1. ECG Monitoring in Anesthesia Kasana Raksamani Siriraj Hospital, Mahidol University

2. ECG, EKG, Electrocardiogram The ECG is easy to understand The abnormalities happen for a reason

3. CONSTANT VIGILANCE !!!

4. The electricity of the heart

5. What to expect from the ECG Essential monitor Rate, rhythm, propagation of the excitation wave, heart position, muscle hypertrophy, regional ischemia NO information about pump function

6. 3-lead system

9. Lead Selection • Lead II is the same as standard lead two as seen in a 12 lead ECG. • It is the most common monitoring lead. • It is not the optimal monitoring lead.

10. Lead Selection • V5 = the best lead to detect ST-T change • Move the LA lead to V5 position • Monitor lead I

11. The shape of the ECG P T QR S

12. Normal ECG

13. ECG interpretation Rate Rhythm Intervals QRS complexes ST segments & T waves

14. Normal Abnormal

15. ECG abnormalities Myocardial ischemia / infarction arrhythmias

16. Myocardial ischemia / infarction • ST depression (0.1mv) • ST elevation (0.2mv) • T wave inversion • Abnormal Q

17. Myocardial ischemia / infarction

19. Bradyarrhythmias Sinus Bradycardia

20. Bradyarrhythmias Junctional rhythm

21. Bradyarrhythmias 1st Degree AV block

22. Bradyarrhythmias: 2nd degree AVB Mobitz type I

23. Bradyarrhythmias: 2nd degree AVB Mobitz type II

24. Bradyarrhythmias: 3rd degree AVB

25. Tachyarrhythmias: Premature complexes Atrial Premature Complexes

26. Tachyarrhythmias: Premature complexes Ventricular Premature Complexes

27. Tachyarrhythmias A.Fib

28. Tachyarrhythmias Atrial Flutter

29. Tachyarrhythmias PSVT

30. Tachyarrhythmias Ventricular Tachycardia

31. Tachyarrhythmias Torsades de pointes

32. Tachyarrhythmias Ventricular Fibrillation

33. Asystole

34. Thank You