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| Name | 2 minute EM: Approach to ECG interpretation |
| Video Uploader | Video From 2minuteEM |
| Upload Date | This Video Uploaded At 04-06-2020 08:45:56 |
| Video Discription | 2minuteEM ECG EKG interpretation Emergency Medicine Wow - I think I bit off more than I can chew here! This is a whistle stop tour of basic ECG interpretation. Good for basic level of understanding. Hopefully more aspects of ECG interpretation to follow. Hope you find it useful. I found "The ECG Made Easy" a really useful book (search for on Amazon - other book providers are available!) Additional stuff for slides: 1. Get the basics right Check you have the right patient! The paper speed and voltage settings are standard across all 12 lead ECGs world wide as far as I'm aware. If your QRSs look a bit shrunk or tall, or the rate appears to be abnormally slow or fast, just double check the calibrated settings are correct. One "big" ECG square = 0.2 seconds One "little" ECG square = 0.04 seconds (or 40 ms) 2. Is this sinus rhythm? No P waves? This may be atrial fibrillation: https://litfl.com/atrial-fibrillation-ecg-library/ Normal PR interval = less than one big square (0.2 s) 3. Check out your QRSs "Broad" QRS complexes are greater than 3 small squares (120 ms) Many causes, but look for LBBB (WiLLiaM) and RBBB (MaRRoW): https://litfl.com/ecg-conduction-block-ecg-library/ 4. Check out your STs and your Ts Look at lots of "normal" ECGs to get a feel for this slight concave upwards shape. Over time you will get an appreciation for friendly looking ST elevation, such as high take-off or "benign early repolarisation"; the "scooped" STs of acute pericarditis; and the sweat-inducing nasty looking ST elevation of a STEMI. https://litfl.com/st-segment-ecg-library/ Your Ts tend to be inverted in aVR and V1. If you imagine these leads as being to the right of the praecordium, the majority of depolarisation and repolarisation takes place away from here, hence both the QRSs and Ts will be inverted. 5. Rate When you have "fast AF" , or AF with a fast ventricular response, you can count out say 3 seconds on the ECG - now if one big square = 0.2 s, then 5 big squares will make one second. Now, count the number of beats in that 3 second space, multiply by 20 and you've got the number of beats per minute. Or just look at the calculated rate. 6. Axis Axis needs its own 2minuteEM video, and maybe more. Try to remember common causes of LAD, RAD, and...(dramatic pause)..."EXTREME AXIS DEVIATION". I tend to calculate my own axis using lead I as the x axis and aVF as the y axis. Once you get the hang of it, it's dead simple to use and you can see how closely to the computer's calculated axis you can get! If you click any link, click this one, as it's a great skill to learn: https://litfl.com/super-axis-man-sam/ 7. QTc (corrected QT) Again, another deserver of a 2minuteEM video in its own right. Rough rule of thumb - the QT interval should be less than half the RR interval. If the computer's calculated QTc seems odd, you can manually calculate using QTc = QT/square root of RR. This is called Bazett's formula. Other formulas are available. The QTc becomes important in lots of situations, but mainly sudden death, syncope, toxidromes, adverse drug reactions and metabolic disturbance. https://en.wikipedia.org/wiki/QT_interval 8. Pattern recognise Very much like blood gas analysis, you've just got to practice looking at lots and lots of ECGs. There are lots of good websites out there. I'll put a couple of links to them here. EMin5 is always good: https://emin5.com/?s=ekg Life in the Fast Lane are the trailblazers: https://litfl.com/category/ecg-library/ ECG Guru has lots of interesting ECGs: https://www.ecgguru.com/ Thanks for watching! |
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