ECG From Scratch #18: The Hexaxial System
You now know all 6 limb leads.
But there’s a simple way to put them all together and understand where each lead is looking from.
That is the hexaxial reference system.
From triangle to hexaxial system
Einthoven’s triangle shows the orientation of: I, II, III
The triaxial diagram shows:
aVR, aVL, aVF
Combine them, and all 6 axes intersect at a common central point.
This creates the hexaxial (six-axis) reference system.
It is one of the most important diagrams for understanding the QRS electrical axis.
A useful shortcut
Because some leads look at the heart from similar directions, their ECG patterns often resemble each other:
Lead I ≈ aVL
Their positive poles point in broadly similar directions.
Lead II ≈ opposite of aVR
Their positive poles point in opposite directions.
Therefore, the ECG pattern in aVR is usually approximately the reverse of the pattern in Lead II.
For example:
Lead II: qR
aVR: rS
And what about III and aVF?
Lead III ≈ aVF
Their patterns often resemble each other, although this relationship is not absolute.
The key idea
Don't try to memorize six separate ECG patterns.
Instead, start thinking of the limb leads as different viewpoints of the same electrical activity.
I ↔ aVL
II ↔ aVR (opposite)
III ↔ aVF
Once you understand these relationships, the hexaxial system becomes much easier to use when determining cardiac electrical axis.
4 Things You MUST-KNOW about Opioids on Pharmacology Exams
1. Check respiratory rate, blood pressure, & level of consciousness
-↓ RR, ↓ BP, ↓ LOC, & pinpoint pupils = TOO MUCH opioid
2. Opioid toxicity = give antidote (NALOXONE)
3. Assess pt's bowel movements...can cause constipation!
-Stool softeners are helpful to take while taking opioids
4. Know which meds are opioids: Fentanyl (highly potent), Morphine, Tramadol (don't let the name fool you), Oxycodone, Hydromorphone etc.
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⇒ Normal segment thickens by about 50% during systole moves inward well that's healthy muscle doing its job
⇒ Hypokinesis means the wall still moves
just weaker than it should thickening drops below 30%
motion looks sluggish not absent
⇒ Then there's the segment that doesn't move at all
no thickening no inward motion this is dead or badly ischemic tissue different problem than sluggish muscle
⇒ Dyskinesis is the one that surprises people early on
wall doesn't just fail to move inward it moves outward during systole it bulges instead of contracts