Hey, what's up? Everyone?
Doctor zeeshan here. So before you listen to this
lecture on EKGs, or at least an intro to EKGs, I highly suggest
you watch this on YouTube first. We put this exact lecture on
YouTube. So it gives you a sense of
actually visualizing what I'm going to talk about.
All right, so let's get started with EKGs.
So again. With EKGs on the boards.
I want you to understand that there's a few things that
they're going to ask you and they want you to focus on.
Don't make it more complicated than it is.
I know it's very daunting and intimidating subject but think
of it from a board perspective and the way that I think the way
that I would ask questions. What I want you to know is
they're going to try to make you identify strips and the more
common ones. Ones that I cover here are the
ones I want you to worry about. Okay, they're going to want you
to know, potentially what the causes are potentially and I'll
tell you for the ones that they'll want you to know, but
definitely what you're going to do about it.
So, how are you going to treat that Rhythm and the progression
of? How are you going to treat that
rhythm? so, if it's Procedure wise,
cool. If it's medication, wise know,
the side effects, things of that nature.
You're going to want to pay attention to what I'm providing
you with these notes with these notes and just focus on that,
just focus on that. But let's also understand.
Let's understand what EKGs are showing us.
So, the first thing that we have to do, is we have to look at The
different portions of it. We've got a p-wave A Q wave and
are wave and S Wave and the T. Wave P Q R S.
T. The p.
Is what? Part of the heart?
What part of the heart is the P showing us?
It's showing us. The atrium. it's showing us the
atrium when a p-wave happens, that means that the atrium has
contracted which means the qrst is going to be what The
ventricle good. The ventricles.
So when the qrst happens, now, we've got the ventricles
Contracting. What electrolyte predominantly
controls the atrium? Calcium calcium.
What? Electrolyte predominantly
controls the ventricles. Potassium.
So now you ask yourself as you go back to day one, when I talk
about ask graph and why changes in potassium or so important,
it's because they predominantly control the ventricles.
If they predominately control the ventricles and we've got
changes in potassium, low or high.
We can go into a dysrhythmias. The ventricles can go into a
disparate Mia. And what dysrhythmia are we
freaking out about v-fib? We will get into v-fib when I
get into the ventricles. Okay, and we'll talk about what
we're going to do and how to identify it.
But this is the basics. Of how I want you to understand
the different portions of an EKG.
The second thing I want you to know, is how to approximate.
A heart rate. As quickly as possible.
Now, is this the only way to approximate a heart rate?
Know if you have your own way of knowing how to read and find the
heart rate, stick to it. If you don't have a way, this is
a method that I use that ends up being quick and fast for me
because the boards are going to make things quick.
They're going to make things simple.
What I want you to do is I want you to look at your RR interval.
So between your are and your are.
And in between those two ours, those two little Peaks are going
to be big boxes. And all you have to do is count
the number of big boxes. And divide 300 by it. so, in
this situation, I've got how many big boxes are in between my
are and my arm are two peaks. There are four.
Right? My drawings.
Not that great. But yeah, there's four there.
Right? So, one, two, three, four, so
what would I take? I would take 300 and divide it
by 4, which would give me a heart rate of what?
Approximately 75. The boards are not going to
overly complicate it, they're going to make it simple.
So understanding understanding. That you can glance at a strip.
And look at your Peaks, your are in your art count.
The number of big boxes. Take the number 300 divided by
the number of big boxes. And now all you've got is your
approximate heart rate. They're not going to make it
unclear or ambiguous. It's going to either be
blatantly low, blatantly normal, or blatantly.
Hi. Okay, so don't overthink it.
Don't overthink it. So let's get started with normal
sinus rhythm. So normal sinus rhythm.
It's got the word sinus in there.
And what does that mean? Well.
We've got two nodes in our heart.
We've got the sinoatrial node, which is also known.
As the pacemaker. Of the heart.
And then we've got the atrial, ventricular node.
So, let's think about this. This sinoatrial node is the
pacemaker of the heart. Meaning, it's going to start the
heart off. And what's the first part of the
heart that's going to contract' the first part of the heart
that's going to contract is now the atrium.
And as the sinoatrial node fires, The Atrium will contract,
we will develop a p-wave. Now the atrium is going to have
a signal that is going to hit the atrioventricular node, which
is a signal, is coming from The Atrium.
And now it's going to cause The ventricle to contract.
And now we have a q r s t. So let's go through that one
more time. There is a node in the heart
called the sinoatrial node or that SA node.
It is the pacemaker of the heart.
It's what starts everything off. When the sinoatrial node starts,
and it fires it will contract The Atrium.
And now we've got a P wave. That impulse that signal will
now, travel through the atrium, get to the AV node.
And now the eight AV node will fire.
So now that signal from The Atrium is not going to make the
ventricle contract through the AV node.
And now we've got a q r s. T.
So, a normal sinus rhythm. Okay, so let's just break that
up. Let's take out the word normal.
Let's just worry. Let's work.
Let's focus on the word. Sinus rhythm.
How about that? Okay, sinus rhythm means what
the sinoatrial node is firing correctly?
If the sinoatrial node is firing correctly, The Atrium is going
to contract. So we will have a p-wave.
That signal will now hit the AV node.
And now the AV node will fire and The ventricle will
Contracting lava qrst. So in every sinus rhythm in
every sinus rhythm. What are we going to see a p q r
s t who just signed his shortest just so weird sinus rhythm.
How about that? So now tell me the difference
between normal sinus rhythm. Sinus, bradycardia and sinus
tachycardia. Just by the words itself, normal
is going to be a heart rate of what?
60 to 100. Okay?
For the board to remember normal is normal.
There is no ambiguity. 100 is now borderline 16 out
borderline. It's normal.
So, in normal sinus rhythm will be see a pqrst.
Absolutely, and when we go to check the heart rate with that
RR interval. Just like we did previously and
we solve for big boxes, it fell between 60 and 100.
So we have a normal sinus rhythm.
In sinus bradycardia. Are we going to have a pqrst?
Yes, because it's a sinus rhythm.
But the heart rate is going to be where?
Below. 60 in sinus. Tachycardia.
Are we going to have a pqrst? Yes, because the sinoatrial node
is firing. So we got that P wave then it
hits the AV node and we get our qrst.
So yes, but the difference in tachycardia is it's going to be
where? It's going to be above 100.
Okay, so understand what sinus rhythm means is just
understanding that art pacemaker or sinoatrial node is firing.
Our Atrium is Contracting. We got a p-wave.
That signal hits the AV node. And now the ventricle contracts.
You gotta qrst that is sinus. Rhythm normal is going to be
between 60 and 100. Brady is going to be below 60
and tacky is going to be above 100.