User:Bron766/ECG/Rate

Subject: Medicine - - - Level: Tertiary - - - Resource type: Active learning exercises

The ECG rate describes how often the heart is electrically activated, in beats per minute.

Skills:

• Calculate the ECG rate using large squares, small squares or a longer interval.
• Recognise an abnormal heart rate in adults.
• Recognise an abnormal heart rate in children and infants.
• Separately calculate the P wave rate and QRS rate and understand the clinical significance of the two rates.
• Understand the term 'pulse deficit' and why the peripheral pulse rate may differ from the ECG rate.
• Practise fast and accurate estimation of heart rate from the ECG.
• Avoid the pitfalls of instantaneous vs. average heart rate calculation.

How to use this page:

• Explore the sections below by clicking on Process, Review, Apply or Contribute to find a variety of educational exercises. Click again to hide the same content.
• Read the suggestions for each type of activity.
• Choose your learning goals using the list of skills on the previous slide.
• Make this page better by editing it or leaving comments on the talk page.

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

Materials (click here)

Time and the ECG - acadoodle.com (4.5 min) Favourite! Rate - ECGpedia Rate - Life in the Fast Lane ECG: Calculation of Heart Rate Method #1 (small squares) (3 min) ECG For Dummies: Heart Rate Determination Tutorial (5 min) Determining Rate 6-3 - ECG / EKG Interpretation -- BASIC (14 min) Average and instantaneous Heart Rate Output: (try these suggestions, or be creative!) Make a poster for medical or nursing students with methods and examples Create a short youtube video or vodcast in Pecha Kucha, Ignite or Just a Minute Instant Tutorial (JAMIT) style

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Exercises:

Process

Active learning exercise: Can you process some new information and transform it into something different? Help: Learning by connectivism involves remixing information to create new connections and links. Start by choosing materials from the collection above that are most relevant to you. Keep a record of which materials you have accessed (suggested ways of doing this can be found here). Transform the information from one format to another. A traditional example of this learning exercise might be taking a lecture and processing it to make dot point notes, but also consider other formats like diagrams, mind maps, short movies and more. Revise your notes by transforming them again rather than just passively reading them. The theory is that this exercise helps you to engage elements of active learning and learning by teaching to increase the quality of your own learning while also creating something useful for others to learn with if you choose to share it.

Review

Active learning exercise: Can you review your knowledge by trying this quiz? 1 ECG rate can be estimated using the formula: 300 / number of large squares between two QRS complexes 60 x number of large squares between two QRS complexes 300 / number of small squares between two QRS complexes 60 x number of small squares between two QRS complexes 2 Which of the following ECG rates are likely to be in the normal range for that person? HR 65 in a 45 year old male HR 80 in a 26 year old female HR 45 in an elite athlete HR 46 in a 78 year old male with dizziness HR 150 in a breathless 75 year old female with palpitations HR 155 in a newborn infant HR 68 in a 2 year old child 3 What is meant by the term pulse deficit? There is a deficit when the ECG rate is less than the pulse rate (e.g. palpated radial pulse) There is a deficit when the pulse rate (e.g. palpated radial pulse) is less than the ECG rate

Apply

Active learning exercise: Can you apply this information to these clinical examples? What is the approximate rate using large squares? Case 1 Answer There are 4 large squares between each QRS complex. Rate = 300/4. The rate is approximately 75 beats per minute. You can also work this out by memorising the sequence 300, 150, 100, 75, 60, 50 and counting to the 4th number, which also works out at 75 beats per minute. Case 2 Answer There are 2 large squares between each QRS complex. Rate = 300/2. The rate is approximately 150 beats per minute. You can also work this out by memorising the sequence 300, 150, 100, 75, 60, 50 and counting to the 2nd number, which also works out at 150 beats per minute. Case 3 Answer There are 6 large squares between each QRS complex. Rate = 300/6. The rate is approximately 50 beats per minute. You can also work this out by memorising the sequence 300, 150, 100, 75, 60, 50 and counting to the 6th number, which also works out at 50 beats per minute. Case 4 Answer There are 8 large squares between each QRS complex. Rate = 300/8. The rate is approximately 38 beats per minute. What is the instantaneous (beat to beat) rate using small squares? Case 1 Answer There are 25 small squares between these two QRS complexes. Rate = 1500/25. The instantaneous rate is 60 beats per minute. Case 2 Answer There are 19 small squares between these two QRS complexes. Rate = 1500/19. The instantaneous rate is 79 beats per minute. What is the average rate using a larger interval? Case 1 Answer This ECG is irregular. The rate will vary depending on which beats or intervals are used to calculate it. In 6 seconds of the bottom rhythm strip recording (30 large squares), there are 7 QRS complexes. Rate=60/6 seconds x 7. The average rate is 70 beats per minute over this interval. In 4 seconds of the lead 2 recording (20 large squares), there are 5 QRS complexes. Rate=60/4 seconds x 5. The average rate is 75 beats per minute over this interval. Case 2 Answer This ECG is irregular. The rate will vary depending on which beats or intervals are used to calculate it. In 4 seconds of the lead V1 recording (20 large squares), there are 12 QRS complexes. Rate=60/4 seconds x 12. The average rate is 180 beats per minute over this interval. What is the rate? Is it normal or abnormal? (Extension: what's the diagnosis?) Case 1 (Answer here.) Case 2: A nursing home patient is brought by ambulance with a cough (Answer in comments section below article) Help: For each skill, here is a collection of relevant cases and clinical examples. You can practise these skills and exercises in any order, but the coloured icons () should help you to find examples of a similar difficulty level. Planned future versions of this page should allow you to keep track of which exercises you have completed, for example by exporting the list to Learnist where you can mark each item as 'done'. You can also review the concepts, theory and background knowledge in the 'Review' section above.

Connect

Active learning exercise: Can you connect with the online medical community to share your growing knowledge? Wikiversity is a community devoted to collaborative learning. We build learning resources from the ground up and also link to existing internet resources. By getting involved, you can benefit from powerful educational models including active learning to strengthen your own knowledge, while also helping others around the world to access medical education. Join in the community: Create your own portfolio of medicine study notes for free on Wikiversity - just add {{med portfolio}} to your Wikiversity user page to get started. Add links to this page by learning how to edit Wikiversity pages. Help to improve the quality of Wikipedia medicine articles and consider joining WikiProject Medicine - Contribute clinical images to Wikimedia Commons or help to sort and classify these resources. Join the FOAM community discussions on Twitter by summarising what you have learned, using the hashtags #FOAMed or #MedEd. Create a free blog or consider guest posting on an established medical blog. You can also learn more about the projects that this page is designed to support, including FOAM, and

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