Obtunded patient? ECG can clinch the diagnosis!
Episode 79
March 4, 2013

A patient presents obtunded, GCS 3, RR 8. The ECG makes the dx!
 
Go through the following steps EVERY TIME you interpret a tough ECG
 
5 Step Approach to ECG Interpretation
  1. Rate and Rhythm
  2. Axis
  3. Intervals
  4. Enlargement
  5. Ischemia & Infarction (Q-waves, ST-segment changes, T-wave inversions)​

​​Recognize abnormalities and stop to think about the differential diagnoses that explain them.

Right Axis Deviation Differential

  • LPFB
  • Lateral MI (from Q-waves)
  • RVH
  • Acute (PE) and chronic (COPD) lung disease
  • Ventricular ectopy
  • Hyperkalemia
  • Na-channel blocking drugs (TCA)
  • Normal thin adults with horizontally positioned hearts
  • Lead misplacement

Causes of QRS prolongation

  • BBB (LBBB or RBBB) or paced rhythm
  • Pre-excitation (WPW)
  • Ventricular ectopy
  • Metabolic/Electrolytes (i.e. acidosis, hyperkalemia)
  • Medications - Na2+channel blocking drug toxicity (TCA’s, Quinidine & Anti-arrhythmics)
  • Nonspecific intraventricular conduction delay (ex. from LVH, hypothermia) or congenital

Causes of QT-interval prolongation

  • Hypothermia
  • Hypokalemia (due to U-wave), Hypomagnesemia , Hypocalcemia
  • AMI
  • Increased ICP
  • Na2+channel blocking drugs (TCA’s, Quinidine & Anti-arrhythmics)
  • Congenital

Na2+ channel blocker toxicity (ex. TCA’s)

  • Tall R wave in aVR
  • Tachycardia
  • Right Axis Deviation
  • Prolonged QRS

Approach each ECG systematically so that you don’t miss things. These previous episodes are loaded with pearls and differentials that will help you save lives…

The 5 step approach to ECG interpretation

Deadly, can’t miss ECG!

 

 
 
Obtunded patient? ECG can clinch the diagnosis!
Episode 79
March 4, 2013

A patient presents obtunded, GCS 3, RR 8. The ECG makes the dx!
 
Go through the following steps EVERY TIME you interpret a tough ECG
 
5 Step Approach to ECG Interpretation
  1. Rate and Rhythm
  2. Axis
  3. Intervals
  4. Enlargement
  5. Ischemia & Infarction (Q-waves, ST-segment changes, T-wave inversions)​

​​Recognize abnormalities and stop to think about the differential diagnoses that explain them.

Right Axis Deviation Differential

  • LPFB
  • Lateral MI (from Q-waves)
  • RVH
  • Acute (PE) and chronic (COPD) lung disease
  • Ventricular ectopy
  • Hyperkalemia
  • Na-channel blocking drugs (TCA)
  • Normal thin adults with horizontally positioned hearts
  • Lead misplacement

Causes of QRS prolongation

  • BBB (LBBB or RBBB) or paced rhythm
  • Pre-excitation (WPW)
  • Ventricular ectopy
  • Metabolic/Electrolytes (i.e. acidosis, hyperkalemia)
  • Medications - Na2+channel blocking drug toxicity (TCA’s, Quinidine & Anti-arrhythmics)
  • Nonspecific intraventricular conduction delay (ex. from LVH, hypothermia) or congenital

Causes of QT-interval prolongation

  • Hypothermia
  • Hypokalemia (due to U-wave), Hypomagnesemia , Hypocalcemia
  • AMI
  • Increased ICP
  • Na2+channel blocking drugs (TCA’s, Quinidine & Anti-arrhythmics)
  • Congenital

Na2+ channel blocker toxicity (ex. TCA’s)

  • Tall R wave in aVR
  • Tachycardia
  • Right Axis Deviation
  • Prolonged QRS

Approach each ECG systematically so that you don’t miss things. These previous episodes are loaded with pearls and differentials that will help you save lives…

The 5 step approach to ECG interpretation

Deadly, can’t miss ECG!

 

 
 
  1. medinuggets reblogged this from ekgumem and added:
    An ECG tutorial from the master…….some pearls on Differentials for R axis; Long QT; and widened QRS
  2. muradfadhil reblogged this from ekgumem
  3. ekgumem posted this
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