Cardiac Emergencies | ECG Monitoring

Electrocardiographic Monitoring: a record of the electrical activity in the heart, transferred to the ECG machine and displayed or printed on paper

Boxes on the paper represent time: .2 sec largest lines
Positive impulses go upward, negative go downward
Flatline: Isoelectric line is produced if no electrical impulse is present

ekgsegmentsP-Wave: occurs first and represents depolarization moving through the atria,resulting in atrial contraction. Upright and round, usually 60-100
PR Segment:pause as the impulse passes through the AV node
QRS Complex: depolarization moving through the ventricles, ventriclecontraction/systole
ST Segment: Repolarization of the ventricles, shows flat
T wave: Complete repolarization
U wave: sometime a small wave before the next P wave



Dysrhythmias: irregularities of the heart rhythm including:

  • Myocardial ischemia/necrosis
  • Autonomic nervous system imbalance Distention of heart chambers
  • Acid-base abnormalities
  • Hypoxemia
  • Electrolyte Imbalance
  • Drugs
  • Electrical injury
  • Hypothermia
  • CNS injury
  • Atrial dysrhythmias
  • Ischemia
  • Hypoxia
  • Atrial stretching due to CHF
  • Increased pulmonary artery pressure
  • Wandering atrial pacemaker >>>pacemaker site switches from beat to beat (also MAT multifocal atrial tachycardia)
  • Atrial flutter 250-350 beats a minute
  • Atrial fibrillation> multiple area fire simultaneously










Detailed Physical Exam: JVD, Thorax, Epigastrum (AAA?) Vitals: BP, heart rate, skin temp, color, condition, pulse Ox

EKG: The EKG is just showing the electrical impulses. This is not proof that the heart is, in fact, beating. Check the pulse, there may be no mechanical capture of the electrical signal.

Management: ABCs(CBA), is the patient stable?

Treat patient and rhythms according  to state/national guidelines for asystole, PEA, V-Fib and V-Tach.

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