EKG ...what u look for

EKG MASTER CLASS 2014: INTERPRETATION OF AN EKG:

What do you look for in an EKG?

1. VALIDITY : Name on EKG
Indication for EKG
Mirroring of Lead I and Lead aVR
“R” Wave progression in precordial Leads

2. RHYTHM: Sinus or not, P present or not If P present sinus origin P or not
P married to QRS or not

3. RATE: Regular or not
If irregular, pattern
Same rate or variable rate

4. AXIS: Vertical axis normal. Left or right or intermittent Horizontal axis same as before or now more clockwise or less

5. INTERVAL: PR normal, short or long
RR constant or increasing
QT normal or long

6. HYPERTROPHY: P waves tall, wide, bifid or normal
Voltage criteria for RVH and LVH met or not

7. CONDUCTION : Normal QRS duration in V1 –V2 or not
Normal QRS duration in V5-V6 or not
Axis & hypertrophy compatible or not ,else should look for Hemi block .

8. PERFUSION: Ischemia or not (T Inversion)
Injury or not ( ST depression)
Infarction or not (ST elevation or q)
Infarction old or new
LBBB with infarction or not

9. SEGMENTS : Baseline stable or not
PR depressed or not
ST reflecting perfusion or something else

10. EXTRA FINDINGS: RR Prime or Osborne waves
Delta waves or IVCD
CEREBRAL T waves or T inversion etc,...

Comments

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...

sedationstation

Search This Blog