6-Step EKG Interpretation for Nurses

Introduction

• Focus on EKG interpretation for nursing students and new nurses.
• 6-step process to interpret EKGs efficiently.

Important Concepts

Conduction System of the Heart

• Consists of special cardiac cells conducting signals for heart contraction.
• SA Node (Sinoatrial Node):
  • Located in the right atrium.
  • Known as the heart's natural pacemaker.
• AV Node (Atrioventricular Node):
  • Located at the border between the right atrium and ventricle.
  • Acts as a gatekeeper, deciding which impulses to allow through.
• Bundle of His:
  • Conduction moves from AV node to this structure.
• Bundle Branches and Purkinje Fibers:
  • Conduction splits into left and right branches, leading to Purkinje fibers at the apex of the heart.

Inherent Rates of Cardiac Cells

• SA Node: 60-100 beats per minute (bpm)
• AV Node/Bundle of His: 40-60 bpm
• Bundle Branches/Purkinje Fibers: 20-40 bpm

EKG Components

• P Wave: Atrial depolarization (atria contraction).
• QRS Complex: Ventricular depolarization (ventricles contraction).
• T Wave: Ventricular repolarization (ventricles relaxation).
• Atrial Repolarization: Occurs within the QRS complex; masked by ventricular activity.

Key EKG Segments and Intervals

• Focus on PR interval, QRS complex, and their importance in EKG interpretation.
• PR Interval: 0.12 to 0.20 seconds.
• QRS Complex: 0.06 to 0.12 seconds.

EKG Interpretation Steps

1. Identify and Examine P-Waves:
   • Normal P-waves are present and upright.
   • Absent/inverted P-waves may indicate dysrhythmias (e.g., junctional rhythm).
2. Measure PR Interval:
   • Count small boxes between start of P-wave and start of QRS complex.
   • Multiply by 0.04 seconds.
   • Normal: 0.12 to 0.20 seconds.
3. Measure QRS Complex:
   • Count boxes between start and end of QRS complex.
   • Normal: 0.06 to 0.12 seconds.
4. Identify the Rhythm:
   • Regular or irregular rhythm determined by R-to-R intervals.
   • Use an index card to measure distances between R waves.
5. Determine Heart Rate:
   • 6-Second Method: Count R waves in a 6-second strip and multiply by 10.
   • Big Box Method: Divide 300 by number of big boxes between two R waves.
6. Interpret Your Strip:
   • Analyze findings and conclude diagnosis.

Conclusion

• Understanding EKG interpretation is crucial for effective patient monitoring.
• Practice with different methods to determine heart rate and identify dysrhythmias.

• Note: Ensure your EKG strip is a 6-second strip when using the 6-second method.
• Feedback: Like and subscribe for more content on heart blocks, junctional rhythm, etc.
• Presenter: Don from Mint.