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RAPID
INTERPRETATION
OF
EKGs
6th Ed.
C o p y r i g h t 2 0 0 0 C OV E R I n c .
Dale Dubin, MD
Dubins Method
for
Reading EKGs
from: Rapid Interpretation of EKGs
by Dale Dubin, MD
COVER Publishing Co., P.O. Box 07037, Fort Myers, FL 33919, USA
00
50
00
75 60 50
3
1
Using the triplets:
Name the lines following the Start line.
214 125 88 68
187 115 83 65
167 107 79 62
1500
May be calculated: = RATE
mm. between similar waves
Always:
Check for: P before each QRS.
QRS after each P.
Check: PR intervals (for AV Blocks).
QRS interval (for BBB).
Has QRS vector shifted outside normal range? (to rule out Hemiblock).
pause
An unhealty Sinus (SA) Node may
Then
Atrial
Escape Beat
(page 119)
or the SA Node
automaticity focus.
usally resumes
Junctional pacing.
Escape Beat
(page 120) or
Ventricular
Escape Beat
(page 121)
Atrial
Escape Rhythm +
++
+++
+
Rate 60-80/min. +
+
+
+
+
+
+
++ ++
+++
++ +
+
+
+ +
+
causing an automaticity focus to
+
But a sick Sinus (SA) Node may
or +
++
+
escape to assume pacemaker
++
(page 114)
cease pacing (Sinus Arrest),
Junctional
Escape Rhythm
Rate 40-60/min.
+++
++ +
+
+
+ +
+ +
+ +
++ ++
or
(pages 115-116)
(idiojunctional rhythm)
Ventricular
Escape Rhythm
Rate 20-40/min.
status.
C o p y r i g h t 2 0 0 0 C OV E R I n c .
(page 117)
(idioventricular rhythm)
discharge, producing a:
(pages 124-130)
Rates: Paroxysmal
Flutter Fibrillation
Tachycardia
multiple foci discharging
Bundle Branch Block find R,R' in right or left chest leads (pages 191-202)
Right BBB (pages 194-196) Left BBB (pages 194-197)
A
R. tr
A
.D
E
.
Lead I
Normal:
{ QRS upright in I and AVF
two thumbs-up sign
al
QRS in lead AVF (pages 223-226) I
R.
m
.D r I
A
if the QRS is mainly Positive, then . No
the Vector must point downward to AVF AVF
Lead AVF
positive half of the sphere.
III 150 II 30
D.
AVF 180 -180 o
0o
AVF 0
+180o 0o
Right Axis Deviation R. Normal Range
e
R ig
ard
Patients
rothtward L ef
tw Patients
a ti o on
t a ti
Right Left
n ro
V1 N or m al R a n g e
V6
V2 V3 V4 V5
Download from the fabulous
www.perpetuum-lab.com.hr
341
Personal Quick Reference Sheets
terminal
component
Infarction Location
and
Coronary Vessel Involvement
(pages 259 to 308)
circumflex
anterior
descending
Anterior
Inferior Qs in V1, V2, V3, and V4
(diaphragmatic) (Anterior Descending
Qs in inferior leads Coronary Artery)
II, III, and AVF (pages 278, 292)
(R. or L. Coronary Artery)
(pages 281, 294)
Pulmonary Embolism T
(pages 312, 313)
S1Q3 3 wide S in I, large Q and inverted T in III
acute Right BBB (transient, often incomplete)
R.A.D. and rightward rotation (horizontal plane)
inverted T waves V1 V4 and ST depression in II
Artificial Pacemakers (pages 321-326)
Modern artificial pacemakers have sensing capabilities and also provide a
regular pacing stimulus. This electrical stimulus records on EKG as a tiny
vertical spike that appears just before the captured cardiac response.
pacemaker spikes
are triggered (activated) when
Demand Pacemakers: (page 322)
Miscellaneous continued
from: Rapid Interpretation of EKGs
by Dale Dubin, MD
COVER Publishing Co., P.O. Box 07037, Fort Myers, FL 33919, USA
Electrolytes peaked T
wide,
Potassium (pages 314, 315) flat P no P
moderate extreme
ve
prominent
wa
flat T U wave
Decreased K+ (pages 315)
U
(hypokalemia)
moderate extreme
++ ++
Hyper Ca Hypo Ca
Calcium (page 316)
short QT prolonged QT
notched
P
U
long QT interval
Practical Tips
from: Rapid Interpretation of EKGs
by Dale Dubin, MD
COVER Publishing Co., P.O. Box 07037, Fort Myers, FL 33919, USA
Modified Leads
for
Cardiac Monitoring
Locations are approximate. Some minor adjustment of electrode posi-
tions may be necessary to obtain the best tracing. Identify the specific
lead on each strip placed in the patients record.
Identification
Sensor Electrode Letter Color (inconsistent)
+ R (or RA) red
L (or LA) white
G* G (or RL) variable
* Ground, Neutral or Reference
G
C o p y r i g h t 2 0 0 0 C OV E R I n c .