# EKG Axis and rotation



## Deltachange (Mar 13, 2011)

First, let me start off with, I am an EMTB. I can read EKG's in the aspect of I understand the physiology of the hearts electrical system and what the waveforms are on the EKG, I understand the leads and placement, and I understand the behavior of the electrical currents in the heart, and how they are expressed.

I know all of this because I taught myself out of a book, Rapid Interpretation of EKG's by Dr. Dubins, which was recommended by the paramedic on my ride alongs for my EMT class. So needless to say, its fairly rudimentary, but I think I am getting a grasp on normal EKG's Blocks, Ischemia, Q waves etc.

However I can't for the life of me understand the axis of the heart, and how you determine rotation. So if any paramedics or EKG trained people on here wouldn't mind helping an ambitious, motivated EMTB, I could really use some help, either on the thread or through PM, at your convenience.

P.S.: I searched the forum using EKG Rotation, but I couldn't find anything on the lists. Google spit a bunch of highly technical stuff at me that I don't quite understand yet. So help with that would also be appreciated!

Thanks


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## Scott33 (Mar 13, 2011)

First of all, congratulations on wanting to expand your EMS knowledge beyond that of the classroom spoon-feeding.

I will defer to the guy who really should produce an EKG book, Tom Bouthillet. His excellent blog has a very user-friendly 6 part axis tutorial.

Read this, digest the info, then go back and read it again and you _will _ know axis.

http://ems12lead.com/2008/10/04/axis-determination-part-i/


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## Deltachange (Mar 14, 2011)

Wow, that helped me so much more than anything I have found on the internet! Thank you so much, If you or someone else doesn't mind answering some more questions, I would greatly appreciate it.

The block method he refers to, is that the 300,150,100 method?
Now I understand how to determine the axis deviation, what clinical significance does that have for the paramedic and doctors/nurses at the hospital?


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## EMSrush (Mar 14, 2011)

Awesome link!


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## Aprz (Mar 14, 2011)

Deltachange said:


> The block method he refers to, is that the 300,150,100 method?


Yep.



Deltachange said:


> what clinical significance does that have for the paramedic and doctors/nurses at the hospital?


MIs, ventricular hypertrophy, and hemiblocks.

Edit: Nice link.


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## TomB (Mar 14, 2011)

Thank you, Scott.

@Deltachange I wrote a post called "Why Learn Axis?" in Dec 2010.

http://ems12lead.com/2010/12/23/why-learn-axis/

I hope this helps.


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## HotelCo (Mar 14, 2011)

TomB said:


> Thank you, Scott.
> 
> @Deltachange I wrote a post called "Why Learn Axis?" in Dec 2010.
> 
> ...



Great article!


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## Naota_X (Mar 14, 2011)

thanks scott that was a great article


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## Moshi (Mar 14, 2011)

Wow those links helped me immensely! Thank you!


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## Deltachange (Apr 29, 2011)

Wow, thank you so much to everyone who helped me, all of those references are helping me slowly understand EKG's more. I knew axis was important, but it was the only part that I wasn't able to comprehend myself, I am learning more and more every day!!!


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## mycrofft (Apr 30, 2011)

*"EKG Axis and rotation "*

Yes, definitely, if you are having trouble reading the monitor or strip, turn the machine a different direction.


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## Deltachange (May 9, 2011)

Alright, so I have more questions lol. I talked to some other paramedics at my IV class, and basically the overwhelming response was either: A. I don't care or B. I look at leads 1,2, and 3, and all I care about is pathological or physiological left or Right Axis Deviation. So what makes knowing the exact axis within ten or fifteen degrees so important? Also, when determining axis on the hexaxial (sp?) system, why is it based on the lead that is most isoelectric, wouldn't finding the lead with the highest amplitude, positive or negative, give you the same results?

I'd like to thank everyone for taking the time they have to answer my questions, I greatly appreciate it, I will understand eventually.


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