EKG

  • General Interpretation
  • Tachyarrhythmias
  • Bradyarrhythmias
  • Ischemia/Infarction

General Interpretation

  • Background
    • A basic, systematic approach to interpreting the EKG includes determination of Rate, Rhythm, Axis, Hypertrophy, Intervals, and Infarction
  • Findings
    • Rate
      • Normal
      • Tachycardia
      • Bradycardia
    • Rhythm
      • Regular
      • Regularly Irregular
      • Irregularly Irregular
    • Axis
      • Normal Axis
      • Left Axis Deviation
      • Right Axis Deviation
      • Extreme Right Axis Deviation
    • Hypertrophy
      • Left Atrial Enlargement
      • Right Atrial Enlargement
      • Left Ventricular Hypertrophy
      • Right Ventricular Hypertrophy
    • Intervals
      • Shortened PR
      • Prolonged PR
      • Widened QRS
      • Prolonged QT
    • Ischemia
      • Q-Waves
      • ST-Segment Elevation
      • ST-Segment Depression
      • Hyperacute T-Waves
      • Inverted T-Waves
Video Credit: Anna Pickens

*Deep Dive: Computer Based ECG Interpretation: It’s Use in the ED (EMOttawa)



Tachyarrhythmias

  • Background
    • Defined as any EKG with a rate of > 100 bpm. Further divided based mechanism/etiology.
  • Common Types
    • Sinus Tachycardia
    • Atrial Fibrillation
    • Atrial Flutter
    • Multifocal Atrial Tachycardia
    • Supraventricular Tachycardia
    • Ventricular Tachycardia
Video Credit: Strong Medicine

*Deep Dive: Tachydysrhythmias with Amal Mattu and Paul Dorion (EM Cases)



Bradyarrhythmias

  • Background
    • Defined as any rhythm < 60 bpm. Further divided based on mechanism/etiology. 
  • Common Types
    • Sinus Bradycardia
    • Junctional Bradycardia
    • Sinus Arrest
    • AV Nodal Blocks
      • 1st Degree
      • 2nd Degree, Mobitz Type I (Wenckebach)
      • 2nd Degree, Mobitz Type II 
      • 3rd Degree
Video Credit: Crazy Medicine

*Deep Dive: 4-Step Approach to Bradycardia (EM Cases)



Ischemia/Infarction

  • Background
    • Cardiac ischemia and/or infarction can be diagnosed by analyzing the QRS complexes, ST segments, and T-waves on a 12-lead ECG. 
  • Common Findings
    • Ischemia
      • St-Segment Depression
      • T-Wave Flattening or Inversion
      • Hyperacute T-Wave
    • Infarction
      • ST-Segment Elevation
      • LBBB (If meets Sgarbossa criteria)
Video Credit: Strong Medicine

*Deep Dive: Upping our ECG Game: OMI vs STEMI (REBEL EM)


Brandon Simpson, PA-S2
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