Professional Documents
Culture Documents
12- lead EKG- cardiac depolarization and repolarization from 12 different sites on
the body surface
There are 6 chest leads- electrodes positioned horizontally around the 4-5th interspaces on
the left-anterior hemithorax:
Leads V1 and V2 record the current flux over the right ventricle directly.
Leads V3 and V4 record directly the electrical activities of the ventricular septum and the
anterior wall of the left ventricle.
Leads V5 and V6 record the current flow generated by the left ventricle directly.
In sinus rhythm when the SA node is the pacemaker, the mean direction of atrial
depolarization (the P wave axis) points downward and to the left, in the general direction of
lead II within a coordinate between 15o and 75o and away from lead aVR.
On this count the P wave is always positive in lead II and always negative in lead aVR during
sinus rhythm. Conversely, a P wave that is positive in lead II and negative in lead aVR
indicates normal P wave axis and sinus rhythm.
PR interval extends from the beginning of the P wave to the beginning of the QRS.
Normal range is 120 – 200 ms (3 to 5 1-mm-divisions) and no longer.
QRS axis is between -30o and -90o or deviated to the left (left axis deviation or LAD) if the
QRS is positive in lead I but negative in lead II.
QRS axis is between +90o and +150o or deviated to the right (right axis deviation or RAD) if
the QRS is negative in lead I but positive in lead II.
Anytime a patient is pulseless you are code blue and remember that 2 different
types of rhythm- shockable and non-shockable
Shockable rhythm are V-tach and V-fib- CPR- shock before medication
Non-shockable: asystole, and pulseless electrical activity- Drugs- IV 1 mg
epinephrine
V-fib will not have a pulse
v-tach may have pulse
Signs of anterior MI (grey area), territory supplied by the left anterior descending coronary
artery (LAD), are seen in V1 to V4.
Signs of lateral MI (grey area), territory supplied by the left circumflex coronary artery (LC),
are seen in leads I, aVL, V5 and V6.
Signs of inferior MI (grey area), territory supplied by the right coronary artery (RCA), are
seen in leads II, III, and aVF.
Synchronized cardioversion: non-emergency- patients with an arrhythmia with a
pulse
Non-synchronized cardioversion: pts with an arrhythmia but no pulse
Gastroenterology: Gallbladder
Cholelithiasis: