cardiac dysrhythmia overview to help with acls...
TRANSCRIPT
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
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry
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RHYTHM &♥ ETIOLOGY
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
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry
3
RHYTHM &♥ ETIOLOGY
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
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry
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RHYTHM &♥ ETIOLOGY
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
RHYTHM &♥ ETIOLOGY
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.
6
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.
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.Heart Block Tricks from Terry
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http://www.univie.ac.at/cga/courses/BE513/EKG/qrs.gif
http://pspl.technion.ac.il/projects/2004s22/ecg1.JPG