6-Step EKG Interpretation

Introduction

• Presenter: Don from Mint (Nursing educational channel)
• Topic: Easiest way to do EKG interpretation
• Audience: Nursing students and new nurses

Important Concepts

Conduction System of the Heart

• Special Cardiac Cells: Responsible for conducting signals causing heart contractions.
• SA Node (Sinoatrial Node):
  • Location: Right atrium
  • Known as: Natural pacemaker
• AV Node (Atrioventricular Node):
  • Location: Border of right atrium and right ventricle
  • Known as: Gatekeeper of the heart
  • Function: Decides whether to let the impulse through
• Bundle of His: Connects AV node to ventricles, bifurcates into left and right bundle branches.
• Purkinje Fibers: Found at the apex of the heart, extend from bundle branches.
• Order of Conduction: SA node → AV node → Bundle of His → Right & Left Bundle Branches → Purkinje Fibers

Inherit Rate of Cardiac Cells

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

EKG Components

• P Wave: Represents atrial depolarization (atria contracting)
• QRS Complex: Represents ventricular depolarization (ventricles contracting)
  • Mnemonic: 'V' for ventricles (inverted V shape)
• T Wave: Represents ventricular repolarization (ventricles relaxing)
• Atrial Repolarization: Occurs within QRS complex but is masked by it.

Segments and Intervals

• PR Interval: From the beginning of P wave to the beginning of QRS complex
• PR Segment: Also discussed but less important for quick interpretation
• QRS Complex: Duration between the beginning and end of QRS complex
• ST Segment and QT Interval: Mentioned but not focused on for faster interpretation
• EKG Strip Basics:
  • Large box contains 5 small boxes
  • Each small box = 0.04 seconds
  • Large box = 0.20 seconds

6-Step EKG Interpretation

1. Identify and Examine the P Waves:
   • Normal P wave: Present and upright
   • Abnormal P wave: Absent or inverted (indicates dysrhythmias like junctional rhythm)
2. Measure the PR Interval:
   • From beginning of P wave to beginning of QRS complex
   • Count small boxes and multiply by 0.04 seconds
   • Normal range: 0.12 to 0.20 seconds
   • Deviation: >0.20 seconds could indicate heart block
3. Measure the QRS Complex:
   • Count small boxes within QRS complex
   • Normal range: 0.06 to 0.12 seconds
   • Deviation: >0.12 seconds could indicate dysrhythmia like PVC
4. Identify the Rhythm:
   • Regular: Even distance between R waves (using index card or calipers)
   • Irregular: Uneven distance between R waves
5. Determine the Heart Rate:
   • 6-Second Method: Count R waves in 6-second strip and multiply by 10 (best for irregular rhythms)
   • Big Box Method: Divide 300 by the number of large boxes between R waves (best for regular rhythms)
6. Interpret the Strip: Combine all the above information to make a final interpretation

Conclusion

• Recap: 6 steps to easily interpret an EKG
• Encouragement to like and subscribe, and suggest future content in the comments
• Presenter: Don from Mint