Tag Archives: axis determination

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac Axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac Vectors, which is the […]

90 year old female CC: Seizure – Conclusion

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This is the conclusion to 90 year old female CC: Seizure. Be sure to start there first! When we left off, we had completed our initial assessment of a 90 year old patient who, based on bystander accounts, had a seizure. She is pale, cold to the touch, and feels lethargic. During our assessment she […]

64 year old male CC: Indigestion – Discussion

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This is the discussion to 64 year old male CC: Indigestion. If you recall, we had a stubborn gentleman complaining of indigestion with a significant cardiac history. Considering the symptoms kept our patient awake, are highly suggestive of a coronary event, and we have uncompensated hypotension, we should have a keen interest on any ECG […]

Video: Axis Determination

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So you’ve read our blog, followed us on Facebook, submitted your own case studies, but you’re looking for more. You’re looking for the next big thing in EMS 12-Lead education. As a test run I’ve put together a video, shot Kahn Academy style using a pen and tablet, covering rapid axis determination. When I learned 12-Lead interpretation in […]

Why learn axis?

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A few weeks ago on JEMS Connect there was a thread called Vectors, Axis and Cardiology. In it, Dave M. asked: I truly enjoy learning and studying the heart, how it works and why it works that way. I had the privilege of teaching a paramedic class today and going over the vectors and axis […]

Axis Determination – Part VI

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By now you can predict the QRS axis in the frontal plane within 15 degrees as long as you have an equiphasic (or isoelectric) lead in the frontal plane. So what constitutes a normal QRS axis? What is a left axis deviation? A right axis deviation? If you don’t have a copy of the hexaxial […]

Axis Determination – Part V

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In Part IV, I promised that I’d show you a fascinating relationship between the standard 12 lead ECG and the hexaxial reference system. You will recall that to use the hexaxial reference system, you find the most equiphasic (or isoelectric) lead in the frontal plane (first 6 leads of the 12 lead ECG) and look […]

Axis Determination – Part IV

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By now you should have a fairly good grasp of how the hexaxial reference system is derived from the first 6 leads of the 12 lead ECG. Before we break down the finished diagram, let’s look at the hexaxial reference system laying on top of the patient’s anterior chest, with the arrows and leads in […]

Axis Determination – Part III

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In Part II, we discussed the heart’s mean electrical vector and how Einthoven’s Triangle (leads I, II, and III) can be redrawn to form the first 3 spokes of the hexaxial reference system. Essentially, we ended up with a shape like the one on the right. When leads I, II, and III are drawn this […]

Axis Determination – Part II

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In Part I, we looked at Einthoven’s Equilateral Triangle and Einthoven’s Law, and I told you that it was the key to understanding the formation of the hexaxial reference system. But before we delve further into the hexaxial reference system (the instrument we’ll be using to calculate the heart’s QRS axis) we need to address […]

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Comments
Aman
The 12 Leads of Christmas: V2
Thank you for your response. By all means, take your time! As for the source of the first figure, I got it from the book "Essential Cardiology: Principles and Practice - 3rd edition" by Clive Rosendorff - Chapter 7, Figure 7.3 (Page 97). It's one of the rare texts where I found a mention of…
2015-04-27 06:52:25
Vince DiGiulio
The 12 Leads of Christmas: V2
Your questions on this topic are some of the best I've encountered—no need to apologize! It makes me very happy to see this post reaching the right people. I'm working non-stop the next two days but I will get back to you soon with my full response. Two things to start: First, where did you…
2015-04-27 05:14:11
Aman
The 12 Leads of Christmas: V2
Thank you so much! I wonder why this information is not found in ECG texts. I have a query though. The critical information seems to be the fact that leads V1 and V2; V3; and V4-V6, each are physically located on a different transverse plane with respect to the theoretical electrical center. (Also mentioned in…
2015-04-26 18:24:06
Matthew
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I lean toward what jason said above - Going to the PCI Hospital, but not activating the lab yet. Go with the Hyper K treatment enroute.
2015-04-26 13:34:57
Ken Grauer, MD
Understanding Digoxin
Digoxin is used much less frequently these days than in the past - when it was a drug that virtually every patient with heart failure was taking. As a result - many clinicians in modern times are far less familiar (and comfortable) with how to dose Digoxin. Digoxin pharmacokinetics are linear - You double the…
2015-04-16 03:27:43

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