EMT 254 - Advanced ECG Interpretation

1. Identify pathophysiological principles and assessment findings to formulate a field impression for the patient with cardiovascular disease.
2. Identify cardiovascular injury based on 3-lead and 12-lead cardiac monitoring and interpretation.
3. Implement the treatment plan for the patient with cardiovascular disease/injury based on 3-lead and 12-lead cardiac monitoring and interpretation.
4. Define cardiovascular anatomy and physiology and cardiovascular pathologies.

1. Describe cardiovascular disease and injury and the importance of basic and advanced cardiac monitoring as integrated in patient assessment and management.
2. Identify and describe the anatomy and physiology of the cardiovascular system throughout the levels of body organization, including mechanical and electrophysiology.
3. Describe medical prefixes, suffixes, common root words, and terminology as they relate to cardiology and electrocardiogram (ECG) interpretation.
4. Explain the phases of cardiac depolarization, 3-lead placement, electrical cardiac conduction, and normal (ECG) tracings of the healthy heart.
5. State the proper systematic approach for 3-lead ECG interpretation.
6. Identify and explain abnormal 3-lead ECG tracings as they relate to pathophysiology for rhythms originating from the atria, atrioventricular junction, and the ventricles. 
7. Synthesize and explain proper 12-lead placement and ECG tracings as they relate to the anatomy and physiology of the healthy heart.
8. Differentiate options in 12-lead placement and interpret ECG tracings and axis determination as they relate to the anatomy and pathophysiology of the diseased and injured heart.
9. Explain the proper systematic approach to 12-lead ECG interpretation.
10. Identify and explain abnormal 12-lead ECG tracings and axis deviations as they relate to the anatomy and pathophysiology of the cardiovascular system.
11. Discuss common pathologies and emergency management of cardiovascular diseases and injuries utilizing ECG monitoring.
12. Relate additional diagnostic assessments and tools utilized in confirming cardiovascular emergencies.
13. Explain the importance of proper ECG monitoring as it relates to initial and on-going patient assessment, management, and legal documentation.
14. Demonstrate the proper systematic approaches in patient assessment, formulating a field impression and implementing a treatment plan based on the mechanisms of illness and injury for the patient with cardiovascular emergencies utilizing 3-lead and 12-lead interpretation and monitoring.
15. Examine current trends and changes in healthcare, and demonstrate the ability to integrate roles and responsibilities by formulating a field impression and implementing simulated patient care following guidelines, protocols, and standing orders.

1. Introduction
   1. Cardiac monitoring for traditional and non-traditional patient emergencies
   2. Importance of basic and advanced cardiac monitoring and interpretation
2. Review of cardiovascular anatomy and physiology
   1. The vascular system
   2. Myocardial placement, location, and positioning.
   3. Levels of body organization relating to the myocardium
   4. Myocardial circulation
   5. Electrophysiology of the heart
   6. Autonomic nervous system
3. Review of Electrocardiographic (ECG) monitoring
   1. Electrophysiology and waveforms
   2. Leads and electrodes
   3. Standardization
   4. Waveform analysis
   5. Lead systems and heart surfaces
4. Review of Lead Systems and Heart Surfaces
   1. Rate
   2. Systematic approach to 3-lead ECG interpretation
   3. Regularity
   4. Rhythm origin
   5. Atrioventricular characteristics and relationships       
   6. Ectopy
   7. Patient relativity
5. Abnormal 3-Lead ECG Tracings as They Relate to Anatomy and Pathophysiology
   1. Sinoatrial
   2. Atrial
   3. Atrioventricular junction
   4. Ventricular
   5. Excitation rhythms
   6. Heart blocks
   7. Abnormal wave characteristics and changes
6. 12-Lead Placement and Normal ECG Tracings
   1. Standard limb leads
   2. Augmented leads
   3. Precordial vector leads
7. Axis Determination, Axis Deviation, and Augmented Lead Placement
   1. ECG tracings and axis determination
   2. ECG tracings and axis deviation
   3. Augmented lead placement and ECG tracings
8. Systematic Approach to 12-Lead ECG Interpretation
   1. Rate
   2. Regularity
   3. Rhythm origin
   4. Atrioventricular characteristics and relationships       
   5. Ectopy
   6. Axis determination
   7. Patient relativity
9. Abnormal 12-Lead ECG Tracings as They Relate to Anatomy and Pathophysiology
   1. Inferior wall (lateral and posterior)
   2. Anterior wall (i.e., septal, lateral and high lateral)
   3. Posterior wall (right ventricular wall)
   4. Right axis deviation
   5. Left axis deviation
   6. Indeterminate axis
10. Cardiovascular Pathologies and Management
    1. Ischemia, injury, infarction (with normal and abnormal ECG tracings)
    2. Electrolyte imbalances
    3. Hypertrophy and cardial myopathies
    4. Pericarditis
    5. Trauma
    6. Thermal
    7. Neurological impacts
    8. Blocks and hemi-blocks
    9. Emboli
    10. Artifact
    11. Age-specific variants
    12. Pharmacology
11. Adjunctive Diagnostics
    1. Physical signs and symptoms
    2. Patient medical history
    3. Comparative ECG analysis
    4. Blood gasses:  metabolic panel, cultures, enzyme and drug levels, clotting factors
    5. Radiography, echocardiogram, scanning, and or catheterization
12. Special Considerations in ECG Monitoring
    1. Initial 3 and 12 lead ECG analysis
    2. Comparative ECG analysis from previous tracings
    3. ECG changes before, during, and after patient interventions             
    4. Proper patient information and documentation
13. Systematic Approach to Patient Assessment and Management Utilizing ECG Monitoring
    1. The initial examination, focused history, on-going exam and interventions utilizing 3 and 12-lead ECG monitoring.
    2. Apply pathophysiological principles to the assessment of a patient with cardiovascular disease and injury
    3. Formulation of field impression; decisions based on patient assessment and ECG findings
    4. Develop and execute a patient management plan based on field impression
14. Integration
    1. Current trends and changes
    2. Demonstration of knowledge and skills competencies