EKG or ECG- Simple Simple!

all right so we got quite a few requests for an ECG video and I should really try my hardest to get it up as soon as possible because I I know even some of you had tests that were coming up soon so you want to have something to review so - last night I was kind of racking my brain a little bit about how to make a really simple ECG video because there are a lot of ECG videos out there that you can find on YouTube and different things like that but I think that really always keep it as simple as possible without losing important information and being able to take that information and apply it something that's more advanced now you see geez really go from something that's very basic to something that's very advanced hence why we have ACLs courses for any nursing students or nurses that haven't taken in ACLs class I would certainly recommend doing an ACLs class I would think it would be a better idea that you do in ACLs class after you've done some kind of basic ECG course whether it's in class um whether you've done BLS that way it's good really going to get it going to help you transition from you know pretty fundamental you do stuff to more advanced you to do things so I think the easiest way to do this video overall is to really focus on some of the basic concepts and then to focus on the most common heart rhythm disorders and by common I guess what I'm really trying to say is the popular ones popular in the sense that if you were going to have a test tomorrow what are the rhythms that you're more than likely going to need to know in order to take that test so that's what I want to focus on and just making sure that you have an example um and a solid understanding of just looking at an ECG strip and what it means and that way it's going to make more sense to you when you start to look at more and more of them so to start off with I just have this picture here of an ECG tracing now we know that all these waves and these dips they represent something an ECG tracing essentially is just snapshot of the activity that's happening in the heart each one of these ways and these dips represent a piece of the heart so first thing I think we all do is I'll draw our heart this is more like a valentine heart but just so we have an idea right and I'm going to draw our chambers so we know that our top chambers are our atrium and our bottom chambers are our ventricles okay so really this ECG tracing is telling us what part of the heart is doing what and how it's doing it so here's a my example of that so here I'm going to start writing the letters that correspond with each one of these dips and these waves so if we're looking at it in 2d tracing these are all the identifiable parts that we should see we should have a P wave a Q our X we should have a T wave and sometimes I'll put a little asterisk sometimes you might see a u wave now a u wave is really unknown meaning that we don't know what it represents normally however we have recognized that when the cau a present if it's a prominent new wave if it's elevated or depressed that can really indicate there's a serious cardiac issue that's happening you know in this in this individual so our P wave belongs to our atria so I'm going to put the peas in there our QRS which is known as a QRS complex because it's really this entire kind of pyramid this entire waveform here belongs to our ventricles so I'm going to write QRS here and our T wave belonged to our ventricles as well and for this we're going to leave the u wave out because it's really I don't want to say it's not something you shouldn't focus on but it's really not the of what you're going to be looking at okay so let's talk about these a little bit more in depth so we're going to come over here and let's write our p-wave let's write our QRS complex and let's write our T wave and then we can talk about what they mean now if you're even looking at this ECG pattern I'll I'll always point this out if you notice the P wave the to wave the sometimes you wave they all look pretty consistent right as far as shape and size goes but this QRS complex is really big it's it's the one that stands out the most in ECG tracing and if you think about it it makes sense if the QRS complex represents ventricle activity what we know the ventricles are larger and we know that they squeeze harder so it makes sense that on a pattern that it's going to be a little bit more dominant than the P wave is okay so the P wave we know belongs to the atria right it represents atrial contraction in the term that you're going to see for this is depolarization depolarization means contraction I always like to write the squeeze so this is what the P wave represents the QRS complex which is here right this whole section here represents ventricle contraction or like I said our fancy term depolarization which is the same as the squeeze okay and then our T wave which we have here is going to represent our ventricles again remember we put it in our ventricle spot so we can see that it represents ventricle relaxation so when our ventricles relax we know they're really filling right the opposite of depolarization is free polarization so this means the relaxing or the filling so if you've seen these terms I'm sure you have you seen the terms depolarization repolarization remember that depolarization means to squeeze right repolarization means to relax and I guess an easy way to remember that is that there's an R and repolarization and there's an R and relax so that's how you'll know the difference depolarization is contraction repolarization is relaxation all right so that is then our basics so now we know that P belongs to the atrium that is going to represent atrial activity QRS belongs to our ventricles T belongs to our ventricles as well when it's going to represent the squeeze and one is going to represent the relax all right now one thing that I used to ask when I would go over TCG's and even when I learned as a student is how come you can see the ventricles relax but you never see the atria relax do they not relax no they do they do relax the issue is that you don't see it so nicely on an ECG tracing because this QRS complex is so large it kind of overtakes what you would see on the wave okay so what I'm going to do is I'm going to come down here and I'm going to separate this so we can talk a little bit more about the electrical conduction of the heart and we'll talk about those popular heart rhythms that I want to go over so I'm going to draw the heart again and of course like I say in every video by now I'm not a Picasso so bear with my funny drawings as a matter of fact I need to make this atria a bit bigger okay so I'm going to draw a heart here and what I'm going to do is now we're going to focus on the electrical conduction in the heart and see what remember about that so first thing I'm gonna start drawing our nodes and as I'm drawing them think to yourself do I remember what these nodes are what these branches are what is she drawing okay I'm going to come here and let me do one of these okay good all right now what is this what I've drawn here are our nodes so essentially for looking at this point here we have an SA node we have an AV node we have a bundle of his-- and I'm just going to write this there and down here these these two branches that you see here or fibers are Purkinje fibers so I'm going to write them they're Purkinje fibers now this heart is going to represent the electrical conduction now the conduction is what's going to actually cause activity in our heart it's going to cause a squeeze and it's going to cause the relaxation so let's talk about these nodes because these are kind of our our bosses in a sense this is what's going to send out the electrical impulses for the heart to beat so we have our SA node and we have our AV node our SA node sets a rate of about 60 to 100 beats per minute and our AV node sets a rate of about 40 to 60 beats per minute this is really important to keep in mind and to remember okay so let's talk a little bit about some conduction issues this is one we're going to get into the heart rate patterns that I want you to recognize because these are our popular ones or the more common ones and certainly the ones that are going to come up very often in testing so the first thing if we're going to focus on our disorders of our atrium right so atrial issues so I'm going to right atrium here the common atrial disorders are issues that we're going to see will be a fib a flutter and our SVT now a fib the S stand for atrium right or atrial so this means atrial fibrillation fibrillation essentially means to quiver right quiver meaning that it's not really squeezing there's no good contraction that's happening it's really just a shake if you will like a really dull shake so atrial fibrillation occurs when the SA node this guy here is rapidly firing rapid rapid rapid so we're having a rapid firing here of the SA node and it's just circulating around in the atrium as a result the atria is don't ever contract they don't squeeze like they should they just quiver they're just shaking here inside the atrium well a shaking atria is not a squeezing atria and that can be a problem why is that a problem if you're a trios don't contract they don't squeeze then they're not fully emptying the blood into the ventricles right if they're not fully emptying the blood into the ventricles that means that some of the blood is staying stagnant in the atria and so instead of having a nice empty atria you're going to end up with an atrium that has some blood left in it now we know that if you leave blood sitting and anything think about leaving blood sitting in a container it's going to clot eventually and it's going to clot specifically in this atrial fibrillation because it's not being squeezed out properly it's just quivering now if we end up with a blood clot in the atria right so if we end up with a blood clot so here's just a representation of let's say we've got some blood clots floating around in there and one of these clots become dislodged and make its way down to the ventricles remember where the ventricles pump out to write our ventricles depending on what side is going to go to our lungs or it's going to go to our body anywhere in our body if we throw a clot to our lungs we can end up with a pulmonary embolism if we throw a clot anywhere to our body we can end up with an obstruction imagine if that clot ended up in a vessel in our brain now we're looking at the stroke right so an atrial fibrillation can be a very dangerous rhythm now if you're looking at you strip and I'm going to do my best to draw it as proper as possible so you can recognize it moving forward if you're looking at a rhythm strip and atrial fibrillation kind of looks like a little bit of this with your numeral QRS a little bit of this with your normal QRS and little bit of this with your normal QRS what you see here is that you can clearly see the QRS complex right it's still there but that P wave you can't identify the P wave it kind of looks like this flattened chaotic quiver if you will and that's essentially what's happening in atrial fibrillation now atrial fibrillation is a very very fast rate atrial fibrillation is anywhere between 300 to 650 beats per minute that's very very fast and again we know there are biggest concerns that that blood is not really emptying these are the patients that end up on blood thinners as an example they'll be on prophylactic blood thinner medication anticoagulant therapy to prevent any blood clots from developing but they don't have the risk of throwing a clot and ending up in a really serious medical situation now atrial flutter which is our next thing here atrial flutter is also an important rhythm to recognize and to understand it's another one of our common ones atrial flutter is very similar to atrial fibrillation it's that same chaotic firing that's happening in the atria via the SA node but instead of this 300 to 650 beats per minute we actually end up with one that's a little bit less still high but a bit less which would be about 250 to 350 beats per minute now the difference when you're looking at a rhythm strip instead of this kind of flattened wobbly what should be P waves you end up with something called sawtooth so if you look how I'm drawing it you see that those P waves they're called sawtooth for a reason because they look like the teeth that you would see on a saw very jagged lines that QRS is still present that you see there but that P wave you see it looks more like sawtooth and I'm going to go ahead and write the rate here so we have it so 250 to 350 beats per minute that's the difference slightly less now coming down to our SVT SVT stands for Supra ventricular tachycardia and SVT is essentially a very fast rhythm that's happening it's being originated by the SA node SVT can be something that is brought on suddenly sometimes people we see it um current or clients that exercise it can be exercise induced and it's another one of these rapid firing scenarios that we have that's happening in the heart an SVT it looks really similar to a ventricular tachycardia so where you kind of have that normal rhythm but it's a little bit fast and so here's my very bad drawing of it um essentially it looks like a super uh excuse me looks like a ventricular tachycardia so you can slightly identify all those normal waves but it's a very very fast rhythm now SVT ham can be I wouldn't say let's see 100 to 300 beats per minute um svt can actually be reversed or stopped or you know throw the heart back into rather regular rhythm by doing vasovagal maneuvers so somebody that comes into SVT before we like to do any kind of medicinal therapies depending on if they're symptomatic or not is have them do some vasovagal maneuver so we might have them bear down like they're trying to have a bowel movement right so that the bear down we might apply some ice packs to the neck we might try to have them blow through a straw so doing vasovagal maneuvers can help actually trigger the SA node to kick back into a normal cycle if not then we have to move on to medicinal therapies okay so those are our common ones of our atrium I'm going to try to put a better picture of an SBT on this video so you can see my drawing is not so good a fibbin a flutter is good okay so if we're moving down so this is our SA node right so moving down now let's look at issues with our AV node so I'm going to come over here so we have some space and I'm gonna put our AV node okay so with our AV node what I want you to remember is BBB and not Better Business Bureau this is our bundle branch blocks so we can have a first degree a second degree or a third degree bundle branch block and essentially in a bundle branch block we know it's an issue at the AV node there's going to be a conduction issue between this AV node and the bundle of hiss and it can also then translate to an issue of the conduction being sent down to these Purkinje fibers which we're going to target our ventricles a bundle branch block is essentially just that and depending on the degrees depends on the severity so we can have a partial bundle branch block right which would be our first and second degrees which means that there's going to be a slowed rate between the AV node to the bundle of hiss the Rays going to be slowed because there's some kind of blockage same thing with our second degree now our third degree is going to be the worst of them all because that means that we have a total block and the issue becomes this if there is not any communication between the AV node and the bundle of hiss that means that the ventricles aren't getting the electrical communication right because there's no kind of communication here we have ourselves a block somewhere we have ourselves a slowing at some point in these areas that means that ventricles are going to suffer if the electrical communication doesn't get to the right spot it can be shot anywhere in the muscle of the heart and that's a problem obviously a third degree we're looking at a total block so we're not going to get too deep into the bundle branch block but I want you to recognize what it is kind of how you would identify on a strip and what it what it really means okay now if we move down to our ventricle and let's make a ventricle spot here right so disorders active ventricles so we did a trio and did a V and ventricles we can have a v-fib and our v-tach these our these are our common ventricle conduction or heart rate disorder so just in the sense that a fib is a quivering of the atria v-fib is a quivering of the ventricles okay now we saw that in a fib you kind of have that wacky rhythm with the P wave you can't really identify it as essentially the same idea and looking at a rhythm strip but instead of it being the P wave because that's atria right P wave is atria it's going to be with the QRS because that is the contraction of ventricle so you're going to have kind of this erratic QRS it's going to be high because we know it's big you know all over the place and that's going to represent a ventricular fibrillation now the ventricular fibrillation is a deadly rhythm I'm going to circle that in ride it's a deadly rhythm and a shockable rhythm think about again quivering in fibrillation if our ventricles are quivering right remember the same idea that means that we're not having emptying full emptying I should say of the blood in our ventricles as a result that means that we're not sending blood out of the ventricles like it should be so what's going to suffer our lungs are going to suffer and our body is going to suffer because we're going to have a decreased amount of blood going to our lungs to get oxygen because it's just sitting here quivering away and we're going to have a decrease amount of blood getting out to our body because it's just sitting here quivering away that can be deadly that can be deadly essentially we could suffocate because we're not getting enough blood to the lungs and our body can suffer because we're not getting the right amount of perfusion now in a ventricular tachycardia this is just an abnormally fast rate so what happens is that the ventricles are contracting too quickly with no regards to what's happening in the atria so this is going to look more like a regular ECG tracing but it's going to be very very rapid and you're going to see higher Peaks and more more pronounced more defined Peaks in that Q wave so this is my Q wave if I was making them nice and even and normal it would look kind of like on an even scale but more defined and it's going to represent that um really fast contraction without any regards to what's happening with the P wave um and what I'm going to do because I can kind of see my image I'm going to put up some images so you can see the differences on the fib and v-tach as far as how they look on an ECG strip now kind of coming back for a second on this SA and AV node I want to make sure that we're clear on the rate that this sucks because in the event that the SA node fails or in the event that the AV node fails we know that that you've set their own rate so for instance somebody that's having a failure with an SA node or an issue we know that we're going to lose that set rate of 60 to 100 kind of our baseline the AV nodes going to keep going but it's going to only go at about 40 to 60 beats per minute then we know that that's not the ideal heart rate that we want for perfusion and for function so this is why I wanna make sure you understand those rates now another thing that comes up very often and I'm going to draw in a different color and it comes up in questions that I get from students and I see it on tests how to identify a myocardial infarct on a rhythm strip in one of the big ways is that we see this here this is known as an ST elevation myocardial infarct or a STEMI when we're looking at our rhythm right here that we see we see our P wave we see our Q we see our R and our s and our T wave here it's elevated right I should actually even let me make this a little bit more elevated to show you kind of how it looks so we can have a clearer idea we have an elevation of our s and our T wave this is a classic hallmark sign of a myocardial infarct and I want to be clear it's not the only way that we identify a myocardial infarct on an ECG but it is certainly a classic one that comes up very often so one of the questions that you might get will say something about you know what does an ST elevation indicate you should be thinking that it's going to indicate a myocardial infarct okay so if you have any other questions please let me know I'm going to go ahead and upload some images of strips so that we can see what they look like and just kind of compare to some of my wacky drawings here but I wanted you to have an idea and just so you're clear I would say that if you have any type of exam or test coming up about ECGs get familiar with what these tracings look like specifically the ones that we discussed okay so let's recap a little bit we talked about our normal ECG tracing right we know our pqrst and you what they represent in relation to the chambers of the heart and the activity of the heart we talked about the conduction the electrical conduction how we go from SI to AV to bundle opus down to our Purkinje fibers and then back and then our B per minute that each of these nodes sect we discuss our common or popular dysrhythmias like our a fib or a flutter SVT v-fib v-tach and our bundle branch blocks so make sure you're familiar with those again recognizing what they look like and what they mean because these are definitely the more common ones that as nurses and as nursing students we need to be familiar with okay and then of course our STEMI so as always feel free to watch this over and over again as much as you need to until you've got it there are a lot of good ECG information out there the best way it's just to kind of practice with this information that you've already got so look at some of these rhythms and just try to decipher you know where you can see these waves and the abnormalities and what that really means and again reaching me is very easy you can reach me on instagram at toot RN t oo t RN or you can email me or you can reach me on my website at www.stampingmadly.com

Channel: tootRN, LLC.

Views: 662,572

Rating: 4.9121094 out of 5

Keywords: Electrocardiography (Invention), ecg, ekg

Id: mUY2nWqdPxA

Length: 27min 47sec (1667 seconds)

Published: Mon Jan 13 2014