Download Session Number 314 STRIP TEASERS: IDENTIFYING FUNKY

Session Number 314
STRIP TEASERS: IDENTIFYING FUNKY RHYTHMS
Deborah Tuggle, MN, APRN, CCNS, FCCM
President & Consultant, Critical Care Curriculum / Critical Care CNS
Norton Healthcare
Louisville, Kentucky
Content Description
If you've found yourself staring numbly at your patient's ECG wishing you could remember just
a bit more of the content you learned in previous courses, then it's time for a tune up! This
session will do a quick review of common dysrhythmias and heart blocks (don’t blink), and then
move to more advanced concepts related to the identification of acute coronary syndromes, long
QT syndromes, and the differentiation of wide QRS rhythms.
Learning Objectives
At the end of this session, the participant will be able to:
1. Describe lead selection and set-up for monitoring both dysrhythmias and ischemia/infarction.
2. Review criteria for the recognition of common dysrhythmias, conduction defects, acute
coronary syndromes, and risk of ventricular ectopy.
3. Differentiate between the morphological characteristics of wide QRS rhythms such as
ventricular ectopy, supraventricular ectopy with aberration and bundle branch block.
Outline
I. Bedside Monitoring Set Up
A. Standard Electrode Placement
B. Routine Lead Monitoring For Dysrhythmias: II and V1
II. Quick Recall: An ECG Strip Review Of Common Dysrhythmias and Heart Blocks
III. Long QT Interval
A. Measurement
B. Causes
IV. 2:1 2nd Degree Heart Block: It’s Not All Mobitz Type 2
A. Mobitz type 1
1. Generally narrow QRS and normal PR
2. If advances to 3rd degree: junctional escape rhythm
B. Mobitz type 2
1. Generally wide QRS and long PR
2. If advances to 3rd degree: ventricular escape rhythm (or asystole)
V. Acute Coronary Syndromes
A. ST Changes
1. Elevations
2. Depressions
B. Best Monitoring Leads: III and V3
VI. PAC’s: The Great Mimickers
A. P Wave
1. Early
2. Different Shape
B. QRS Complex
1. Normal (same as sinus beat)
2. Blocked
3. Aberrant: wide and abnormal in appearance due to temporary bundle branch block
(rate related)
VII. Supraventricular Aberration Versus Ventricular Ectopy: Morphological Difference
A. SV Aberration: Generally transient RBBB, triphasic, rsR’
B. V Ectopy: monophasic, biphasic, or a tall left peak
VIII. AV Dissociation
A. Seen With 3rd Degree Heart Block
B. Seen With Ventricular Ectopy: Two opposing forces (one from the atria/SA node
and one from the ventricle) cause a temporary blockage at the AV node
Bibliography
Conover M. Understanding Electrocardiography. Elsevier Health Sciences; 2003.
Drew BJ, et al. Celebrating the 100th birthday of the electrocardiogram: lessons learned from
research in cardiac monitoring. Am J Crit Care. 2002; 11(4): 378-386.
Fenton JM. The clinician’s approach to evaluating patients with dysrhythmias. AACN Clin
Issues. 2001; 12(1): 72-86.
Webliography
emedu.org
netmedicine.com
sprojects.mmi.mcgill.ca/ heart/ecg
anaesthetist.com/icu/organs/heart/ecg
fammed.wisc.edu/pcc/ecg/ecg
medstat.med.utah.edu/kw/ecg
Speaker Contact Information
[email protected]