EKG like a BOSS Part 1 - How to Read EKGs (ECG interpretation for nurses) - 双语字幕
If you're anything like me, the first time you saw all the squiggly lines on an EKG, you went cross-eyed.
I how can you tell what's going on with your patient by just looking at a of lines on a page?
I'm gonna show you how to quickly figure out what rhythm your patient is in and what to do about it.
And when you're done, you're gonna be able to interpret EKGs like a boss.
My name is Nicole I've been a nurse for 10 years and I've worked in ICU and emergency
department so I have looked at so many EKGs in my lifetime.
I'm an educator with NRSNG and I really want to help you demystify the EKG.
I want to help you know how to identify normal and how to identify some of the most common abnormalities.
Now I remember learning how to interpret EKGs in nursing school and
my instructor made it very clear that what I needed to know was something that was too fast, too slow, or deadly.
So what we're going to go through today.
And going to make sure that you can identify those quickly and take care of your patients like you need to.
So first, you've got to understand the EKG graph paper.
What are you even looking at?
So what you're going to see is some dark light.
And inside of those dark lines is some lighter lines.
So what you're going to see is what we call large boxes and small boxes.
And inside each large box,
if you zoom in, you're going to see that there's five small boxes across and five small boxes up and down.
Now, you don't need to know that there's 25 boxes, just that there's five across.
So the vertical lines, axis up and down is our amplitude.
So one small box is one millivolt.
And all that's telling us is how much electricity there is.
So the taller the waveform is, the more electricity that's going on.
Now the horizontal line is what you really need to pay attention to.
The horizontal is time.
So a small box on the horizontal line.
line is 0.04 seconds.
So if there's five small boxes in one large box, do the math.
one large box is 0.20 seconds and if you do the math again you'll know that five large boxes is one
second so make sure that you understand that it's really going to come into play as we start to look at the specific waveforms.
Now the big thing to know about an EKG waveform is it represents electrical activity doesn't necessarily tell us the heart's actually pumping efficiently
just that the electricity is happening and so we have something called PEA pulseless electrical
activity means there's electricity but nothing's pumping right so important to know that it's just
But also what I'm going to show you is that each part of this waveform actually represents a certain part of the electricity.
So going to go through that in a second,
but knowing that is going to help you to understand what's going on with your patient if there's any abnormalities.
So first, let's really quickly review the AMP of the electrical activity.
the heart.
So we have our heart and we have the essay node in the right atrium.
That is what starts all of our electrical activity in the heart.
So it beats at 60 to 100 beats per minute.
It's going to fire a signal and that signal is going to go down the atria down to the AV node and the AV
node is going to pause for a split second and then it's going to send it down towards the ventricles,
sends it down through the bundle of hiss down the left and right bundle branches and out
the perkin g fibers up to the ventricles so that they can contract.
So we call the electrical stimulus process depolarization and then when everything relaxes that's called repolarization.
So what you're going to see is waveforms that represent all of those difference.
So let's look at the specific waveforms.
The first waveform you're going to see on an EKG is the P-Wave.
It's a small positive deflection on your waveform, and it represents atrial depolarization.
So the signal comes from the SA node through the atria, makes the atria contract.
So atrial depolarization.
So after the P-Wave, you're going to see QRS complex.
The QRS represents ventricular depolarization.
So you'll notice it's much taller, much larger than the P wave.
It doesn't have anything to do with strength or force of contraction.
It everything to do with the fact that the ventricles are bigger.
There's much more electricity going through them, right?
So you're going to see more electricity.
Then you're going to see the T-Wave.
The T-Wave actually represents a repolarization.
So this is when the electricity is kind of reversing and the ventricles are getting a chance to relax.
Notice you don't see atrial repolarization.
The thought is it's probably hiding somewhere in where the QRS is.
It's not really represented on our waveform.
You're also going to need to look at some interesting intervals on this waveform.
The first one you're going to see is the PR interval.
The PR interval goes from the beginning of the P wave to the beginning of the QRS complex.
And this signifies the time it takes for the SA node to fire,
get to the AV node, the AV node to pause, and then to start the signal to the ventricles.
And so if that's slow, we know there's a.
problem with that communication between SA and AB nodes, right?
So that PR interval should be less than 0.20 seconds or less than five small boxes.
So always pay attention to that and make sure your timing looks right.
The second interval you're going to look at is actually the QRS complex itself.
We want to make sure that ventricles are contracting efficiently and effectively, which means quickly, right?
So, that QRS complex, or from the beginning of the queue to the end of the S,
should be less than 0.12 seconds, or less than three small boxes.
If it's any wider than that,
we're having slow conduction through the ventricles, and it's not going to be an efficient pump, so that's a problem as well.
The next interval...
is the qt interval.
This is actually the beginning of the q to the end of the t.
So this is actually the full time it takes for the ventricles to fully contract and fully relax.
Again, we want to make sure everything's being efficient.
The problem we can have here if this is prolonged is now we're trying to contract a ventricle that's still trying to relax.
and can cause a lot of problems.
So wanna make sure the QT interval is where it needs to be and it's not prolonged.
Now you'll also see some segments on your EKG waveform.
The one is the ST segment.
This is one we actually look at quite often.
And it's the line between the S wave and the T wave.
It should be all the way down at the bottom at baseline, which is also called the isoelectric line.
If it's elevated by more than two small boxes,
so more than two millivolts, that's a problem we call the ST elevation, could signify infarction or a schemia of that heart muscle.
It's definitely a problem.
The other segment that you might see labeled as the PR segment,
again, that's the pause between SA and AB node, but we don't really pay that much attention to it.
So now that you know what each waveform does,
we need to look at a full rhythm so that you know what you're looking at when you see it.
This is normal sinus rhythm.
This is what it should look like.
For every rhythm you should see AP, and then a QRS, and then a T.
every single time.
If you're not seeing those things in order,
you know there's definitely a problem because we need the atria to contract and then the ventricles
to contract and then of course we need everything to relax as well.
Remember not alone in this.
We've got you.
Happy nursing.
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