normal Sinus
Brady: Heart Blocks
12-lead interpretation
Abnormal: Junctional, PAC
STEMI
Broad Complex Rhythms
Arrest Rhythms(pVT, VF, PEA,
Asystole) Tachy: VT/VF
5H5T Brady: IVR, AIVR
Abnormal: BBB, PVC
Pacemaker
點解要學? 點解要做?
無protocol要求識睇ECG
有DM會自己判斷係唔係STEMI
咁點解要學?
案例 1
案例 2
開call Dizzy
到場，屋村街邊，伯伯坐電動輪椅，由輪椅跌左落地。頭附
近有已經乾左的血跡，目測大概20ml, Small Laceration
wound on forehead。
伯伯LOC Slightly Drop, No neck pain
BP 67/38
案例 3
開call 頭暈
伯伯睇電視中頭暈，由坐位Sir落地。現在訓在床上，GCS
356，全身冷汗，pale cool clammy，同你講好暈無晒力。
V/S: RR20 shallow, SpO2 RA 86, Pulse 46 very weak
irregular,
BP 125/86, GCS 356, Skin pale cool clammy
Hx: Arrthymia, COAD, DM
點解唔做?
無Protocol?
無用？ [Link]
唔識？
怕尷尬？
12 Lead ECG 有可能有 false negative
心律不正有可能非常危險
醫護人員應有的知識
Clinical Reasoning
Decision Making
幾時需要做ECG?
Chest Pain
Abnormal Pulse – Brady,
Tachy, Irregular
Pleth abnormal
主管覺得需要時
基礎心臟生理
Normal sinus
基本判讀
Rate
Anything irregular?
P wave? QRS? T wave?
PR interval? QT interval?
J point
ST Segment
Rate
Rate
6秒法
數大格法
用300除大格法
P wave
0.08-0.1 s (2 細格)
Up
Atrial depolarization 心房去極化
QRS Complex
0.06-0.12 s (3-4 細格)
Q: First negative deflection
R: First positive deflection
S: First negative deflection
below baseline after R
T wave
Normally Up
0.1-0.25 s (2-6 細格)
Ventricular repolarization
PR interval
0.12-0.2s (3-5 細格)
Electrical impulse from SA node to Bundle of His
QT interval
Should be < than half of
preceding RR’
Time between ventricular
depolarization and
termination of repolarization
ST Segment & J point
基本判讀
Rate • 60-100
Anything irregular? • irregular?
P wave?
• P (2 細格)
QRS?
• QRS (3-4 細格)
T wave?
• T (2-6 細格)
PR interval?
QT interval?
• PR I (3-5 細格)
J point • J point at baseline?
ST Segment • ST Segment at baseline?
Irregular?
Normal Sinus竇性心律
Rate • 60-100
Anything irregular?
• Regular
P wave?
• P (2 細格)
QRS?
T wave? • QRS (3-4 細格) following P
PR interval? • T (2-6 細格) following QRS
QT interval? • PR I (3-5 細格)
J point
• J point at baseline
ST Segment
• ST Segment at baseline
Sinus Tachycardia竇性心搏過速
Rate • >100
Anything irregular?
• Regular
P wave?
• P (2 細格)
QRS?
T wave? • QRS (3-4 細格) following P
PR interval? • T (2-6 細格) following QRS
QT interval? • PR I (3-5 細格)
J point
• J point at baseline
ST Segment
• ST Segment at baseline
Sinus Bradycardia竇性心搏緩慢
Rate • <60
Anything irregular?
• Regular
P wave?
• P (2 細格)
QRS?
T wave? • QRS (3-4 細格) following P
PR interval? • T (2-6 細格) following QRS
QT interval? • PR I (3-5 細格)
J point
• J point at baseline
ST Segment
• ST Segment at baseline
Practice
Heart Rate Calculations
基本判讀
Rate • 60-100
Anything irregular? • irregular?
P wave?
• P (2 細格)
QRS?
• QRS (3-4 細格)
T wave?
• T (2-6 細格)
PR interval?
QT interval?
• PR I (3-5 細格)
J point • J point at baseline?
ST Segment • ST Segment at baseline?
閱讀ECG
正常?
邊到唔正常？
點樣唔正常?
44
Practice
Come out and draw
STEMI
12 Lead
Positive & Negative Deflection
LA
RA
Lead III
LL
RL
V6
V5
V4
V3
V2
V1
12 Lead
I (LCX) aVR V1 (LAD) V4 (LAD)
Lateral Septum/ Anterior Anterior
II (RCA) aVL (LCX) V2 (LAD) V5 (LCX)
Inferior Lateral Septum/ Anterior Lateral
III (RCA) aVF (RCA) V3 (LAD) V6 (LCX)
Inferior Inferior Anterior Lateral
Lateral Wall:
I, aVL, V5, V6
Inferior Wall:
II, III, aVF Septum: Anterior Wall:
V1, V2 V1-V4
ECG progression of MI
Real Case
CC Vomit and stomach discomfort
Just finished swimming
Pale and wet, H’stix 13.4, P 50, SpO2 98, BP
109/69
Hx: HT, DM
LOC drop after chest pain, found drowsy
Kidney disease, no cardiac history, BP 97/58，
HR 48
Cardiac Arrest Rhythm
Ventricular Tachycardia (VT)
Ventricular Fibrillation(VF)
Ventricular Tachycardia
Regular, broad complex tachycardia
Rate > 100 bpm
Can be Monomorphic(單形) / Polymorphic(多形)
Monomorphic
Polymorphic
Torsades de pointes
Ventricular Fibrillation (VF)
Chaotic irregular deflections of varying amplitude
No identifiable P waves, QRS complexes, or T waves
Rate 150 to 500 per minute
Amplitude decreases with duration (coarse VF –> fine VF)
Ventricular Fibrillation (VF)
Pulseless Electrical Activity
(PEA)
Any organized rhythms
(except VT) on the ECG
monitor
But without a palpable pulse
No ventricular activity/
ventricular activity too weak
Asystole
Complete absence of ventricular
electrical activity
Heart is no longer contracting
P waves may occasionally be
seen
Reversible cause for Cardiac Arrest
5H5T
5H Corresponding Treatment 5T Corresponding Treatment
Hypovolemia Blood transfusion Toxins Antidote
Hypoxia Ventilation Tamponade -Pericardiocentesis
-Thoracotomy
Hydrogen Ion Sodium bicarbonate Tension -Needle decompression
(Acidosis) pneumothorax -Chest drain
Hyper/ Calcium/ Thrombosis Percutaneous coronary
hypokalemia Potassium (Cardiac) intervention
Hypothermia Active warming Thrombosis Anticoagulant
(pulmonary)