Lecture Notes: EKG Interpretation

Introduction

• Speaker: Don from Mint
• Topic: Easiest way to interpret EKG for nursing students and new nurses.
• Approach: 6-step EKG interpretation.

Important Concepts

Conduction System of the Heart

• SA Node (Sinoatrial Node):
  • Location: Right atrium.
  • Known as the natural pacemaker of the heart.
  • Starts the conduction process.
• AV Node (Atrioventricular Node):
  • Location: Border of right atrium and right ventricle.
  • Known as the gatekeeper; decides which impulses to allow through.
• Bundle of His:
  • Follows the AV node in the conduction pathway.
• Right and Left Bundle Branches:
  • Bifurcate from the Bundle of His.
• Purkinje Fibers:
  • Extend into the apex of the heart.

Inherent Rates of Cardiac Cells

• SA Node: 60-100 beats per minute.
• AV Node & Bundle of His: 40-60 beats per minute.
• Bundle Branches & Purkinje Fibers: 20-40 beats per minute.

EKG Parts

Waves

• P Wave: Atrial depolarization (atria contracting).
• QRS Complex: Ventricular depolarization (ventricles contracting).
  • V for Ventricles
• T Wave: Ventricular repolarization (ventricles relaxing).

Additional Note: Atrial repolarization occurs during the QRS complex.

Segments and Intervals

• PR Interval: Between start of P wave and start of QRS complex.
• QRS Complex: Key part of interpretation.
• Ignoring other segments (ST, QT) for simplicity in basic interpretation.

EKG Interpretation Steps (6-step Method)

1. Identify and Examine P Waves:
   • Normal P-wave: Present and upright.
   • Abnormalities could indicate dysrhythmia.
2. Measure PR Interval:
   • Count small boxes between P wave and QRS complex; multiply by 0.04 seconds.
   • Normal range: 0.12 - 0.20 seconds.
3. Measure QRS Complex:
   • Count small boxes in QRS complex; multiply by 0.04 seconds.
   • Normal range: 0.06 - 0.12 seconds.
4. Identify Rhythm:
   • Regular or irregular by measuring the distance between Rs.
   • Use index card for measuring.
5. Determine Heart Rate:
   • 6-second method: Count Rs in a 6-second strip, multiply by 10.
   • Big box method: Divide 300 by the number of big boxes between Rs.
   • Choose method based on rhythm regularity and strip length.
6. Interpret the Strip

Conclusion

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• Offers to create additional content on dysrhythmias.
• Speaker: Don from Mint

Note: Ensure to verify the strip length before using heart rate calculation methods. The 6-second method is only applicable for confirmed 6-second strips.