ECG Study Guide Table of Contents ECG STUDY GUIDE ..................................................................................................................................................................... 3 2015 AMERICAN HEART ASSOCIATION (AHA) GUIDELINES HIGHLIGHTS UPDATE FOR CARDIOPULMONARY RESUSCITATION (CPR) AND EMERGENCY CARDIOVASCULAR CARE (ECC). ....................................................................................................... 3 ECG INTERPRETATION BASICS ............................................................................................................................................. 4 EKG GRAPH PAPER ................................................................................................................................................................... 4 Components of the Normal EKG Waveform ......................................................................................................................... 6 RATE MEASUREMENT ................................................................................................................................................................ 9 The Six Second Method ......................................................................................................................................................... 9 Large Box Method ................................................................................................................................................................ 9 Small Box Method ............................................................................................................................................................... 10 BASIC EKG RHYTHM ANALYSIS GUIDE ................................................................................................................................... 11 Rhythm Interpretation ......................................................................................................................................................... 13 Six Basic Steps for Rhythm Interpretation Summary .......................................................................................................... 13 NURSING PRIORITIES AND POTENTIAL TREATMENTS ............................................................................................................... 14 Bradycardia ........................................................................................................................................................................ 14 BASIC CHARACTERISTICS OF CARDIAC RHYTHMS ................................................................................................................... 16 TYPES OF RHYTHM .................................................................................................................................................................. 18 NORMAL SINUS RHYTHM ......................................................................................................................................................... 18 SINUS BRADYCARDIA............................................................................................................................................................... 19 SINUS TACHYCARDIA ............................................................................................................................................................... 20 PREMATURE ATRIAL CONTRACTIONS (PACS) ......................................................................................................................... 22 ATRIAL FIBRILLATION ............................................................................................................................................................. 23 ATRIAL FLUTTER ..................................................................................................................................................................... 24 JUNCTIONAL RHYTHM .............................................................................................................................................................. 25 ACCELERATED JUNCTIONAL RHYTHM/JUNCTIONAL TACHYCARDIA ........................................................................................ 26 ATRIOVENTRICULAR BLOCKS .................................................................................................................................................. 27 1ST DEGREE AV BLOCK ........................................................................................................................................................... 27 2ND DEGREE AV BLOCK (MOBITZ TYPE I, WENCKEBACH) ..................................................................................................... 29 3RD DEGREE AB BLOCK / COMPLETE HEART BLOCK .............................................................................................................. 31 VENTRICULAR RHYTHMS ......................................................................................................................................................... 33 PREMATURE VENTRICULAR CONTRACTION (PVCS) ................................................................................................................ 34 VENTRICULAR TACHYCARDIA ................................................................................................................................................. 36 VENTRICULAR FIBRILLATION ................................................................................................................................................... 37 ASYSTOLE ................................................................................................................................................................................ 38 POLYMORPHIC VENTRICULAR TACHYCARDIA (TORSADE DE POINTES).................................................................................... 39 IDIOVENTRICULAR (IVR) ......................................................................................................................................................... 40 ACCELERATED IDIOVENTRICULAR (AIVR) .............................................................................................................................. 41 PACED RHYTHMS ..................................................................................................................................................................... 42 Pacemaker Summary .......................................................................................................................................................... 45 CONCLUSION .............................................................................................................................................................................. 46 REFERENCES .............................................................................................................................................................................. 47 2 ECG Study Guide The ECG Assessment Testing is an assessment of your basic knowledge and should be completed as part of your new hire process. Although we are sure that you know the information, you need to study this information to be prepared to pass the test. Please remember the following guidelines: . The study guide is a good overall review of the components of the ECG waveform and more common dysrhythmia. You will need to be able to recognize the four lethal rhythms. Asystole, Ventricle Tachycardia (VT), Ventricle Fibrillation (VF), and Polymorphic Ventricle Tachycardia (Torsade de pointes). Use this study guide and other resource books to review ECG interpretation. You will be expected to calculate rates properly interpret each strip. Practice measuring your strips in the study guide. The rhythm strips on the exam are NOT always 6-second strips. Use calipers or review pages 9 & 10 for rate calculation. Memorize your blocks…there are several rhythm strips on blocks. Rules for passing the exam . Minimal passing score = 85% . If you do not correctly identify any of the following rhythms, you will be required to retake the exam, even if your test score is above the passing score. o Ventricular tachycardia o Ventricular fibrillation o Asystole o Torsade de pointes . If you correctly identify the four lethal rhythms and achieve an overall score of at least 85%, you have passed the exam. 2015 American Heart Association (AHA) Guidelines Highlights Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). For Information Purpose Only http://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf This “Guidelines Highlights” publication summarizes the key issues and changes in the 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Because this publication is designed as a summary, it does not reference the supporting published studies and does not list Classes of Recommendation or Levels of Evidence. For more detailed information and references, readers are encouraged to read the 2015 AHA Guidelines Update for CPR and ECC, including the Executive Summary, published in Circulation in October 2015, and to consult the detailed summary of resuscitation science in the 2015 International Consensus on CPR and ECC Science with Treatment 3 ECG Interpretation Basics EKG Graph Paper The paper used to record EKG tracings is grid like in nature and has specific markings utilized