ECG rhythm

Question 1

indications for ECG monitoring

Answer 1

cardiac arrest 
syncope 
situational syncope 
chest pain 
sepsis 
PE 
electrolyte abnormality 
post major surgery

Question 2

where should defib pads be placed

Answer 2

under right clavicle and left mid axillary line

Question 3

calculation of heart rate from ECG trace

Answer 3

300/number large squares r-r

number of cardiac cycles in 30 squares x10

Question 4

6 steps to rhythm recognition

Answer 4

is there electrical activity 
what is the ventricular QRS rate 
is the QRS regular 
is the QRS narrow or wide 
is there a P wave? 
what is the P wave relation to the QRS

Question 5

in a patient who is bradycardic with no syncope, shock, myocardial ischaemia or heart failure and no risk asystole what do you do

Answer 5

observe

Question 6

what are the asystole risks

Answer 6

recent asystole
MII heart block
>3s ventricular pause
3rd CHB with broad QRS

Question 7

in a patient who is bradycardic with apparent syncope, shock, myocardial ischaemia or heart failure what do you do

Answer 7

500mcg IV atropine, if improvement and no risk asystole observe, if no improvement then 500mcg atropine again up to 3mg and isoprenaline and adrenaline with expert consult
or transcut pacing

Question 8

in a patient who is bradycardic with no syncope, shock, myocardial ischaemia or heart failure and possible risk asystole what do you do

Answer 8

500mcg IV atropine, up to 3mg and isoprenaline and adrenaline with expert consult

Question 9

what to do in a patient who is tachy and has either syncope, shock, myocardial ischaemia or heart failure

Answer 9

synchronised DCCV

Question 10

what to do in a patient who is tachy with no syncope, shock, myocardial ischaemia or heart failure, narrow QRS and regular rhythm

Answer 10

vagal manoeuvre
unsuccessful adenosine, unsuccessful verapamil or BB
unsuccessful DCCV

Question 11

what to do in a patient who is tachy with no syncope, shock, myocardial ischaemia or heart failure, narrow QRS and irregular rhythm

Answer 11

AF

BB, digoxin or amiodarone, anticoag

Question 12

what to do in a patient who is tachy with no syncope, shock, myocardial ischaemia or heart failure, broad QRS and regular rhythm

Answer 12

Consider VT so amiodarone and DCCV if unsuccessful

if they have established SVT with BBB then use vagal manoeuvre, adenosine, verapamil/BB then DCCV

Question 13

what to do in a patient who is tachy with no syncope, shock, myocardial ischaemia or heart failure, broad QRS and irregular rhythm

Answer 13

could be AF or polymorphic VT
If established AF with BBB then treat as such
if polymorphic VT then IV magnesium