Download ECGs, Illustrations, and other Resources for your classes.

ALL OUR CONTENT IS FREE OF CHARGE AND FREE OF COPYRIGHT IF USED IN A CLASSROOM SETTING

ECG Challenge from
Limmer Creative & ECG Guru

Great practice strips for your students. Easy to use app for your mobile device

GET THE APP

ECG & ILLUSTRATIONS ARCHIVES SEARCH (SCROLLABLE LIST)

Dawn’s Classes

Are you transferring to a monitored area? About to start EMT, Paramedic, Nursing, or Med school? Having trouble with ECG classes? Dawn Altman 0ffers customized ECG Classes on site or via Zoom. We offer many topics and levels. Individual tutoring via Zoom also available
[email protected]
CONTACT DAWN
Dawn's picture

Instructors' Collection ECG: Ventricular Standstill

The Patient: This 72-year-old woman called EMS because of a sudden onset of breathlessness and anxiety. She had a history of COPD (asthma), CHF, and Type II diabetes. We do not know her medications or any other history. She was found to have bilateral breath sounds with "minimal" expiratory wheezing. She was alert and very anxious. Her initial pulse rate was recorded at around 60 bpm and irregular. A systolic BP was heard at 140 mm Hg, but the paramedic could not hear a pulse after that. She was given oxygen via CPAP (Continuous positive airway pressure). The first ECG at 15:50 was recorded during this assessment. After appearing to improve, she became neurologically altered, and her level of consciousness varied during the call. She was turned over to emergency department staff conscious and able to speak, but had a cardiac arrest subsequently. The paramedics were unable to obtain followup information regarding the outcome.

ECG at 1550: The first QRS on the recording has no associated P wave, and is presumed to be an escape beat, probably junctional, with an interventricular conduction delay (QRS .12 sec.). This is a right bundle branch block pattern with left anterior fascicular block (bifascicular block). The second QRS is about the same width, but with a different morphology and discordant T waves, so probably ventricular. The third QRS is very much like the first, except that it appears to be conducted from the preceding P wave. For the next five seconds, there are only P waves, which are regular at about 130 bpm. The three-beat pattern seen at the beginning repeats itself near the end.

This ECG shows evidence of severe conduction blocks. The wide QRS complexes indicate interventricular blocks. In this case, some are probably premature ventricular contractions and some are sinus beats with bifascicular block. Even more worrisome is the intermittent loss of AV conduction. This can be called "intermittent trifascicular block", or "intermittent ventricular standstill". This is not a "third-degree AV block", because there are signs of AV conduction, but it is very close. With two of the three main fasicles of the left bundle branch blocked initially, it only takes a block in the remaining fascicle to produce a complete lack of AV conduction. Of course, there are no pulses during the time of ventricular standstill. The really concerning part of this situation is the lack of an ESCAPE RHYTHM. This is a good time for a temporary pacemaker, either transcutaneous or, if available, transvenous.

Dawn's picture

Ask The Expert

 

Is there a quick and easy way to screen for limb lead wire misplacement?

  Today's Expert is Dr Jerry W. Jones, MD, a long-time contributer to the ECG Guru. 

                                         Dr Jones is known for his Master Classes in Advanced ECG Interpretation and his published texts, Getting Acquainted With Wide Complex Tachycardias, Getting Acquainted With Laddergrams, and Getting Acquainted With Ischemia and Infarction. His books are available on Amazon.com and on BarnesAndNoble.com. Dr.                                              Jones provides a wealth of free, high-quality ECG instruction on his webpage, and offers tutoring via Zoom. He is a sought-after instructor who is well-known for his celebrated ability to explain complex concepts so that they become understandable and manageable.

 

OPEN THE RESOURCE LINK BELOW FOR YOUR COPY OF THIS ARTICLE

Dr A Röschl's picture

ATRIAL FIBRILLATION

Unfortunately, I can't remember who the author of this ECG is. Perhaps he/she will get in touch with me. However, the ECG is very nice (despite the less than optimal recording quality) and that's why I want to post it. I don't know the history.
In the first section of the ECG we see coarse fibrillation waves and QRS complexes with very different RR intervals, which is why this is atrial fibrillation. It is not atrial flutter because the fibrillation waves are of different size and polarity (depending on the lead) and the intervals between the atrial actions are irregular.

Dawn's picture

For Fans of Dr Jerry W Jones

“Jerry W. Jones, MD FACEP FAAEM is pleased to announce the move from LinkedIn to his ECG education website: https://medicusofhouston.com/ . Join him there for his popular twice weekly posts on ECG topics for beginners through advanced and announcements regarding his Masterclasses and book releases.” I want to thank all of you for your interest in my teaching and in electrocardiography. I hope to see you in one of my Masterclasses soon! And I hope to hear from you in my new location! Jerry W. Jones, MD FACEP FAAEM

Dawn's picture

New Book From Dr. Jerry Jones

AVAILABLE NOW at:   AMAZON

Dawn's picture

ECG Glossary from Dr. Ken Grauer

Are you looking for a comprehensive ECG glossary that goes beyond simply defining words? Dr. Ken Grauer, who is the ECG Guru's Consulting Expert, has a Glossary available on his website that explains the terms.  Instructors and students alike will benefit from having this glossary readily available.  The glossary is exerpted from his e-Publication, "A 1st Book On ECGs - 2014", available on Amazon.

Coronary Arteries Anterior View Labeled

Click to open: 
Anterior view of coronary arteries

This is an original illustration by Dawn Altman.  It is free for your use in an educational setting.  For other uses, please contact Dawn at [email protected].

 

ECG Guru Ads - Products and Services of Interest to our Members

 If you would like to place ads for products or services of interest to our readers, please contact us at [email protected]

 

ECG HISTORY:     ECG was first put into clinical use in the early 1900s.  In 1909, it helped diagnose an arrhythmia.  A year later, indications of a heart attack were noted.

 

 -

All our content is FREE & COPYRIGHT FREE for non-commercial use

Please be courteous and leave any watermark or author attribution on content you reproduce.

Become an ECG Guru Member!

By registering as a member, you will be able to comment on our blogs, ECGs, art and other content.

Help Support the ECG Guru

in our efforts to provide high-quality, copyright FREE content for instructors and their students