5 Step
EKG INTERPRETATION
Heart rate
Rhythm
P wave
PR interval
(in seconds)
QRS
(in seconds)
60 -100/min
Regular
Present before
each QRS, identical
P/QRS ratio 1:1
0.10 - 0.20
(<5 small squares)
Normal shape
< 0.12
8 x 10 = 80
Heart Rate
1. Normal Sinus Rhythm
Rate - 60 -100
count the peaks - we have 8 here
multiply by 10 = 80 beats!
1
2
3
4
5
6
7
8
Rhythm
2. Rhythm - R peaks are evenly spaced apart.
To quickly measure this simply grab some
paper & mark 2 R peaks then just march it out.
The R peaks should be even every time.
R
R
R-R int.
R
R
R
R
P Wave
R
3. P wave - which is our atria contracting is it present? & does it have its buddy QRS?
we need a P with QRS every time
P
T
Q
PR interval (in seconds)
P
R
P
PR int.
R-R int.
5 mm
0.2 sec
PR
ST
seg.
seg.
P
PR int.
T
Q
ST int.
S
QRS
int.
QT int.
0.5 mV
5 mm
0.2 sec
QRS (in seconds)
5. QRS - Ventricles contracting
Is it present, upright & TIGHT?
Should NOT be wide, should only be
3 boxes - .12 seconds here.
T
Q
S
0.5 mV
4. PR interval - basically measures the
time it takes between atrial contractions
& ventricular contractions should be 5 mini
boxes or less - or .10 - 2.0 seconds here.
R
S
R
9 ECG Strips on the NCLEX
1. Normal sinus rhythm
Treatment:
None - continue to monitor
Causes:
Being healthy
Memory tricks
Normal beat - evenly spaced
2. Bradycardia
Treatment:
BRADY Bunch
old TV show (slow times)
Atropine ONLY if symptomatic
showing low perfusion (pale,
cool, clammy)
<60
Causes:
ATROPINE
Vagal maneuver (bearing down),
Memory tricks
meds (CCB, Beta Blockers)
BRADYcardia
Below 60/min
3. Ventricular Fibrillation (V Fib)
Treatment:
1. V Fib - Defib #1 Defibrillation
immediately Stop CPR
to do it & before drugs!
*NO synchronization needed
2. Drugs: LAP - Lidocaine,
Memory tricks
Fib is flopping- squiggly line
4. Ventricular Tachycardia (V Tach)
Amiodarone, Procainamide
Causes:
Untreated V Tach, Post MI,
LIDOCAINE
P
PROCAINAMIDE
AMIODARONE
Memory tricks
Causes:
Post MI, Hypoxia,
Treatment:
1. Early Defibrillation! NCLEX TIP
V Tach Tombstone pattern
A
E+ imbalance, proarrhythmic meds
Low potassium, Low magnesium
Memory tricks
L
Apply defibrillator pads
Call out & look for everyone to be
CLEAR!
Shock & IMMEDIATELY continue
chest compressions
2. When to Shock? NCLEX TIP
V Tach with No pulse = Defibrillation
V Tach with Pulse = Cardioversion
C
C - Count a pulse
C - Cardiovert
*Synchronize First
& Sedation
D
D - Dead - NO PULSE
D - DEFIB!!
*NO Synchronize
D - Don't wait
9 ECG Strips on the NCLEX II
5. Atrial Fibrillation (A Fib)
Digoxin
Causes:
Valvular disease, Heart failure, Pulm. HTN,
A
COPD, after heart surg.
Treatment:
1. Cardioversion (after TTE to rule out clots)
*Push Synch
2. Digoxin - Deep Contraction
Check ATP Before giving:
A - Apical pulse 60
T - Toxicity (Max 2.0 range) visual disturbances,
T
Max 2.0
60
40 kg
P
N/V, Anorexia
Memory tricks
No P wave = Fibrillation FloPPing
6. Atrial Flutter (A Flutter)
P - Potassium below 3.5 - HIGHER risk for
toxicity
< 3.5
3. Anticoagulants: Warfarin (monitor INR, Vit.
Potassium
K antidote, moderate green leafy veggies)
K+
Causes:
Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg.
Treatment:
1. Cardioversion (after TTE to rule out clots)
*Push Synch
2. Digoxin - Deep Contraction
Check ATP Before giving:
A - Apical pulse 60
T - Toxicity (Max 2.0 range) visual disturbances,
N/V, Anorexia
Memory tricks
P - Potassium below 3.5 - HIGHER risk for
toxicity
3. Anticoagulants: Warfarin (monitor INR, Vit.
A FluTTer = sawTooTh
Max 2.0
40 kg
< 3.5
K
Potasssium
K+
KAPLAN
Causes:
Stimulants, Strenuous exercise, hypoxia,
heart disease
Super Fast = Supraventricular
60
K antidote, moderate green leafy veggies)
7. SVT - Supraventricular Tachycardia
Memory tricks
DIGOXIN
Treatment:
1. Vagal Maneuver (bear down like
having a bowel movement, ice cold
stimulation)
2. Adenosine - RAPID PUSH & flush
with NS - HR may stop
Which medication should be held 48-hours
prior to an elective cardioversion for SVT?
Digoxin due to increased ventricular
irritability
Client with SVT has the following
assessment data: HR 200, BP 78/40, RR 30
Priority action: Synchronized
cardioversion
PRIORITY
3. Cardioversion - *Push Synch
8. Torsades de Pointes
Memory tricks
M
Magnesium
Causes:
Post MI, Hypoxia, Low magnesium
Treatment:
Magnesium Sulfate NCLEX TIP
Memory tricks
Tornado Pointes
Magnesium
Mg+
M
Mellows out the heart
9 ECG Strips on the NCLEX III
9. Asystole - Flatline
Epinephrine, Atropine & CPR
*NO Defibrillation
(NO shock) NCLEX TIP
Memory tricks
Assist Fully! … patient is flatlined
R
NCLEX Key Terms
R
PP
P
Q
Q
S
S
4. “Bizarre” - Tachycardia
1. P wave = Atrial rhythm
3.
Asystole
Question:
2. QRS wave - Ventricular rhythm
Ventricular Tachycardia
“Bizarre rhythm with wide QRS complex”
Answer: Ventricular Tachycardia
Question:
“Lack of QRS complexes”
Answer: Asystole
R
Q
S
3.
V Tach
5. “Sawtooth” - Atrial Flutter
“Wide bizarre QRS complexes”
Answer: V Tach
3. “Chaotic or unorganized” - Fibrillation
Question:
A FluTTer = sawTooTh
“Chaotic rhythm with no P waves”
Answer: Atrial Fibrillation
Atrial Flutter
“CHAOTIC rhythm without QRS complexes”
Answer: Ventricular Fibrillation
Atrial Fibrillation
If you know these, you will pass the NCLEX!
NCLEX TIP
Normal sinus rhythm
Bradycardia
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V Tach)
Atrial Fibrillation (A Fib)
Atrial Flutter (A Flutter)
Torsades de Pointes
Asystole - flatline
3.
SVT - Supraventricular Tachycardia
EKG Quick view
9 strips to know for the Nclex
Normal sinus rhythm
Bradycardia
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V Tach)
Atrial Fibrillation (A Fib)
Atrial Flutter (A Flutter)
SVT - Supraventricular Tachycardia
Torsades de Pointes
Asystole - flatline
Heart Sounds &
5 EKG Lead Placement
Memory Trick
Heart Sounds
APETM
“All Pigs Eat Too Much”
PULMONIC
(2nd Intercostal Space
L Sternal Border)
AORTIC
(2 Intercostal Space
R Sternal Border)
A - Aortic
P - Pulomonic
E - Erb’s point
T - Tricuspid
M - Mitral
nd
TRICUSPID
(3nd or 4th Intercostal Space
L Sternal Border)
ERB’S POINT
(3rd Intercostal Space
L Sternal Border)
MITRAL
(5th Intercostal Space
Midclavicular Line)
5 EKG Lead Placement
QRS Complex
R
Memory Trick
P
PR Segment
PR Interval
Q
ST Segment
White on Right
Smoke over Fire
Brown in the Middle
Grass under sky (white)
T
S
QT Interval
Proper 12-Lead Placement for Left Side of Chest
v1
4th intercostal space to the right of the sternum
v2
4th intercostal space to the left of the sternum
v3
directly between the leads V2 & V4
v4
5th intercostal space at midclavicular line
v5
level with V4 at left anterior axillary line
v6
level with V5 at left midaxilary line
(directly under the midpoint of the armpit)
v4R 5th intercostal space, right midclavicular line
v1
v4R
v2 v
3
v4
v5
v6