Dan Thorward MS, RN, CCEMT-P

Cardiology and EKG:

An Overview for the ACLS Provider

A.A.S. Emergency Medical Services

A.D. Nursing
B.S. Health Professions

Dan Thorward MS, RN, CCEMT-P

B.S. Nursing
M.S. Nursing Education
PhD Student, Leadership
CCEMT-Paramedic
BLS Instructor, OSUWMC
ACLS Instructor, OSUWMC

Nurse Manager, The James Cancer Hospital

Lecture Series
1.

Responding to Emergencies

2.

IV Therapy: PIV to CVC

3.

Cardiology and EKG

4.

Labs for Clinical Practice

Dans Disclaimer
I have no significant relationships with any
pharmaceutical company or manufacturer.
This is not an official AHA course. The information
provided is for professional development only.
Thank you to Dr. Michele Weber for her help with
this presentation.

Cardiology and EKG

Electrophysiology

Electrophysiology

SA Node

EKG Rhythms

AV Node

12-Lead EKG

Bundle of His

Selected Meds

Lifepak 20

Right and Left

Bundle Branches

Summary

Purkinje Fibers

EKG Waveforms

P-wave

QRS Complex

T-wave

ST Segment

Naming Cardiac Rhythms

A word about how rhythms are named
Location! Location! Location!
Where dose the depolarization begin?

Heart Rate
The fastest functioning pacemaker
sets the heart rate

QT Segment

EKG Rhythms

Normal Sinus Rhythm (NSR)

Sinus Bradycardia

EKG Rhythms Continued

V-Tach

V-Fib

Sinus Tachycardia

Asystole

Heart Blocks

Its all about the AV Node!

First Degree Heart Block
Second Degree Heart Block: Type I

Wenckebach

Second Degree Heart Block: Type II

Third Degree Heart Block

EKG Rhythm Variations

Torsades de Pointes
Atrial Flutter
Atrial Fibrillation
Supraventricular Tachycardia
Pulseless Electrical Activity
PVCs and Bigeminy

12-Lead EKG

12-Lead EKG

Why do we need a 12-lead?

V1 - 4

Landmark identification

V2 - 4

Electrode placement

V4 - 5

Diagnostic quality

Skin preparation

V3 - Mid point between V2 and V4

V5 - 5 intercostal space anterior

Patient Positioning

Basic12-Lead EKG Interpretation

What is the Rate?

I See All Leads

Dont trust the computer to read for you!

Vasoactive Drips

Dopamine
Dobutamine
Levophed
Epinephrine

th intercostal space, mid

clavicular line

th

V6 - 5

th

intercostal space mid axillary

line

Selected ACLS Medications

300, 150, 100, 75 , 60, 50

ST Depression, ST Elevation, Q wave formation

th intercostal space, left of the

sternal border

axillary line

MONA

What is the Rhythm?

STEMI?

th intercostal space, right of the

sternal border

Morphine Sulfate
Oxygen
Nitroglycerin
Aspirin

Atropine Sulfate
Adenosine
Epinephrine

Lifepak 20
AED
Cardiac Monitor
Defibrillator
Pacemaker

Summary

Electrophysiology

Rhythms

12-Lead EKG

Selected ACLS Medications

Lifepak 20