EKG

Question 1

1. what are the steps to analyzing a rhythm?
2. What is sinus rhythm? What should its rate be?
3. one tiny box is how long?
4. the bigger box is how long?
5. How long is the typical rhythm strip?
6. typical SA rate is …… . Typical AV rate is ……

Answer 1

1. rate, regularity, p-waves (present? upright? rounded?), QRS (narrow? wide?), PR interval
2. Rhythm originating in the SA node. 60-100
3. 0.04 sec.
4. 0.2 sec (it’s 5 tiny boxes)
5. 6 sec
6. 60-100, 40-60

Question 2

1. how long is a normal PR interval?
2. how long is a normal QRS interval?
3. how long is the QT interval?
4. absence of a P wave =
5. Prolonged QT interval can convert to ……… . What causes this?
6. what is an artifact?

Answer 2

1. 0.12 - 0.2 (3 tiny boxes - 1 big box)
2. 0.04 - 0.12 (1 tiny box - 3 tiny boxes Should be less than a big box).
3. 0.36 - 0.44 (up to 2 big boxes)
4. no atrial contraction
5. v-fib. Meds like Zofran or Haldol (look for QT interval prolongation).
6. movement of leads that can look like an arrythmia

Question 3

1. When do we treat bradycardia?
2. What does CASH stand for?

Answer 3

1. When accompanied by CASH
2. Chest pain, Altered loc, Shortness of breath, Hypotension

Question 4

1. can p waves look different? Give example
2. inverted P waves are caused by?
3. extra P waves can mean?
4. Wide QRS are …….. Narrow QRS are ……
5. what does it mean when someone is v-paced or atrial paced?

Answer 4

1. yes. can be notched, wide, biphasic. Can be inverted
2. P waves originating from AV junction or from the ventricles.
3. heart block
4. abnormal, normal
5. it is the location of the heart that the pacemaker is stimulating to contract. Could stimulate the atria or ventricles. Always report what kind of pacing.

Question 5

1. A flutter waves have a rate of ….. - ….

Answer 5

1. 250 - 350

Question 6

1. what is a PVC?
2. How do they look?

Answer 6

1. early beat that originates in ventricles before SA can fire.
2. all looks normal then you’ll have a random bizarre looking QRS that is early and wide-looking.

Question 7

1. What is sinus dysrhythmia?
2. What is block?
3. What is sinus arrest, or pause?
4. How do you differentiate sinus dysrhythmia from sinus block?

Answer 7

1. normal sinus rhythm, but it speeds up and slows down, in accordance with breathing. Happens in a pattern as opposed to pacs which happen randomly.
2. Sinus rhythm, but 1entire P-QRS is dropped
3. Sinus rhythm but 2 or more P-QRS is dropped
4. in a block, you can fit an entire P-QRS in between beats and make it regular. In sinus dysrhythmia, you can’t. It’s just a delay.

Question 8

1. What is a wandering atrial pacemaker (wap)
2. Describe a pac and how you can differentiate it from sinus dysrhythmia:

Answer 8

1. the pacemaker moves around from sa to av or av junction, thus making p waves that continually differ in appearance. Can be inverted, upright, or absent. Looks like normal sinus, but P waves vary in look.
2. pacs are random early beats in a normal sinus rhythm. They differ sinus dysrhythmia in that they are random whereas sinus dysrhythmias happen in a pattern along with breathing.

Question 9

1. What is a PJC and what must it have? what is a distinguishing feature?
2. What is common to all junctional rhythms?
3. What is the rate of junctional escape?
4. rate of junctional accelerated?
5. rate of junctional tach?

Answer 9

1. a random early beat that originates from the av or junction. It needs an underlying rhythm. The p wave is either inverted or absent
2. p waves are absent, inverted, or follow QRS
3. 40-60
4. 60-100
5. 100 - 180

Question 10

1. what indicates a 1st degree heart block?
2. What indicates a 2nd degree type 1?
3. What indicates a 2nd degree type 2?
4. What indicates a 3rd degree?

Answer 10

1. consistent PR interval prolongation. No dropped QRS. No extra P’s
2. PR interval progressive longer PR intervals until a QRS finally gets dropped. Pattern repeats.
3. more P’s than QRS, but the duration or the PR interval remains the same (when there is a QRS).