The ECG Made Easy, 9e

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To do this place a piece of scrap paper over the ECG and mark a dot next to the top of a QRS complex, draw another dot next to the top of the next QRS then slide the paper along the ECG. If the rhythm is regular you should see that your two dots match to the tops of the QRS complexes throughout the ECG. There are many different systems to interpret the ECG. This system ensures you will never miss anything: When the rate is fast it can be difficult to see the irregularity but careful measurement will show it. AF is often asymptomatic and is increasingly common with age. Other common fast narrow complex tachycardias include supraventricular tachycardias (SVTs) or atrioventricular nodal re-entrant tachycardias. These are usually fast, regular rhythms associated with palpitations generally in a younger age group.

Figure 5. The axis of the heart – a useful diagram for assessing the cardiac axis using the method above. Causes of axis deviation Left axis deviation Increased intracranial pressure; increased vagal tone due to straining during defecation, vomiting, intubation, mechanical ventilation. Trust your gut; nurses have great intuition skills—don’t be afraid to ask questions and seek more information when you feel something isn’t right. Carry This Card On Your Badge For HelpWhenever the direction of electrical activity moves away from a lead, a negative deflection is produced.

A mimic of ST elevation is high-takeoff. High-takeoff is also known as benign early repolarization. The more familiar you are with different rhythms, the easier interpretation becomes. Don’t forget your colleagues are great resources as well; let them know you are working on your 12 lead EKG interpretation skills and ask them to save interesting tracings for your review.

The QRS may be small (or low voltage) in pericardial effusion, high BMI, emphysema, cardiomyopathy and cardiac amyloid. For over forty years The ECG Made Easy has been regarded as the best introductory guide to the ECG, with sales of over half a million copies as well as being translated into more than a dozen languages. Hailed by the British Medical Journal as a “medical classic”, it has been a favourite of generations of medical and health care staff who require clear, basic knowledge about the ECG.

Now you are a whizz at placing the leads where they should be, do you know what you are looking for? Let’s start with the basics; every ECG consists of a P wave, QRS complex and a T wave. This is known as the cardiac cycle or in easier terms the period between the start of one heart beat and the beginning of the next, this should last 0.8 seconds. There are six limb (I, II, III, AVR, AVL, AVF) leads and six precordial (V1-V6) leads. The limb leads look at the heart from a vertical perspective; the V leads show a horizontal perspective.When evaluating lethal rhythms on a 12 lead EKG, it is important to remember the rhythm alone can be lethal as well as what the EKG/ECG is showing you in terms of heart function. Heart failure, COPD, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, complication of coronary bypass or valve replacement surgery Follow ACLS protocol for administration of atropine for symptoms of low cardiac output, dizziness, weakness, altered LOC, or low blood pressure. Sinus rhythm should have clear P waves. The commonest tachycardia is poorly controlled AF - look for the variable RR interval with the loss of clear P waves. As the user steps through each of the interpretation stages, there are options to define and reveal more information, or to open a new tab for more in depth review.