Chapter 11 - Putting It All Together

BASE HOSPITAL GROUPONTARIO

Chapter 11 for 12 Lead Training

- Putting it all together-

Ontario Base Hospital GroupEducation Subcommittee

2008

TIME IS MUSCLE

OBHG Education Subcommittee

Putting it all together

REVIEWERS/CONTRIBUTORS

Neil Freckleton, AEMCA, ACPHamilton Base Hospital

Jim Scott, AEMCA, PCPSault Area Hospital

Ed Ouston, AEMCA, ACPOttawa Base Hospital

Laura McCleary, AEMCA, ACPSOCPC

Tim Dodd, AEMCA, ACPHamilton Base Hospital

Dr. Rick Verbeek, Medical DirectorSOCPC2008 Ontario Base Hospital Group

AUTHOR

Greg Soto, BEd, BA, ACPNiagara Base Hospital


Chapter 11 - Objectives

Describe the importance of using a systematic approach to interpretation of the 12 Lead ECG

Use a simple algorithm for a time-saving approach to reading 12 Lead ECGs

Practice interpreting 12 Lead ECG


Systematic Approach

In initial assessment of patient acquire at least a 6-second ECG strip for rhythm interpretation

Decide if life threatening arrhythmias exist - if so, treat accordingly

Could 12 Lead ECG assist in dysrhythmia interpretation?

Acquire 12 Lead ECG


Systematic Approach

Look for ST elevation Locate the AMI Look for ST depression, reciprocal

changes and Q waves Rapid treatment and transport Rapid triage for reperfusion – ALERT

RECEIVING HOSPITAL Acquire 2nd 12 Lead enroute to look for

changes


Junctional rhythm - Inferior STEMI with RCs


AFib w/ PVCs and RBBB


Underlying Sinus Rhythm w/ PVCs - Inferolateral ischemia


NSR - old Septal wall MI


A Fib w/ RBBB


NSR - Inferolateral STEMI


NSR – No STEMI


NSR – Extensive Anterior AMI


NSR w/lateral ischemia


NSR – Anteroseptal STEMI w/RCs


Junctional – Anteroseptal ischemia


1st° Block w/PVCs – Anteroseptal STEMI


NSR – old Septal MI


1st° Block – Lateral wall ischemia


NSR – Inferior STEMI w/RCs


NSR w/LBBB


S Brad – Lateral STEMI w/RCs


1st° Block – Inferior STEMI w/RCs


NSR – no STEMI


AFib w/PVCs – No STEMI


1st° Block w/PVCs – RBBB


NSR – no STEMI


STach – Inferior STEMI w/RCs


NSR – Extensive Ant STEMI


NSR w/ PAC


NSR w/ couplets (PVCs)


1st degree AV block


SBrad – inferolateral ischemia


Paced rhythm




S Brad – Inferior STEMI w/RCs


2nd° Type I - LBBB


A Fib – RBBB




NSR w/PVC – No STEMI


S Brad – old Anteroseptal MI


A Fib – Inferior STEMI w/RCs


STach – No STEMI


NSR - Anteroseptal MI


NSR – old Inferior MI


RBBB w/sinus exit block


3rd° block – broad Ischemia


S Brad – Anteroseptal & Inferior STEMI


Normal


S Brad – old anteroseptal MI


Anterior (septal)


NSR – old inferior MI


NSR lateral ischemia


Incomplete LBBB


Anterolateral


NSR – no STEMI


SVT w/RBBB


1st° block, Anteroseptal AMI


NSR – ST depressions(subendocardial injury)


Conclusions

This course is intended to introduce the paramedic to the basic concepts and purposes of prehospital 12 Lead ECG interpretation.

12 Lead ECG mastery is achieved only through the application of study and practice.

Keep in mind: the main goal of prehospital 12 Lead ECG is to identify patients at risk of acute myocardial infarction for rapid triage and transport for in-hospital STEMI reperfusion.


Thanks & So Long!


QUESTIONS?


Well Done!

Education Subcommittee

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Chapter 11 - Putting It All Together