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Emotional State: Interpreting EKGs:

1. Anxiety/ nervousness: watching every

movement; asthma, respiratory failure, hypoxia Left Bundle Branch Block:
2. Depressed: quiet, denial 1. 2 R waves in V5 and V6
3. Anger/ combative/ irritable: electrolyte 2. Cannot diagnose infarct
imbalance 3. Same as anterior Hemiblock = posterior
4. Euphoria: drugs, OD hemiblock which is also same as biphasicular
5. Panic: hypoxia, tension pneumothorax, status block
asthmaticus. Right Bundle Branch Block:
1. 2 R waves in V1 and V2
2. QRS is wide and looks like an M
A-a Gradient:
Anterior Hemiblock:
1. If normal, hypoxia caused by hypoventilation,
1. Q in lead I and S in III
consider drug overdose, neuromuscular
2. QRS slightly widened
3. Occurs in left anterior descending of RCA with
2. If abnormal & SpO2 improves with increased
MI and heart disease
FiO2. Consider PE, pneumothorax, asthma,
4. Causes Right Axis Deviation
emphysema, pneumonia, bronchitis, heart
5. May be associated with RBBB
failure, congenital heart disease, aging.
6. 50% of posterior MIs
3. If abnormal & refractory hypoxemia occurs,
Posterior Hemiblock:
hypoxia caused by shunting problem onsider
1. S in 1 and Q in 3
pneumonia, atelectasis, pulmonary edema
2. Normal or slightly widened QRS
or ARDS.
3. Occurs in Right anterior descending of RCA
with MI or heart disease
4. Causes Right Axis Deviation
Adjusting Flow Termination on Vision/Bipap: 5. Rule out other causes of RAD
1. Start: 25% for adults 6. Rare, causes AV block, deadly
1. Higher percentage desired (40%) Bifasicular Block:
a. In leak situation 1. A combination of blocks
b. To reduce auto PEEP 2. Anterior Hemiblock + RBBB
2. Low Percentage desired (10%) 3. Posterior Hemiblock + RBBB
a. To maximize tidal volume 4. Anterior Hemiblock + Posterior Hemiblock
(also called LBBB)
5. May cause intermittent AV block
More EKG interpretations: Right Axis Deviation:
Left Ventricular Hypertrophy: 1. QRS negative in lead I
1. QRS complexes with exaggerated 2. QRS positive in AVF
amplitude both in height and depth 3. QRS negative in AVF and lead I if extreme
2. S wave in V1 is deep, large R in v5 RAD
3. Height of S in V1 + R in V5 =>35 mm 4. QRS in V1, V2 isoelectric
4. T wave inversion in V5 and V6 with a 5. Slender person with ventricular heart
gradual downward slope 6. Ventricular hypertrophy
Hyperkalemia: Flat p waves, wide QRS, peaked T 7. Pulmonary disease
Hypokalemia: Flat T waves, wide QRS, u waves 8. MI on left side of heart
Hypercalcemia: QT interval shortens Left Axis Deviation:
Hypocalcemia: Prolonged QT interval 1. QRS positive in lead I
Digitalis effect: a. PABS early sign 2. QRS negative in AVF
1. Gradual down-sloping of ST segment 3. QRS in V5 and V6 are isoelectric
2. Low K enhances Digitalis effect 4. Obese patients
Quinidine Effects: (Anti-arrhythmic) 5. Left Ventricular Hypertrophy
1. Widening of p waves and QRS 6. MI right side of heart
2. Often ST depression, prolonged QT
3. Maybe presence of U wave 09/08/2009