EKGs Flashcards
Normal Sinus Rhythm
Rate: 60 - 100 bpm
Rhythm: Regular
P Waves: uniform, upright in leads II, one precedes each QRS
PRI: 0.12 - 0.20 seconds and constant from beat to beat
QRS: 0.11 or less
Sinus Tachycardia
Rate: 101 - 150 bpm
Rhythm: Regular
P Waves: uniform, positive in lead II, will precede each P but may be hard to distinguish between a P wave and a T wave
PRI: 0.12 - 0.20 seconds and constant
QRS: 0.11 or less
Treatment: interventions directed at correcting underlying cause, fluid replacement, relief of pain, removal of offending medications or substances, reducing fever and/or anxiety
Sinus Bradycardia
Rate: <60 bpm
Rhythm: Regular
P Waves: present and uniform, positive in lead II, one precedes each QRS
PRI: 0.12 - 0.20 seconds and constant
QRS: 0.11 seconds or less
Treatment: No treatment necessary is asymptomatic;
If symptomatic interventions may be O2 administration, Atropine, or transcutaneous pacing (TCP)
Awake and Look great? Drugs they can take.
Looking like Crap? Zap, Zap, Zap
Sinus Dysrhythmia
Rate: 60 - 110 bpm
Rhythm: irregular, phasic with respiratory pattern, HR increases gradually with inspiration and decresease with expiration
P Waves: present and uniform
PRI: none
QRS: 0.11 seconds or less
Treatment: no intervention necessary unless it’s accompanid by bradycardia that causes hemodnamic compromise.
Atropine may be needed
Premature Atrial Contraction (PAC)
Rate: normal
Rhythm: regular with premature beats (irregular if 2+ PACs)
P Waves: premature, occuring earlier than the next expected P wave
PRI: may be normal or prolonged depending on the prematurity of the beat
QRS: less than 0.11 seconds
Treatment: usually don’t require any in infrequent PAC’s; PAC’s may initiate episodes of A-Fib, A-Flutter or PSVT.
Treat underlying cause. May be treated with BBs, CCBs, or anti-anxiety meds
Atrial Flutter
Rate: List both
- Atrial Rate* - 250-450 bpm
- Ventricular Rate* - not exceed 180 bpm
Ventricular Rate
<strong><em>Flutter (atrial) rate listed (from top of flutter to next one then divide 1500 by this number)</em></strong>
Rhythm: Atrial rate regular; ventricular rate may be regular or irregular
P Waves: No P waves; saw-tooth or scallop flutter waves
PRI: Not measurable
Treatment: control ventricular rate (cardizem, Amiodarone). CCB, BB.
If client becomes seerely symptomatic synchronized cardioversion
Atrial Fibrillation
Rate:
<strong>Atrial Rate</strong> - 300-500 bpm<br></br><strong>Ventricular rate</strong> - variable
Rhythm: irregularly irregular
P Waves: no identifiable P waves, wavy baseline
PRI: not measurable
QRS: 0.11 seconds
Treatment: control ventricular response (cardizem, amiodarone, Digoxin), CCB, BB
If symptomatic may attempt synchronized cardioversion (give anticoags before cardioversion to prevent emboli)
1st Degree Heart Block
Rate: usually normal, depends on underlying rhythm
Rhythm: regular
P Waves: normal, P waves precedes each QRS
PRI: prlonged, greater than 0.20 seconds but constant
QRS: 0.11 seconds or less
Treatment: no treatment necessary unless symptomatic
Second Degree Type I - Wenchbach
Rate: atrial rate is greater than ventricular rate (list both)
Rhythm: atrial rate regular, ventricular irregular
P Waves: normal, a QRS doesn’t follow some P waves
PRI: Lengthens with each cycle, although lengthening may be slight, until a P wave appears with a QRS complex. Repeat. (may not always be the pattern in the saying below)
<strong>Lengthen, lengthen, lengthen, Drop. I’m a type 1 Wenchbach</strong>
QRS: 0.11 seconds or less, occasionally dropped
Treatment: usually none
Second Degree Type II - Mobitz II
Rate: Atrial rate greater than ventricular rate, ventricular rate often slow (list both)
Rhythm: atrial rate; p waves plot through ventricular is often slow
P Waves: normal; a QRS complex does not follow some P waves; MORE P’S THAN QRS’s
PRI: within normal; but constant for conducted beats
QRS: 0.11 seconds or greater, may be absent after some P waves
Treatment: PACE, atropine usually not helpful
Third Degree Complete Heart Block
Rate: atrial rate is greater than ventricular rate (list both)
Rhythm: Atrial Rate (P-P plot through); ventricular rate regular, but no relationship between atria and ventricular rhythms
P Waves: normal
PRI: atria and ventricles beat independently of each other, all PRI will be different or varied
QRS: narrow or wide
Treatment: PACE!
Ventricular Tachycardia
Rate: 101 - 250 bpm
Rhythm: essentially regular
P Waves: none
PRI: none
QRS: greater than 0.11 seconds. WIDE AND BIZARRE
Treatment: cough, ventricular anti-arrhythmic drugs (lidocaine, procainamide), and synchronized cardioversion.
check pulses and notate
Premature Ventricular Contractions (PVC)
Rate: usually normal, depends on underlying rhythm
Rhythm: essentially regular with premature beats
P Waves: usually absent
PRI: none with PVC - ectopic beat originates in the ventricles
QRS: greater than 0.11 seconds, WIDE AND BIZARRE
Treatment: may or may not be serious. Treat with ventricular anti-arrhythmic drugs (amiodarone, lidocaine, procainamide)
Monitor and treat underlying causes
Can be:
<strong>Bigeminy</strong>: PVC, normal, PVC, Normal (every other beat)<br></br><strong>Trigeminy</strong>: PVC, normal, normal, PVC (every 3rd beat)<br></br><strong>Quad</strong>: PVC, normal, normal, normal, PVC (every 4th beat)<br></br><strong>4 or more</strong>: run on VTach<br></br><strong>Unifocal:</strong> all the PVC’s will look the same<br></br><strong>Multifocal:</strong> all the PVC’s will look different
Ventricular Fibrillation
Rate: none
Rhythm: rapid, chaotic, and no pattern or regularity
P Waves: none
PRI: none
QRS: none
Treatment: Defibirillate, CPR, Drugs (amiodarone, lidocaine, and procainamide)
Aystole
Rate: none
Rhythm: none
P Waves: none
PRI: none
QRS: none
Treatment: CPR, Epi, Vasopressin (after epi and only once)
Treat underlying cause (H’s & T’s)
H’s
<strong>Hypoxia: </strong>give 100% O2<br></br><strong>Hypovolemia</strong>: fluid challange<br></br><strong>Hyper/Hypovolemia</strong>: check K+<br></br><strong>Hypothermia:</strong> check core temp and rewarm<br></br><strong>Hypoglycemia:</strong> check glucose<br></br><strong>Hydrogen Ion:</strong> check ABG’s
T’s
<strong>Tablets:</strong> overdose<br></br><strong>Tamponade:</strong> pericardialcentesis<br></br><strong>Tension Pneumothorax:</strong> check lungs<br></br><strong>Thrombosis:</strong> pulmonary<br></br><strong>Thrombosis: </strong>MI<br></br><strong>Trauma</strong>
Paroxysmal Supraventricular Tachycardia (PSVT)
Rate: 150 - 300 bpm
Rhythm: narrow complexes
P Waves: none
Treatment: Treat with adenosine then verapamil
Torsade de Pointes
always treat with MAG SULFATE
