Yes. another ECG question

Annony RN · Apr 20, 2008

LOL, I have that book! I've had it for several years but haven't "read" it in quite some time. I refered to some portions where I needed reinforcement (ie- sorting out the AV blocks) but missed that part. I'll have to pull it back off the shelf. I need to work on "icy iguanas" next anyway. I love that book since it ties EKG's to actual clinical s/s. Very usefull!

To clarify- the pt was in Afib on arrival from ED and most of the night shift. The 12 lead done in ED was def. Afib- certainly no P waves. Was told he converted to sinus in the early AM (late in the night shift) but it was that "sinus" strip that I would have called junctional- or as you clarified, accelerated junctional. Seems like I got one right, then! :w00t: Glad my studying is paying off.

ECMOismygame · Apr 20, 2008

LOL, I have that book! I've had it for several years but haven't "read" it in quite some time. I refered to some portions where I needed reinforcement (ie- sorting out the AV blocks) but missed that part. I'll have to pull it back off the shelf. I need to work on "icy iguanas" next anyway. I love that book since it ties EKG's to actual clinical s/s. Very usefull!
To clarify- the pt was in Afib on arrival from ED and most of the night shift. The 12 lead done in ED was def. Afib- certainly no P waves. Was told he converted to sinus in the early AM (late in the night shift) but it was that "sinus" strip that I would have called junctional- or as you clarified, accelerated junctional. Seems like I got one right, then! :w00t: Glad my studying is paying off.

when taking ACLS last year a RN/EMT-P gave us her version on how to remember the blocks, it really helped out my classmates who didnt have a background on EKG interpt.

it went something like a husband and wife. SR = newly weds, the husband comes home every night at the same time. (wife is P, husband is QRS)

1st degree AV block = after some time, he begins to get home later, but still he shows up every night

2nd degree AV block, type 1 = more time passes by, husband comes home later and later every nite, until one night he doesnt even show up... and the cycle starts again

2nd degree AV block, type 2 = guy doesnt care much, shows up once every 2 or 3 nights on a regular schedule

3rd degree/total HB = divorce, the man and woman are doin different things

anyways, she made it much funnier, but it helped out a lot... i have a diff system, but this one helps as well

UM Review RN, ASN, RN · Apr 20, 2008

And of course, there's always this guy teaching heart blocks:

http://www.youtube.com/watch?v=BhGGzB09wQk&feature=related

:yeah:

rcpals · Apr 28, 2008

ok,

here's a basic method.

there are three discinct areas of the heart; atrial, junctional and ventricular.

each area has specific markers of origin.

the atria.

the identifiers are an upright p-wave. generally all atrial beats must have an upright p-wave. we know all p waves dont look the same. please remember, there are hundreds of potential pacemakers in the atria. so if the sa node does not fire generally one of the other atrial pacemakers should fire. we also know all potential atrial pacemakers have there own size and shape of p-waves.

we know what a sa node pwave looks like. big and round.

if your presented with a p-wave thats small or peaked or biphasic its still an atrial p-wave but probably not a sa node p-wave. most likely its coming from one of the other atrial pacemakers.

bottom line all atrial beats must have the atrial identifier, an upright p-wave and be narrow.

the junction

this area also has its own distinct identifier. the four rules for junctional beats are

1. absent pwave

2. inverted p-wave

3. a pwave that occurs after the qrs.

4. be narrow

both atrial and junctional beats are mostly narrow with qrss that are less than or equal to .12 seconds.

both the atrial and juntional area are above the ventrical and are termed "supraventricular". the reason we describe these specific areas is because we have an easy way of determining if the qrs originates in the supraventricular area or the ventricular area.

the width of the qrs is very helpful. you need to remember this point if you want to be good at reading ecgs. generally here are the rules for identifying supraventricular and ventricular rhythms.

almost all supraventricular rhythms are "narrow" (ie a qrs

almost all ventricular rhythms are "wide" (ie a qrs greater than .12 seconds)

so if anyone asks what is the width of the qrs for any atrial or junctional rhythm, you already know the answer.

if someone asks whats the width of the qrs for any ventricular rhythm you already know the answer > .12 seconds.

the ventricular area.

the ventricular identifier is a qrs > .12 seconds. generally if a qrs originates in the ventricles the qrs will be wide and bizarre ie. greater than .12 seconds. the wider the qrs is, the more it confirms ventricular.

i totally agree about dale dubins ekg book.

i hope this helps and didn't confuse you.:nuke:

jeff rcp