Cardiac Dysrhythmia Overview to help with ACLS...

Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry

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20 rhythm strips on precourse assessment with the following matching choices:

Agonal rhythm/asystoleAtrial FibrillationAtrial FlutterVentricular FibrillationMonomorphic Ventricular TachycardiaNormal Sinus RhythmPolymorphic Ventricular Tachycardia

Pulseless Electrical ActivitySupraventricular TachycardiaSecond-degree atrioventricular block (Mobitz I, Wenckebach)Second-degree atrioventricular block (Mobitz II block)Sinus bradycardiaSinus tachycardiaThird-degree atrioventricular block

RHYTHM &♥ ETIOLOGY

CRITERIAOVERVIEW

UNIQUECRITERIA

SAMPLE STRIPS

***Normal SinusRhythm

♥ Normal, None

RHY – RegularR – 60-100P – UprightPRI – 0.12 – 0.20QRS – 0.04 –0.10

None,normal

rhythm

***SinusTachycardia

♥ Exercise♥ Anxiety♥ Caffeine♥ Nicotine♥ Fever♥ Shock♥ CHF♥ Hypotension♥ Pain♥ Hypoxemia♥ Anterior MI

RHY – RegularR – 100 - 160P – UprightPRI – 0.12 – 0.20QRS – 0.04 –0.10

Rate100 - 160

***Sinus RHY – Regular Rate below


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CRITERIAOVERVIEW

UNIQUECRITERIA

SAMPLE STRIPS

Bradycardia♥ Damage SA♥ Normal sleep

athletes♥ Vagal♥ Glaucoma♥ Hypothermia♥ Inferior MI♥ Drugs – MS,

digoxin, Inderal♥ IICP

R – below 60P – UprightPRI – 0.12 – 0.20QRS – 0.04 –0.10

60

***PVC/PVDPremature Ventricular

Contraction/Depolarization

♥ Hypoxia,♥ Hypotension♥ anemia♥ Ischemic hrt dis♥ Electrolytes♥ M.I.♥ Myocarditis,

pericarditis♥ CHF♥ Stress, fatigue,

smoking,overeating, caffeine

♥ Hypoglycemia♥ Sepsis♥ Cyclic anti-

depressants♥ Acidosis

AN ECTOPICBEATRHY – IrregularR – 60-100P – UprightPRI – 0.12 – 0.20QRS– 0.04 – 0.10

SR, earlybeat hasVENT beat(wide &

bizarre)

SupraventricularTachycardia

♥ Not visible suddenstart or stop.

RHY – RegularR – 160 - 250P – UprightPRI – 0.12 – 0.20QRS– 0.04 – 0.10

Rate above160 - 250

***Atrial Flutter RHY – Regular or Regular or


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CRITERIAOVERVIEW

UNIQUECRITERIA

SAMPLE STRIPS

♥ Ischemic heartdisease

♥ MI♥ Dig toxicity♥ Mitral, Tricuspid

valve disease♥ Stress♥ PE♥ Hyperthyroid♥ Often temp

IrregularR– Atrial 250–400Vent: 70 - 150P – none, F’sPRI – noneQRS – 0.04 –0.10

Irregular, noP’s (calledF’s)Saw tooth

Atrial Fibrillation♥ Ischemic heart

disease♥ Dig toxicity♥ CHF♥ MI♥ Mitral or Tricuspid

valve disease

RHY – IrregularR– atrial 350-600Vent. – below100 controlled,above 100uncontrolled.P – None f’sPRI – noneQRS – 0.04– 0.10

Irregular, noP’s (called f’s)

***PEAPulseless

Electrical Activity

♥ Looks like anyrhythm that shouldhave a pulse butdoes not

***2nd degree AVBlock Type I –

Mobitz I,Wenckeback

RHY – IrregularPRI – varyQRS– 0.04 – 0.10

IrregularEXTRA PsPRI longer &longer,Dropped QRS


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CRITERIAOVERVIEW

UNIQUECRITERIA

SAMPLE STRIPS

***2nd degree AVBlockType II or Mobitz

II

RHY – Regular orIrregularPRI – constantQRS – normal orwide

Regular orIrregularEXTRA Ps

3rd degree AVBlock, Complete

Heart Block♥ Same as 1st degree

RHY - RegularPRI – varyQRS – usuallywide

RegularEXTRA PsPRI variesgreatly

***VentricularTachycardiamonomorpic

♥ All complexes arethe same shapeand look the same

♥ Wide complextachycardia

RHY – RegularR – Above 100P – NonePRI –NoneQRS – Wide,Bizarre

R over 100All Vent beats

***VentricularFibrillation

♥ Following V Tach♥ Acute MI♥ Electrolyte

Imbalance

RHY – ChaoticR – NoneP – NonePRI –NoneQRS – none,fibrillatory line

Chaotic wavyline.No pulse.

Rhythm Strip Samples to help with ACLS Precourse Assessment


CRITERIAOVERVIEW

UNIQUECRITERIA

Torasades dePointes

Polymorphicventriculartachycardia

Best Treated withmagnesium

RHY – ChaoticwavesR – NoneP – NonePRI –NoneQRS – pointstwist

Chaotic wavyline.No pulse.

Points twist

***Agonal♥ Dying heart♥ Drugs used in

cardiac arrestprovide someelectrical waves.

RHY – RegularR – SlowP – NonePRI – NoneQRS – very verywide

Slow widebizarrestretched outwaves.No Pulse

***Asystole♥ Primary event in

cardiac arrest.♥ Untreated V-tach or

V-fib

RHY – Noneunless only PsR – No Vent rateP – may bepresentPRI – NoneQRS – None

Straight lineor only PsNo Pulse

Calculating Heart Rate

Table for Small Box MethodTo calculate the heart rate, count the number of 0.04 squares (or small boxes)

Small Boxesfrom R to R

9 = 168 14 = 107 19 = 79

5 = 300 10 = 150 15 = 100 20 = 756 = 250 11 = 136 16 = 94 21= 727 = 214 12 = 125 17 = 88 22 = 688 = 188 13 = 115 18 = 83 23 = 65

elp with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry

UNIQUECRITERIA

SAMPLE STRIP

Chaotic wavy

No pulse.

Points twist

Slow wide

stretched out

Straight lineor only PsNo Pulse

Calculating Heart Rate - note strips on pretest are longer than 6 seconds.

To calculate the heart rate, count the number of 0.04 squares (or small boxes) between two QRS complexes (1500 divid

19 = 79 24 = 63 29 = 52 34 = 44 39 = 38 44 = 34

20 = 75 25 = 60 30 = 50 35 = 43 40 = 37 45 = 3321= 72 26 =58 31 = 48 36 = 42 41 = 37 46 = 3322 = 68 27 = 56 32 = 47 37 = 41 42 = 36 47 = 3223 = 65 28 = 54 33 = 45 38 =40 43 = 35 48 = 31

with Unique Criteria.

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SAMPLE STRIPS

note strips on pretest are longer than 6 seconds.

between two QRS complexes (1500 divided by X = HR)

44 = 34

45 = 3346 = 3347 = 3248 = 31

Rhythm Strip Samples to help with ACLS Precourse Assessment

Heart Block

elp with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry

Heart Blocks and Tricks for Analysis from Terry

2nd degree AV block Type I

Mobitz IWenckebackFrom TerryExtra P'sRhythm is always irregularfrom QRS to QRSPR intervals get longer andlonger

2nd degree AV block TypeIIMobitz IIFrom TerryExtra P'sPR intervals on conductedbeats are the sameonly heart block with extraP's that has this.

3rd Degree Heart Block

Complete Heart BlockFrom TerryExtra P'sRhythm is always regualrfrom QRS to QRSPR Intervals different.

with Unique Criteria.

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degree AV block Type I

ebackFrom TerryExtra P'sRhythm is always irregularfrom QRS to QRSPR intervals get longer and

degree AV block Type

Mobitz IIFrom TerryExtra P'sPR intervals on conducted

ts are the same - theonly heart block with extraP's that has this.

Degree Heart Block

Complete Heart BlockFrom TerryExtra P'sRhythm is always regualrfrom QRS to QRSPR Intervals different.


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http://www.univie.ac.at/cga/courses/BE513/EKG/qrs.gif

http://pspl.technion.ac.il/projects/2004s22/ecg1.JPG

Cardiac Dysrhythmia Overview to help with ACLS...

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