ALS course documents

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Monitoring, rhythm recognition and 12-lead ECG workshop

Key learning outcomes By the end of this session the candidate will: Understand the indications for ECG monitoring Know how to monitor the ECG effectively Understand the basic physiology of the ECG Understand the 6-stage approach to rhythm recognition Be able to recognise the common 1 -lead ECG patterns of ac!te myocardial infarction Instructor information Use of a rhythm sim!lator and real-time screen is essential" #et the mood$ establish !sef!lness and state learning o!tcomes for the session" %he following points sho!ld be covered: Monitoring Basic ECG monitoring &ndications ' enco!rage candidates to disc!ss indications (ow to monitor the ECG )-lead monitoring and 1 -lead monitoring Use of self-adhesive pads

Electrocardiogram Basic ECG physiology #ino-atrial and atrio-ventric!lar nodes and intracardiac cond!ction Generation of * waves$ the +,# comple- and % waves

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.ormal morphology of these and normal limits for *+/*, interval$ +,# d!ration and +% interval Rhythm recognition

0efinitions of bradycardia and tachycardia" 0emonstration of the 6-stage approach to basic rhythm recognition !sing a vis!al aid and real time rhythm sim!lator" Use rhythm sim!lator/interactive disc!ssion to demonstrate 1 st and
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complete heart bloc1" B!ndle branch bloc1" 2trial fibrillation and fl!tter" 0isc!ss significance of prolonged +% interval" Emphasise the importance of recording an arrhythmia for later review and 1 -lead ECG recordings 3when possible4 for acc!rate rhythm recognition"

12-lead ECG Common patterns of myocardial ischaemia and infarction" #ignificance of + waves$ #% segment and % wave abnormalities" %he following 1 -lead ECG patterns sho!ld be demonstrated !sing the vis!al aids provided: 1. Normal 12-lead ECG .ormal morphology in ) dimensions" &ntrod!ce concept of electrical a-is" 2. Non-ST-segment-ele ation myocardial infarction % wave inversion" #% segment depression" Emphasise that these appearances are nonspecific and only provide evidence of .#%E5& in the appropriate clinical conte-t and with biochemical evidence of myocardial damage" !. "cute ST-segment-ele ation anterolateral myocardial infarction ,elate to indication for immediate reperf!sion therapy" #tart to disc!ss relevance to coronary anatomy 3)-dimensional role of ECG again4 and o!tcome ' anterior infarction generally li1ely to have a worse prognosis than inferior infarction etc" #. "cute ST-segment-ele ation inferior myocardial infarction ,einforce #%-elevation 5& as indication for immediate reperf!sion therapy" 6!rther ill!stration of )-dimensional !se of ECG" 7eads &&$ &&& and a86 reflect events/disease of

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the inferior 78 wall" 28 bloc1 more li1ely to complicate inferior infarction b!t !s!ally recovers and does not always need temporary pacing" Beware: !se of modified lead positions 3on tr!n1 rather than legs4 may alter the appearances" $. "cute ST-segment-ele ation %osterior myocardial infarction 2nother chance to emphasise the )-dimensional nat!re of the ECG" .ow introd!ce the concept of reciprocal change: #% depression at the front act!ally means #% elevation at the bac1 ' where the infarct is" Use the posterior leads to s!pport this point" 2ltho!gh the conventional 1 -lead ECG act!ally shows anterior #% depression$ this is an indication for immediate reperf!sion therapy beca!se it act!ally represents #%E5& of the posterior wall"

2llow candidates to as1 9!estions and reflect on the session content before terminating the session with a s!ccinct review of all the ma:or points covered"

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