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Electrocardiography Class Objectives image

**Terminal Objective:
At the completion of Electrocardiography, the paramedic student will be able to utilize both standard limb and 12-lead electrocardiograms to determine cardiac dysrhythmias, correlate electrophysiological, physiological and pathophysiological cardiac events with patient presentation and determine appropriate interventions based on rhythm interpretation and localization of cardiac infarction.

Course Outline
I. Cardiac Anatomy and Physiology
II. Introduction to the ECG
III. ECG Interpretation
IV. Pacemakers: Rhythms and External Pacing
V. 12 Lead Electrocardiogram
VI. Emergency Cardiac Care

PROGRAM BEHAVIORAL OBJECTIVES**
Behavioral attributes of the MICT student and certified MICT are very important. Because of this, we have developed behavioral objectives for the Cowley MICT student. These objectives are based on what is required of an MICT and employer expectations.
At the conclusion of the program, the MICT student must exhibit appropriate behavior in the following areas:

  • Integrity
  • Empathy
  • Self-Motivation
  • Appearance and Personal Hygiene
  • Self-Confidence
  • Communications
  • Time Management
  • Teamwork and Diplomacy
  • Respect
  • Patient Advocacy
  • Careful Delivery of Service

Other behavioral objectives, found in specific curricular areas, have also been developed as well (these are found in the specific class objectives). We strongly believe that the entry level MICT must have the knowledge, ability to perform and have obtained appropriate professional behaviors.

KEY TO CLASSIFICATION OF OBJECTIVES
(B) - Denotes a behavioral objective
(C) - Denotes a cognitive objective
(M) - Denotes a psychomotor objective
** Denotes objectives added to curriculum by Cowley

I. Cardiac Anatomy and Physiology
**Unit Objective: At the completion of this unit, the paramedic student will understand the anatomy and physiology of the cardiovascular system and be able to perform a complete field assessment in order to identify pathophysiological occurrences.
*Describe the incidence, morbidity and mortality of cardiovascular disease.(C)
*Discuss prevention strategies that may reduce the morbidity and mortality of cardiovascular disease.(C)
*Identify the risk factors most predisposing to coronary artery disease.(C)
*Describe the anatomy of the heart, including the position in the thoracic cavity, layers of the heart, chambers of the heart, and location and function of cardiac valves.(C)
*Identify the major structures of the vascular system.(C)
*Identify the factors affecting venous return.(C)
*Identify and define the components of cardiac output.(C)
*Identify phases of the cardiac cycle.(C)
*Identify the arterial blood supply to any given area of the myocardium.(C)
*Compare and contrast the coronary arterial distribution to the major portions of the cardiac conduction system.(C)
*Identify the structure and course of all divisions and subdivisions of the cardiac conduction system.(C)
*Identify and describe how the heart's pacemaking control, rate, and rhythm are determined.(C)
*Explain the physiological basis of conduction delay in the AV node.(C)
*Define the functional properties of cardiac muscle.(C)
*Define the events comprising electrical potential.(C)
*List the most important ions involved in myocardial action potential and their primary function in this process.(C)
*Describe the events involved in the steps from excitation to contraction of cardiac muscle fibers.(C)
*Describe the clinical significance of Starling's law.(C)
*Identify the structures of the autonomic nervous system (ANS).(C)
*Identify the effect of the ANS on heart rate, rhythm and contractility.(C)
*Define and give examples of positive and negative inotropism, chronotropism and dromotropism.(C)
*Discuss the pathophysiology of cardiac disease and injury.(C)
*Identify and describe the details of inspection, auscultation and palpation specific to the cardiovascular system.(C)
*Define pulse deficit, pulsus paradoxus and pulsus alternans.(C)
*Identify the normal characteristics of the point of maximal impulse (PMI).(C)
*Identify and define the heart sounds.(C)
*Relate heart sounds to hemodynamic events in the cardiac cycle.(C)
*Describe the differences between normal and abnormal heart sounds.(C)
*Identify and describe the components of the focused history as it relates to the patient with cardiovascular compromise.(C)

II. Introduction to the ECG
**Unit Objective: At the completion of this unit, the paramedic student will be able to explain the purpose of ECG monitoring while identifying wave forms and correlating the electrophysiological and hemodynamic events occurring throughout the cardiac cycle.
*Explain the purpose of ECG monitoring.(C)
*Describe how ECG wave forms are produced.(C)
**Use the ECG graph to identify and measure wave forms.(C)
**Measure time and plot out wave forms and complexes.(C)
*Correlate the electrophysiological and hemodynamic events occurring throughout the entire cardiac cycle with the various ECG wave forms, segments and intervals.(C)
*Identify how heart rates, durations, and amplitudes may be determined from ECG recordings.(C)
*Relate the cardiac surfaces or areas represented by the ECG leads.(C)
**Determine heart rate and rhythm.(C)
**Begin a systematic approach to ECG rhythm analysis.(C)
*Given an ECG, identify the arrhythmia.(C)
*Identify the limitations to the ECG.(C)
*Differentiate among the primary mechanisms responsible for producing cardiac arrhythmias.(C)
*Describe a systematic approach to the analysis and interpretation of cardiac arrhythmias.(C)
*Identify the major classifications of pediatric cardiac rhythms.(C)
*Identify the ECG changes characteristically produced by electrolyte imbalances and specify the clinical implications.(C)
*Identify patient situations where ECG rhythm analysis is indicated.(C)
*Value and defend the urgency in rapid determination of and rapid intervention of patients in cardiac arrest.(B)
*Value and defend the possibility of termination of resuscitative efforts in the out-of-hospital setting.(B)
*Demonstrate how to set and adjust the ECG monitor settings to varying patient situations.(M)
*Demonstrate a working knowledge of various ECG lead systems.(M)
*Demonstrate how to record an ECG.(M)
*Defend patient situations where ECG rhythm analysis is indicated.(M)

III. ECG Interpretation
**Unit Objective: At the completion of this unit, the paramedic student will be able to describe dysrhythmias and their origins while understanding the morbidity and mortality associated with myocardial conduction defects.
*Describe the arrhythmias originating in the sinus node, the AV junction, the atria, and the ventricles.(C)
**Identify the ECG characteristics of the atrial mechanisms.(C)
**Differentiate atrial from junctional ectopics.(C)
**Recognize the change in direction of the P wave.(C)
**Differentiate between sinus and junctional P waves.(C)
**Differentiate between ectopic and escape junctional mechanisms.
**Identify the causes for the junctional mechanisms.(C)
*Describe the arrhythmias originating or sustained in the AV junction.(C)
*Describe the abnormalities originating within the bundle branch system.(C)
*Describe the process of differentiating wide QRS complex tachycardias.(C)
*Recognize the pitfalls in the differentiation of wide QRS complex tachycardias.(C)
*Describe the conditions of pulseless electrical activity.(C)
*Describe the phenomena of reentry, aberration and accessory pathways.(C)
*Describe the incidence, morbidity and mortality associated with myocardial conduction defects.(C)

IV. Pacemakers
**Unit Objective: At the completion of this unit, the paramedic student will understand artificial pacemakers being able to describe their risks, benefits and hazards.
*Identify the clinical indications for transcutaneous and permanent artificial cardiac pacing.(C)
*Describe the components and the functions of a transcutaneous pacing system.(C)
*Explain what each setting and indicator on a transcutaneous pacing system represents and how the settings may be adjusted.(C)
*Describe the techniques of applying a transcutaneous pacing system.(C)
*Describe the characteristics of an implanted pacemaking system.(C)
*Describe artifacts that may cause confusion when evaluating the ECG of a patient with a pacemaker.(C)
**Identify the chambers of the heart that are being paced.(C)
*List the possible complications of pacing.(C)
*List the causes and implications of pacemaker failure.(C)
*Identify additional hazards that interfere with artificial pacemaker function.(C)
*Recognize the complications of artificial pacemakers as evidenced on ECG.(C)
*Value and defend the application of transcutaneous pacing system.(B)
*Value and defend the urgency in identifying pacemaker malfunction.(B)
*Set up and apply a transcutaneous pacing system.(M)

V. 12 Lead Electrocardiogram
**Unit Objective: At the completion of this unit, the paramedic student will be able to recognize ECG findings that may evidence myocardial ischemia and correlate these findings to a reach a clinical interpretation.
**Identify the surfaces of the heart visualized by the 12 leads.(C)
**Describe methods to calculate the electrical axis.(C)
**Recognize a significant abnormal axis deviation.(C)
*Recognize the changes on the ECG that may reflect evidence of myocardial ischemia and injury.(C)
*Recognize the limitations of the ECG in reflecting evidence of myocardial ischemia and injury.(C)
*Correlate abnormal ECG findings with clinical interpretation.(C)
**Demonstrate the ability to correctly run a 12 lead ECG.(M)
**Defend the rationale for performing a 12 lead ECG in the pre-hospital setting.(B)

VI. Emergency Cardiac Care
**Unit Objective: At the completion of this unit, the paramedic student will identify cardiac dysrhythmias and demonstrate appropriate interventions for these dysrhythmias.
*Identify the major therapeutic objectives in the treatment of the patient with any arrhythmia.(C)
*Identify the major mechanical, pharmacological and electrical therapeutic interventions.(C)
**Describe the major mechanical, pharmacological and electrical therapeutic interventions.(C)
*Based on field impressions, identify the need for rapid intervention for the patient in cardiovascular compromise. (C)
*Define the terms defibrillation and synchronized cardioversion.(C)
*Demonstrate satisfactory performance of psychomotor skills of basic and advanced life support techniques according to the current American Heart Association Standards and Guidelines, including: (M)
a. Cardiopulmonary resuscitation in out-of-hospital setting
b. Defibrillation
c. Synchronized cardioversion
d. Transcutaneous pacing
e. Valsalva maneuver
f. Carotid sinus massage
g. Precordial thump
*Demonstrate proper techniques for performing infant and child defibrillation and synchronized cardioversion.(M)

 
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