Electrocardiogram or EKG – measures the electrical activity of the heart Electrical conduction

AUTOMATICITY – ability of the heart muscle to initiate an electrical impulse
  1. SA Node (normal pacemaker of the heart)
  2. AV junction
  3. Bundle of His
  4. Purkinje fibers
P wave – Atrial depolarization

QRS Complex – Ventricular depolarization

T wave – Ventricular repolarization

U wave – may or may not be seen; repolarization of Purkinje fibers; Hypokalemia

PR Interval – from the onset of P wave to the onset of QRS complex

QRS Complex – amount of time the ventricles depolarize

1. Avoid bony areas/ scar tissues/ skin folds/ increased muscle mass
2. Perform a 10 cm shaving around the area; AVOID if possible
3. Dry the skin with the use of gauze
4. Remove excess skin oils EXCEPT for geriatric pts
5. Dry with gauze
6. Place the electrodes. Make sure the center is moist; otherwise, discard.
7. EQUIPMENT Trouble shooting
  • Horizontal axis - represents the time in seconds (sec)
    1 small square = 0.02 seconds
    5 small squares = 1.0 seconds
  • Vertical axis - represents the amplitude in millivolts (mv)
    1 small square = 0.1 mv
    5 small squares = 0.5 mv
    2 big squares = 1.o mv
Sinus Bradycardiaatrial rate of 50 or <60>
Sinus Tachycardia
atrial rate of >100 bpm
due to anxiety, blood loss, Fever, Pain

Paroxysmal Atrial Tachycardia (PAT) or Premature Supraventricular Tachycardia (PSVT)>150 – 250 bpm
due to CADse, Mitral valve dse, Thyrotoxicosis
  • Valsalva maneuver + Exhale slowly
  • Rest
  • Medications to sedate
  • Medications to slow electrical conduction to the heart (VERAPAMIL HCL)

Atrial Flutterdue to inflammation, fluid overload
  • Medications to slow ventricular rate (DIGITALIS)
  • Anti arrhythmics – Procainamide HCL
  • Synchronized cardioversion
Atrial fibrillationdue to alcoholism
350 – 600 bpm
decreased CO
  • Administer medications (Digitalis, Verapamil HCL)
  • Synchronized cardioversion
1st degree AV Blockdamaged hearts due to ischemia, Rheumatic fever, Infection
  • Atropine Sulfate (IV- 0.5 mg)
2nd degree AV blockMobitz Type 1 AV Block/ Wenckebach
due acute RF, MI, Digitalis toxicity
2nd degree AV BlockMobitz Type 2 AV Block
due to Pulmonary edema, Digitalis toxicity, worsened MI dse
  • Atropine Sulfate ( IV – 0.5 mg)
  • Isoproterenol
3rd degree AV BlockPacemakers (Permanent, Delayed, Demand, Fixed rate, AV Pacemaker)

Premature Ventricular Contraction (PVCs)
common in Type A personality
due to CADse, can precede dysrrhythmias, Acute MI/ Ischemia
  • Lidocaine HCL (IV bolus, initially then thru Infusion)
  • Atropine Sulfate IV
COUPLETS – IV Lidocaine
Multiform / Multifocal PVCs – Bolus Lidocaine

Ventricular Tachycardia
Due to mild Congestive heart failure
>150 bpm / HPN
  • IV Lidocaine
  • Procainamide
  • Precordial thump (obsolete)

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