Professional Documents
Culture Documents
1 Induction Program
International SOS – Training Department Jakarta
October 2003
Objective :
2 Induction Program
International SOS – Training Department Jakarta
October 2003
ECG?
• Electrocardiography
• Electrocardiogram
• Electrocardiograph
3 Induction Program
International SOS – Training Department Jakarta
October 2003
Purpose of ECG
To determine:
• Dysrithmia
• Hypertropi Atrium/Ventricle
• Ischemia/Infark of myoracardiac
• Pericarditis
• Efect of digitalis, antiaritmia drugs; electrolyte
imbalance
• Function of heart
4 Induction Program
International SOS – Training Department Jakarta
October 2003
Basic ECG
• Electrocardiograph
• ECG Paper
• ECG Lead
• Electrocardiogram
• How to read an ECG
5 Induction Program
International SOS – Training Department Jakarta
October 2003
Electrocardiograph
• First ECG machine
6 Induction Program
International SOS – Training Department Jakarta
October 2003
Electrocardiograph
• Calibration : 1 mv 10 mm
• Speed or record: 25 mm/sec
7 Induction Program
International SOS – Training Department Jakarta
October 2003
ECG Paper
REMEMBER!!
Small Square
• Horizontal : 1 mm = 0.04 sec
• Vertical : 1 mm = 0.1mv
8 Induction Program
International SOS – Training Department Jakarta
October 2003
ECG LEAD
• Bipolar :
– Lead I : RA LA
– Lead II: RA LF
– Leadi III: LA LF
• Unipolar
– Extremities Unipolar leads: AVR, AVL, AVF
– Precordial Unipolar Leads: V1 – V6
9 Induction Program
International SOS – Training Department Jakarta
October 2003
ECG Leads - Bipolar
10 Induction Program
International SOS – Training Department Jakarta
October 2003
ECG Leads – Extremities
Unipolar
• AVR AVL AVF
11 Induction Program
International SOS – Training Department Jakarta
October 2003
ECG Leads-Precordial Unipolar
12 Induction Program
International SOS – Training Department Jakarta
October 2003
Electrocardiogram
• P wave
• QRS wave
• T wave
• U wave?
13 Induction Program
International SOS – Training Department Jakarta
October 2003
Anatomy Dasar Dari Jantung
• SA Node
• AV Node
• Bundle Branch
• Purkinje Fiber
14 Induction Program
International SOS – Training Department Jakarta
October 2003
• Atrium Depolarization - P wave
• Atrium Repolarization – not seen
• Ventricle Depolarization – QRS wave
• Ventricle Repolarization – T wave
15 Induction Program
International SOS – Training Department Jakarta
October 2003
P wave normal
• Wide: < 0.12 sec
• Tall: < 0.3 mv
• + in all leads except aVR
16 Induction Program
International SOS – Training Department Jakarta
October 2003
QRS wave normal
• Wide: 0.06 sec – 0.12 sec
• Q wave normal:
– Wide < 0.04 sec
– Depth < 1/3 R
– Q abnormal = Q pathologic
17 Induction Program
International SOS – Training Department Jakarta
October 2003
T wave
• Ventricle repolarization
• + in all leads, except aVR
• Hyperacute T – signs of
acute infarction
18 Induction Program
International SOS – Training Department Jakarta
October 2003
Arteri Koronari
Arteri Koronari Jantung :
20 Induction Program
International SOS – Training Department Jakarta
October 2003
Sinyal Jantung Satu Perioda
Setelah gelombang P muncul akan terjadi perioda isoelectric
secara singkat / pendek. Hal tersebut disebabkan oleh Atrium
Ventricle Node (AV Node).dapat dikatakan bahwa fungsi AV
Node adalah sedikit penundaan hal ini dikarenakan jalannya
darah ke ventricle.
21 Induction Program
International SOS – Training Department Jakarta
October 2003
Impuls elektrik jantung dan gelombang
EKG yang muncul
22 Induction Program
International SOS – Training Department Jakarta
October 2003
Fase dari kontraksi sel otot jantung
pada elektrogram
DEPOLARISASI
Permindahan dari ion sodium
masuk kedalam sel dan ion
potassium meninggalkan sel
REPOLARISASI
Ion potassium masuk dan ion
sodium meninggalkan keluar dari
sel otot jantung
23 Induction Program
International SOS – Training Department Jakarta
October 2003
Sinyal EKG Satu Peride Dengan Warna Yang Beda
• Warna kuning adalah terjadinya fasa isoelectric atau sinyal datar
• Warna ungu menjelaskan sinyal P
• Warna kuning merah menjelaskan sinal Q
24 Induction Program
International SOS – Training Department Jakarta
October 2003
Elektroda EKG :
25 Induction Program
International SOS – Training Department Jakarta
October 2003
ELECTROCARDIOGRAPH GRID
SYSTEM
26 Induction Program
International SOS – Training Department Jakarta
October 2003
KERTAS ELEKTROKARDIOGRAFI
• Hubungan waktu dan voltase :
• Garis vertikal :
• 1 mm = 0.10 mV
• 10 mm = 1.00 mV
27 Induction Program
International SOS – Training Department Jakarta
October 2003
EKG normal dengan waktu dan amplitudo
masing masing gelombangnya
28 Induction Program
International SOS – Training Department Jakarta
October 2003
EKG dengan ritme regular dan pengangkatan
segment ST
29 Induction Program
International SOS – Training Department Jakarta
October 2003
Kertas grafik EKG dengan nomer kotaknya
30 Induction Program
International SOS – Training Department Jakarta
October 2003
Kotak dari kertas grafik diatas terdiri dari 5 kotak kecil
dengan waktunya
31 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi normal EKG:
Gelombang P
Menunjukan kegiatan listrik yang berasal dari SA node
dan menyelusuri atria. (lebar 3 mm - tinggi 3 mm)
P-R interval
Waktu dari mulainya gelombang P sampai permulaan dari
gelombang QRS. Waktu ini dimulai dari impuls SA node
dan menyelurusi atria kepada AV node hingga ventrikel
(3-5 mm)
32 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi normal EKG:
QRS Complex
Gelombang ini menggambarkan depolarisasi dari otot
ventrikel (2-3 mm)
ST Segment
Interval ini menggambarkan waktu jedah dari hasil
penyelesaian depolarisasi dan memulainya repolarisasi
dari kontraksi dari ventrikel (3-4 mm)
33 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi normal EKG:
Gelombang T
Gelombang ini menggambarkan fase dari recoveri
setelahkontraksi ventrikel
QT Interval
Waktu ini adalah waktu total dari depolarisasi dan
repolarisasidari otot ventrikel.
Waktu QT interval tersebut dimulai dari gelombang
QRS sampai gelombang T.
34 Induction Program
International SOS – Training Department Jakarta
October 2003
Klassifikasi Arritmia
35 Induction Program
International SOS – Training Department Jakarta
October 2003
Gangguan formasi impuls
36 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi Arritmia Dasar :
• Menghitung jumlah denyut jantung
37 Induction Program
International SOS – Training Department Jakarta
October 2003
Denyut Jantung
38 Induction Program
International SOS – Training Department Jakarta
October 2003
Menghitung denyut jantung :
39 Induction Program
International SOS – Training Department Jakarta
October 2003
Menghitung denyut jantung :
40 Induction Program
International SOS – Training Department Jakarta
October 2003
Menghitung denyut jantung :
41 Induction Program
International SOS – Training Department Jakarta
October 2003
Menghitung denyut jantung :
42 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi Arritmia Dasar :
• Menentukan regular (rhythm) dari gelombang R
43 Induction Program
International SOS – Training Department Jakarta
October 2003
Detak Jantung Normal
44 Induction Program
International SOS – Training Department Jakarta
October 2003
Takikardia
45 Induction Program
International SOS – Training Department Jakarta
October 2003
Bradycardia
46 Induction Program
International SOS – Training Department Jakarta
October 2003
Ritme Regular
47 Induction Program
International SOS – Training Department Jakarta
October 2003
Ritme Irregular
48 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi Arritmia Dasar :
49 Induction Program
International SOS – Training Department Jakarta
October 2003
Premature Junctional Contraction
50 Induction Program
International SOS – Training Department Jakarta
October 2003
Atrial Takikardia Tanpa Gelombang P
51 Induction Program
International SOS – Training Department Jakarta
October 2003
Atrial Fibrilasi
52 Induction Program
International SOS – Training Department Jakarta
October 2003
Atrial Flutter
53 Induction Program
International SOS – Training Department Jakarta
October 2003
Junction Rhythms kurang dari 60
(terbaliknya gelombang P)
54 Induction Program
International SOS – Training Department Jakarta
October 2003
Aselerasi Junction Rhytms
(hilangnya gelombang P)
55 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi Arritmia Dasar :
• Mengukur jarak antara P-R
56 Induction Program
International SOS – Training Department Jakarta
October 2003
Gangguan konduksi impuls
57 Induction Program
International SOS – Training Department Jakarta
October 2003
AV Block derajat ke-2 Tipe Pertama
58 Induction Program
International SOS – Training Department Jakarta
October 2003
Derajat Pertama AV Block
59 Induction Program
International SOS – Training Department Jakarta
October 2003
AV Block Derajat -2 Tipe ke-2
60 Induction Program
International SOS – Training Department Jakarta
October 2003
AV Block Derajat ke-3
61 Induction Program
International SOS – Training Department Jakarta
October 2003
Interpretasi Arritmia Dasar :
62 Induction Program
International SOS – Training Department Jakarta
October 2003
ADA 5 BENTUK PVC YANG
BERBAHAYA
• PVC terjadi lebih dari 6/menit
63 Induction Program
International SOS – Training Department Jakarta
October 2003
ADA 5 BENTUK PVC YANG
BERBAHAYA
• Gelombang R terjadi pada gelombang T (PVC terjadi pada
gelombang T)
64 Induction Program
International SOS – Training Department Jakarta
October 2003
ADA 5 BENTUK PVC YANG
BERBAHAYA
• Unifocal PVCs (terjadi pada fokus tunggal pada ventrikel)
65 Induction Program
International SOS – Training Department Jakarta
October 2003
Ventricular Takikardia
66 Induction Program
International SOS – Training Department Jakarta
October 2003
Ventricular Escape Rhythms
67 Induction Program
International SOS – Training Department Jakarta
October 2003
Ventricular Fibrillation
68 Induction Program
International SOS – Training Department Jakarta
October 2003
Asistole
69 Induction Program
International SOS – Training Department Jakarta
October 2003
Tiga kategori prognostik dari
arrhythmias
Tidak menjadi perhatian Gangguan ini mengurangi Ini adalah gambaran irama
yang serius oleh karena effisiensi pemompaan dari yang berbahaya dan
tidak mengalami jantung yang memerlukan memerlukan pertolongan
gangguan sirkulasi pengobatan yang segera resusitasi yang segera
untuk mencegah
terjadinya kematian.
70 Induction Program
International SOS – Training Department Jakarta
October 2003
Tiga kategori prognostik dari
arrhythmias :
Minor Arrhythmias Major Arrhthmias Death Arrhthmias
71 Induction Program
International SOS – Training Department Jakarta
October 2003