chapter 8 - read the rhythm strip

Question 1

what 6 steps should be taken to read ECG?

Answer 1

1) is there electrical activity?
2) what is the ventricular (QRS) rate?
3) is the ventricular rate (QRS) regular or irregular?
4) is the QRS complex width narrow or wide?
5) is atrial activity present?
6) is atrial activity related to ventricular activity and if so - how?

Question 2

how to calculate the ventricular rate?

Answer 2

count the number of R-R intervals in 6s (30 large squares) and multiply by 10

Question 3

if the QRS is prolonged, where does this suggest the rhythm is coming from in the myocardium?

Answer 3

ventricular myocardium or supra ventricular rhythm

Question 4

what is the ECG criteria for LBBB?

Answer 4

QRS > 0.12s

dominant S wave in V1

Question 5

management of regular broad QRS tachycardias (algorithm)?

Answer 5

amiodarone 300mg IV 10-20mins followed by maintenance

if ineffective - 3x DC synchronised shocks

Question 6

management of irregular broad QRS tachycardias (algorithm)?

Answer 6

if Torsades des pointes - MgSo4 2g IV over 10 mins

if AF - BB, anticoagulant

Question 7

management of narrow QRS complex tachycardia regular?

Answer 7

vagal manœuvres - carotid sinus massage, Valsalva manouvere
if fails - adenosine 6mg rapid bolus - then 12mg, then 18mg if failed
if that fails - verapamil or BB
if that fails - 3x DC cardioversion

Question 8

management of adult bradycardia with life threatening features?

Answer 8

atropine 500mcg IV
and repeat o maximum of 3mfg if needed
if no response - continue with interim measures - adrenaline 2-10mcg min IV, isoprenaline 5mcg min IV
OR transcutaneous pacing

until - transvenous pacing