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Send complex calculated

- Before we get started. I'd like to thank you for choosing Allied Health Tools to assist you on your journey to success. It is my firm belief that you are destined for greatness and you have everything within you to succeed. Folks, I have a great lesson in store for you today, so let's jump right over to our scenario. I wonder if you can guess who our superstar patient is for today. (upbeat music) - [Narrator] A patient is in the office today to follow up on the effectiveness of his new heart medication. Dr. B asked the new clinical assistant, Sarah, to perform an EKG on the patient and to report her findings. As you know, an electrocardiogram also known as an EKG or ECG is a test that records the electrical activity of the heart, and is used to detect and study heart problems such as heart attacks, arrhythmias, and heart failure. So Sarah followed the doctor's instructions and performed the ECG. As Sarah reviewed the recording, she realized that she needed help with the measurements. She turns to you and says, "Please give me a refresher on measuring the waves. If I don't report my findings correctly, the patient may be misdiagnosed or end up with the wrong treatment plan. Please help." - So, can you help Sarah? Before you do, let's go through this process together. Hey, everyone. I'm Josh Farquharson, and welcome to another episode of Learning Tools for Allied Health Professions. (upbeat music) Let's begin with exploring some common areas of a 12 lead electrocardiogram. Keep in mind that the ECG's information and layout may differ depending on the manufacturer settings and healthcare provider preferences. The top left area displays the type of ECG, identification number, the date and time of the recording, and the patient information. The top right area displays the ECG reporting data. The bottom left displays the print speed of 25 millimeters per second, and a standardization setting of 10 millimeters per millivolt. The grid has small and large boxes for measuring the wave forms of the ECG. This 12 lead ECG layout includes standard leads one, two, and three, augmented limb leads, aVR, aVL, and aVF, and the precordial leads V1 through V6. On this ECG, lead two is the rhythm strip. A rhythm strip is a long tracing of a lead or multiple leads used to identify an arrhythmia correctly. Now let's take a closer look at the tracing. This is a standardization mark also known as a standard calibration signal. A standardization mark can appear at the beginning or end of a tracing, and corresponds to the 10 millimeter per millivolt inscription on the ECG. This standardized voltage ensures that the EKG correctly measures and records the amplitude of waves above and below the baseline. The baseline or isoelectric line is the line from which the waves and complexes take takeoff. We will use the baseline as our starting point when measuring the wave forms. Here's a brief summary of the electrical conduction system of the heart, and how it relates to the wave forms we see on the ECG. During a normal heartbeat, the electrical activity starts in a small patch of pacemaker cells called the sinoatrial node. The SA node is located in the right atrium. When the impulse activates the atria, it produces a small blip on the ECG called the P wave. Next, the impulse travels to the atrial ventricular node and bundle branches where it activates the main pumping chambers called the ventricles, and produces the big wave group in the middle known as the QRS complex. The T wave represents the recovery period when the impulse reverses and travels back over the ventricles. Now that we have an understanding of the basic structure of an ECG wave form, let's focus on how the grid works for measurements. On the grid, you will notice large boxes and small boxes. The dark thick lines form the large boxes. The light thin lines form the small boxes. One small box has several units of measurement associated with it. It represents the size of one millimeter. It represents the amplitude of 0.1 millivolts, and it represents the time of 0.04 seconds. Let's look at how the small boxes are used for measurements beginning with millimeters. Since the size of a small box equals one millimeter, let's use it to measure the size of a large box. Here's one, two, three, four, and five millimeters. So a large box represents a size of five millimeters. It is five millimeters tall and five millimeters wide. Now let's focus on amplitude. When measuring in a vertical direction, you are measuring amplitude. We know that each small box has a value of 0.1 millivolts. So let's count upwards starting with 0.1 and adding as we go. 0.1, .2, .3, .4, and .5 millivolts. Therefore, a large box represents the amplitude of 0.5 millivolts, which also means that the sum of two large boxes is one millivolt. Remember the standardization mark we saw earlier? It is 10 millimeters high and corresponds to the calibration standard of 10 millimeters per one millivolt. All right, it's time to practice. I want you to state the height and amplitude of this rectangle. The three second timer is about to begin, so press pause if needed. (timer ticks) The height is nine millimeters and the amplitude is a 0.9 millivolts. Did you answer correctly? I knew you would, great job. Now, let's focus on time. When measuring in a horizontal direction, you are measuring time. We know that each small box has a value of 0.04 seconds. So let's count across starting with 0.04, .08, .12, .16 and 0.20 seconds. Therefore, a large box represents the duration of 0.20 seconds or 200 milliseconds, which also means that five large boxes represents the duration of one second. Notice that this is in alignment with the print speed standard of 25 millimeters per second. It's time to practice. State the width and duration of this rectangle. (timer ticks) The width is seven millimeters, and the time is 0.28 seconds. Did you answer correctly? Of course you did. You're definitely ready for wave measurements. Now we will measure the height, width, amplitude, and duration of the waves. Here are the steps we will take to measure the waves. Step one, select the wave to measure, step two, identify the baseline, and step three, determine the height, amplitude, width, and duration of the wave. I'll use the P wave to demonstrate, then you'll have a chance to measure the T wave on your own. For step one, I have selected the P wave to measure. For step two, here's the baseline. I'm using this area of the baseline, because that is where the wave appears. For step three, I see that the height of the P wave is one millimeter so that means the amplitude is 0.1 millivolts, and the width of the P wave is two millimeters so the duration is 0.08 seconds or 80 milliseconds. Now you try it with the T wave. Measure the height, amplitude, width, and duration of the T wave. (timer ticks) The height of the T wave is two millimeters. The amplitude of the T wave is 0.2 millivolts. The width of the T wave is four millimeters, and the duration of the T wave is 0.16 seconds or 160 milliseconds. Did you answer all of them correctly? Great job! You should now have a good grasp on how to measure the individual waves. We'll move on to measuring a couple of intervals and finish the lesson with the QRS complex. An interval includes at least one wave plus, in most instances, the connecting straight line. To measure the PR interval, measure from the beginning of the P wave to the beginning of the QRS complex. As you can see in this example, the width of the PR interval is three millimeters and the duration of the PR interval is 0.12 seconds or 120 milliseconds. Now you try it. Measure the width and duration of this PR interval. (timer ticks) The width of the PR interval is four millimeters. The duration of the PR interval is 0.16 seconds or 160 milliseconds. Did you answer correctly? Nice job! Let's measure the QT interval. To measure the QT interval, measure from the beginning of the Q wave to the end of the T wave. As you can see in this example, the width of the QT interval is nine millimeters and the duration of the QT interval is 0.36 seconds. Now you try it. Measure the width and duration of this QT interval. (timer ticks) The width of the QT interval is seven millimeters. The duration of the QT interval is 0.28 seconds or 280 milliseconds. I have a feeling that you answered correctly. Great job! Let's measure the QRS complex. Here, you will measure from the beginning of the QRS complex as the first wave leaves the baseline, to the end of the QRS complex when the last wave begins to level out into the ST segment. The end of the QRS complex is called the J point. As you can see in this example, the width of the QRS complex is three millimeters and the duration of the QRS complex is 0.12 seconds or 120 milliseconds. Now you try. Measure the width and duration of the QRS complex. The width of the QRS complex is two millimeters. The duration of the QRS complex is 0.08 seconds or 80 milliseconds. I bet you did a fantastic job with every measurement in this video. In fact, if you answered most or all of them correctly, let me know in the comments area below, then give yourself a huge round of applause for a job well done. You now know how to use the ECG grid to measure waveforms. By the way, Sarah still needs your help. She is waiting for you@alliedhealthtools.com with more waveform challenges. Folks, if you haven't done so already, please be sure to like, and subscribe. Stay blessed, my friends. Continue to believe in yourself, and be unstoppable. (upbeat music)