บทที่ 1 - @@ Home - KKU Web Hosting · - 4 - 1. ขอบเขตและกระบวนการในการดําเนินโครงการ ในการบริหารย
Basic EKG - @@ Home - KKU Web Hosting EKG Author User Created Date 3/14/2013 12:02:29 PM ...
Transcript of Basic EKG - @@ Home - KKU Web Hosting EKG Author User Created Date 3/14/2013 12:02:29 PM ...
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Basic EKG
Emergency medicine KKU
August 2012
For nurses
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Cardiac Anatomy
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P
QRS
T
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ขนตอนการอานEKG
1. Rate
2. Rhythm
3. Axis
4. Hypertrophy
5. Infarction
6. Ischemia
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Step1 :Rate
• Rule of 300-> 300 หารจ านวนชองใหญทนบ
ไดระหวางR-R
Number of big boxes
Rate
1 300
2 150
3 100
4 75
5 60
6 50
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Rate=?
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Rate=?
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Step 2. What is the Rhythm?
• Sinus rhythm VS Arrythmias
• arrythimias ทควรร ไดแก
• Atrial fibrillation
• Atrial flutter
• Supraventricular tachycardia(SVT)
• Ventricular tachycardia
• Ventricular fibrillation
• Asystole
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Junctional or AV Nodal Rhythm
เกดจากมความผดปกตของSinus node เชน sick sinus syndrome, hyperkalemia AV node จงท าหนาทผลตกระแสไฟฟาทดแทน เนองจากมกระแสไฟฟาวงสวนทาง P waveจงหวกลบ
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Junctional or AV Nodal Rhythm
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Ventricular rhythm
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Ventricular tachycardia
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Polymorphic VT (TdP)
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Shockable rhythm
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What to do when arrythmias happen?
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ผปวยทมหวใจเตนผดจงหวะจะมอาการอยางไร
• ใจสน
• หววๆ บรเวณทรวงอก
• เหนอยเวลาออกแรง
• เวยนศรษะ
• หมดสต
• หวใจหยดเตน
• ไมมอาการ***
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ขนตอนแรก แพทยและพยาบาล
1. ประเมน ABCs – A = Airway ดแลทางเดนหายใจใหโลง – B = Breathing ดแลการหายใจ – C = Circulation and Cardiac rhythm ดแลการไหลเวยนโลหตและจงหวะการ
เตนของหวใจ
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2. Resuscitation – Airway ใหการดแลอยางเรงดวน
• เปดทางเดนหายใจดวยทา head tilt and chin lift maneuver, Jaw thrust maneuver
• หากมเสมหะ เลอก หรอสงแปลกปลอมในล าคอใหเอาออก suction
• ซมมาก GCS < 9 ใสทอชวยหายใจ
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• Breathing ใหการดแลการหายใจ โดยประเมนจากอตราการหายใจ และความอมตวของออกซเจนในเลอด
• ถา SaO2 < 95 ให O2 supplement
• Circulation and Cardiac rhythm
• เปดหลอดเลอดด า เพอใหยา และหรอน าเกลอ
2. Resuscitation (ตอ)
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unstable
ขนตอนทสอง แพทย
1. การวนจฉยจากประวต ตรวจรางกาย และคลนไฟฟาหวใจ 2. การตดสนใจ ทบทวนประวตของผปวย และสงเกตอาการ
1. Hypotension 2. Sign of shock 3. Ischemic chest discomfort 4. Altered mental status 5. Acute heart failure
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ขนตอนทสาม
1. เลอกวธรกษา ยาหรอการรกษาดวยไฟฟา – หากผปวยเสถยร (stable patient) ใหเลอกการรกษาดวยยา
• Bradyarrhythmias with pulse observe and monitor
• Tachyarrhythmias with pulse amiodarone (VT) or adenosine (SVT)
– หากผปวยไมเสถยร (unstable patient) ใหเลอกการรกษาดวยไฟฟา • Bradyarrhythmias with pulse atropine and cardiac pacing
• Tachyarrhythmias with pulse synchronized cardioversion
• Tachyarrythmia no pulse CPR
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2. การประเมนผปวยซ าหลงรกษา และเฝาตดตามผปวยอยางตอเนอง
– Stable patient
monitor V/S and GCS score every 15-30 min
– Unstable patient
monitor V/S and GCS score every 5 min, before and after treatment, worsening symptom
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การรกษา
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Antiarrhythmic drugs
Wide complex tachycardia • Amidarone
– In cardiac arrest ECG show PVT/VF
• Amiodarone (cordarone) 300 mg IV/IO in 20-30 mL D5W following by 150 mg IV push in 3-5 min
– In non cardiac arrest ECG show VT with pulse, AF
• Amiodarone (cordarone) 150 mg IV over 10 min
• May repeat every 10 min
• Then 300 mg IV over 5 hr the 600mg IV over 20 hrs
• Max. dosage 2.2 gm/day
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Narrow complex tachycardia /SVT
Adenosine
– First dosage 6 mg IV over 1-3 sec follow by NSS 20 mL IV bolus
– Second dosage 12 mg IV in 1-2 min
– Third dosage (last) 12 mg IV in 1-2 min
– Max. dosage 30 mg
– Double syringe technique
Antiarrhythmic drugs
6-12-12
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Defibrillator
Defibrillation mode monitor
Pacing mode
Shock Charge Sync
Lead select paddle lead II ↑/↓ size of ECG
voltage
Strip run ECG
Paddles
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ขนตอนทส
1. ปรกษาแพทยเฉพาะทาง – เพอตรวจวนจฉยเพมเตม Electrophysiology Study : EPS
2. ใหการรกษาจ าเพาะ ในภาวะหวใจเตนผดจงหวะ – รกษาดวยยาตานหวใจเตนผดจงหวะ – รกษาดวยการท า Radiofrequency Catheter Ablation :
RFCA – ตดเครองคมจงหวะการเตนของหวใจ Pacemaker – ตดเครองกระตกหวใจดวยไฟฟา (Implantable
cardioverter-defibrillator : ICD)
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Bradyarrythmias
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AV block
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Causes of AV Blocks
•Autonomic
Carotid sinus hypersensitivity
•Metabolic/endocrine
Hyperkalemia
Hypothyroidism
Hypermagnesemia
Adrenal insufficiency
•Drug-related
Beta blockers
Adenosine
Ca channel
blockers
Antiarrhythmics
(class I & III)
Digitalis
Lithium
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ขอบคณทตงใจเรยนจา