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Important areas each covered by a variety of cases include pacemakers, arrhythmias and myocardial infarction. There are also cases of rarer conditions, and those that illustrate possible important pitfalls in routine clinical practice. This book takes a practical, thought provoking approach. It is a valuable resource for doctors, nurses, technicians and students wishing to extend or reinforce their knowledge of ECG interpretation, and in preparation for examinations.
As more countries institute requirements for the care of laboratory animals in research, this publication offers an effective standard on performing and analyzing ECGs. Topics covered include safety electrocardiography, toxicology, safety pharmacology, and telemetry. Electrocardiography of Laboratory Animals will assist biological and medical researchers, veterinarians, zoologists, and students in understanding electrocardiography of various species of animals used in research.
Covers safety electrocardiography of large laboratory animals Offers comprehensive analysis of ECGs for practical laboratory use Includes a self-evaluation section for testing of ECG reading and analysis. Basic student-level knowledge of ECGs is assumed, so the reader can move directly to learning about the more complex traces that occur in the emergency department.
The level of difficulty is stratified into two sections for specialists in training and specialist emergency physicians. A minimum amount of information is given beneath each trace, as if in the real situation.
Accompanied by learning points, and with the cases presented randomly, this book provides a rich source of information on the interpretation of ECGs — a core skill for all emergency department staff.
Detailed answers concentrate on the clinical interpretation of the results and give advice on what to do. The book can be used as a standalone method of practising ECG interpretation, and even with the most difficult ECGs a beginner will be able to make an accurate description of the trace and will be guided towards the key aspects of the interpretation.
The unique page size allows presentation of lead ECGs across a single page for clarity. It is the most extreme example of why you should look at the patient in conjunction with the ECG!
However, the ECG may help you ascertain the underlying pathology. This can include pericardial fluid or pneumothorax. This is worth thinking about as tamponade and tension pneumothorax are both reversible causes of PEA.
Question 5 A fit and well 31 year old man presents for a routine insurance medical. Present your findings and give the diagnosis. This is a normal ECG.
There are many variants of normal and it is worth looking at as many ECGs as possible to get exposed to the common variants. Question 6 A 65 year old man with a history of ischaemic heart disease is found unresponsive. What is the diagnosis and what will you do? This is ventricular tachycardia VT and in this case the patient is in cardiac arrest as they have no central pulse.
He should be treated as per ALS guidelines with chest compressions beginning immediately. This is a shockable rhythm and should be treated using the ALS algorithm with DC cardioversion and adrenaline. If the patient was conscious the ALS algorithm would not be necessary and management depends on symptoms. If acutely symptomatic urgent DC cardioversion is indicated. If there were no symptoms of decompensation e. She is feeling very anxious. An ECG is performed. What is the diagnosis? The history makes a sinus tachycardia secondary to anxiety seem likely.
However, sinus rhythm rarely goes above BPM and in this case there are no p-waves visible. This is therefore a junctional supraventricular tachycardia SVT : a narrow-complex tachycardia originating from the AV node.
Treatment includes vagal manoeuvres followed by adenosine. Atrial flutter would be a reasonable differential as the rate is regular and close to However, there is no variation in the baseline and not a hint of sawtooth appearance so this is less likely than SVT. Question 8 A 58 year old man who attends the emergency department with chest pain loses consciousness whilst he is having his initial ECG.
He has no central pulse and is taking occasional deep breaths. What is going on? The breaths described are agonal breaths — this does not represent normal respiratory effort and resuscitation for cardiac arrest with CPR should be started immediately.
Question 9 A 72 year old lady presents with collapse. This is her ECG. Present your findings. How would you proceed? This is sinus bradycardia. In a young fit person this rate may be normal. However, in the context of a more elderly person and presenting with collapse it should be further investigated. A medication review, blood tests including thyroid function, repeat ECGs, chest x-ray, echocardiogram and hour tape would be reasonable first-line investigations.
Question 10 A 60 year old man presents with tight central chest pain radiating to his left shoulder. This is his initial ECG. This patient has ST elevation in the anterior and lateral leads. Immediate management also includes aspirin, clopidogrel, heparin, nitrites, morphine and controlled oxygen.
Question 11 A 55 year old renal dialysis patient presents to the emergency department having missed his last session of dialysis due to feeling dizzy and unwell. This is the classic sine wave ECG pattern of severe hyperkalaemia. It can quickly deteriorate into ventricular fibrillation VF. There are three main ECG changes in hyperkalaemia:.
Later changes involve a decrease in height of the p-wave and increase in length of the PR interval as conduction is slowed through the atrial myocardium. This pattern eventually deteriorates to the sine wave pattern seen above.
This is a medical emergency. Inhaled salbutamol has a similar effect if there is no IV access. Bicarbonate 50ml IV can also be given. Ultimately total body potassium needs to be decreased — in this case urgent dialysis or haemofiltration is indicated.
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