THE ECG IS ONLY ONE PARTOF PATIENT ASSESSMENT

• ONLY measures the ELECTRICITY present in the patients heart

• Tells you NOTHING about cardiac output

• ONLY works if the leads are all properly attached to the patient, the

cable is plugged into the monitor, and the monitor is turned on!!

Patient Assessment• A - Airway– Is the airway OPEN and MAINTAINABLE

• B - Breathing– Respiratory rate and quality

• C - Circulation– Pulse rate and quality– Level of Consciousness– Signs of Perfusion– Cardiac Output - blood pressure

• D - Defibrillation– Is the patient in a rhythm requiring defibrillation

Myocardial Cell Type

• Working Cells

• Electrical System Cells

– Formation of electrical impulse

– Conduction of electrical impulse

Mechanism of Impulse Formation

• Automaticity (normal)

• Reentry (tachydisrhythmias)

Causes of Arrhythmias

• Disturbances in Automaticity

• Disturbances in Conductivity

• Combination of Both

Normal Sinus Rhythm

• Rate: 60 to 100/min

• Rhythm: Regular

• QRS: < .12 sec

• Atrial Activity: upright P’s

• P to QRS: 1 to 1

Premature Complexes• Complexes that come earlier than anticipated

• Atrial, junctional, ventricular

PAC: upright P wave

PJC: NO upright P, narrow QRS

PVC: wide QRS

R on T Phenomenon

• Treat ASAP

– do NOT wait to see if supplemental oxygen has any effect

R on T Phenomenon• Also know as ??

Ventricular Tachycardia (sustained)

• With a pulse and stable• With a pulse and unstable• Pulseless

Ventricular Fibrillation

• A - Airway• B - Breathing• C - Circulation• D - Defibrillation

Asystole

• Treat appropriately

• Epinephrine q 3 to 5 minutes

• Atropine q 3 to 5 minutes

• Pacing is rarely effective unless initiated immediately in

a primary asystolic arrest