EKG make it easy By Dr T Preepool

EKG : make it easy By Dr. T. Preepool

����� • PACEMAKER CELL – SA NODE Primary pacemaker – AV NODE Subsidiary pacemaker – VENTRICLE (Purkinje Fiber) 60 -100 / min 40 -60/ min 20 -40 / min CONDUCTING CELL - AV NODE – Common Bundle of His – LBB & RBB – Purkinje Fiber - MYOCARDIUM ) เซลลกลามเนอทวไปจะหดตวเมอถกกระ ตน )

Leads system • Bipolar leads or Standard limb leads • Lead III • frontal plane • Unipolar limb leads และ a. VF frontal plane แต deflection แตกตาง กนท แกนของขวมทศทางเปลยนไปเ ลกนอย – a. VR a. VL – • Precordial or Unipolar Chest leads – V 1 -V 6 – horizontal plane – electrode วางบนตำแหนงตางๆ บนทรวงอก

การตด Limb Leads

Unipolar chest leads • V 1 - Rt. ICS ท ท 4 Parasternal border V 3 - กงกลางระหวาง V 2 -V 4 - Lt. ICS ท 5 Midclavicular line V 5 - Lt. ICS ท 5 Anterior axillary line V 6 - Lt. ICS ท 5 Midaxillary line • V 2 - Lt. ICS • • 4 Parasternal border

Unipolar chest leads

การตดขวไฟฟา (ELECTRODE) • 12 Leads EKG • Standard limb leads • Unipolar chest leads

Normal EKG • P wave : atrial depolarization • QRS complex : • T wave : • U wave : ventricular depolarization ventricular repolarizationของconductingปกตจะไมคอยพบ สวนมาก พบใน hypokalemia

การหา rate ท EKG regular rhythm Interval 25 mm equal to Interval 1 mm equal to Interval 5 mm equal to For 1 minute consist of Or equal to 1500/5 1 sec 0. 04 sec 0. 20 sec 1500 mm 300 blocks ������� 1 ��������� Heart rate / min = 1500 ������ RR interval จำนวนชองเลกทอยระหวาง

Heart rate / min = 1500 = 150ครง / นาท 10

QRS complex • What is the QRS duration? • Is the QRS duration within the normal range? • Are all the QRS complexes equal in duration? • Do all the QRS complexes look alike? • Are the abnormal QRS complexes associated with ectopic beats?

Junctional rhythm Idioventricular rhythm rate 40 -60 bpm rate 20 -40 bpm

Torsades de Pointes (Td. P) • Irregular polymorphic wide complex tachycardia with alternating polarity in a sinusoidal pattern that occurs in the setting of prolong QT • Rate of 150 -250 • สาเหต ครง /นาท : Drugs, electrolyte imbalance, OHD

Ventricular Tachycardia • Usually regular rhythm at a rate of 150 -250 bpm • QRS complex 0. 12 sec, usually >0. 14 sec • ST-T directed opposite to QRS complex • ������ : OHD, electrolyte imbalance, antiarrhythmic drugs

CPR • CPCR : cardio-pulmonary-cerebral resuscitation – To restart the heart , to restore the brain. – Cerebral resuscitation is the important goal of ACLS.

rhythm assessment BLS ACLS Non-VF/VT VT/VF PEA Bradycardia Asystole

What Is Defibrillation? • Electric shock to the heart – Stops uncoordinated rhythm – Allows return of regular rhythm and pulse • An only definitive

DC counter shock 1. Cardioversion - synchronous mode - กรณยงเหน QRS complex: AF, atrial flutter, SVT, AT, MAT, VT* 2. Defibrillation - VF, Pulseless VT

Asystole

Myocardial Infarction : MI