Axis Deviation

&
Hemiblocks

Dana Yost, Senior Paramedic

Paramedic Training
King County, WA

 Recognize Basic Axis Deviation

Understand & Locate Hemiblocks

 Helps us detect Abnormal

Helps us detect Hemi Blocks

Helps us with Stable Tachycardia

Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

Energy moving toward a lead causes a positive QRS

Energy moving away from a lead causes a negative QRS

SA
Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

SA
Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

SA
Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

SA
Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

Both Hands Up

Left up, Right Down

Normal

LAD

Right UP, Left Down

RAD

Both Hands Down

ERAD

Anything else is UNDETERMINATE

Marked RAD

-90
-120

-60
LAD

aVR

-30

-150

aVL
0

180

I
150
30
120

III

RAD

60
90 aVF

II
Normal Axis
-30 to +100

Physiologic Left Axis Deviation

Pathologic Left Axis Deviation

 Hemi means Half

Hemi Blocks mean half a block

Same thing as a Fascicular Block

LBB

X
X

LPF

X
X

RBB
LAF

Rules
Cannot be a LBBB
Cannot be a Pacer
Cannot be Ventricular
Method
Pathologic Left Axis = LAFB
Right Axis = LPFB

BLOCK is interesting
BLOCK BLOCK is a red flag
BLOCK BLOCK BLOCK is concerning.
(Be very careful with BBs and Antiarrythmics)

 Knowing Axis Deviation help you recognize Hemiblocks.

Recognizing Hemiblocks can help you anticipate potential problems.
The more blocks involved the more worried you should be.