Rhythms

Question 1

Normal Sinus Rhythm

Answer 1

Regular, no interventions

Question 2

Sinus Bradycardia

Answer 2

Regular, rate less than 60; if chronic - continue to monitor, if acute - call rapid response (RR)

Question 3

Sinus tachycardia

Answer 3

Regular, rate greater than 100, identify and treat underlying cause

Question 4

Sinus arrhythmia

Answer 4

Normal, but irregular (CAN BE CAUSED BY BREATHING), no interventions necessary

Question 5

Sinus arrest/pause

Answer 5

Irregular due to pause, measure pause and contact provider (MEASURE FROM QRS TO QRS), consider medications or pacemaker, may have to call RR or code team

Question 6

Premature atrial contraction (PAC)

Answer 6

Irregular due to early beat, P wave in early beat differs from sinus P wave, no interventions necessary

Question 7

Atrial flutter

Answer 7

Regular (variable response is irregular), rate 250-350, SAWTOOTH PATTERN, treat with meds (if more than 48 hours, patient must be fully anti-coagulated before synchronized cardioversion due to stroke risk)

Question 8

Atrial fibrillation

Answer 8

No pattern, no clearly defined P waves, CRITICAL RHYTHM DUE TO POTENTIAL FOR CLOTTING, acute - if stable treat with calcium channel blockers, beta blockers, aminocarone, and digoxin, if unable treat with synchronized cardioversion, chronic - continue to monitor and anticoagulant

Question 9

What is the hallmark of a junctional rhythm?

Answer 9

Inverted P waves, may be before, during, or after the QRS complex

Question 10

How many BPM is a junctional rhythm?

Answer 10

40-60

Question 11

How many BPM is an accelerated junctional rhythm?

Answer 11

60-100

Question 12

How many BPM is junctional tachycardia?

Answer 12

100-150

Question 13

Premature junctional

Answer 13

Irregular, P wave inverted before, during, or after QRS complex, no interventions

Question 14

Junctional escape

Answer 14

Regular, P wave inverted before, during or after QRS complex, assess patient, treatment depends on symptoms

Question 15

What are the most critical rhythms?

Answer 15

v tach, v fib, a fib, and asystole

Question 16

Premature atrial contraction (PAC)

Answer 16

Pacer fires prematurely resulting in a single ectopic beat

Question 17

Premature junctional contraction (PJC)

Answer 17

Normal, but missing P wave in premature beat

Question 18

Premature ventricular contraction (PVC)

Answer 18

Premature beat is WIDE AND BIZZARE (3 in a row are considered v tach.)

Question 19

Idioventricular rhythm

Answer 19

20-40 bpm, call RR

Question 20

Accelerated idioventricualr rhythm

Answer 20

40-60 BPM, call RR

Question 21

Ventricular tachycardia

Answer 21

Greater than 100 BPM, check pulse and call code
Monomorphic - QRS looks the same
Polymorphic - QRS looks different

Question 22

Tornadoes de Pointes

Answer 22

Associated with prolonged QT interval, treated like v tach.

Question 23

Ventricular fibrillation

Answer 23

Lethal rhythm, chaotic activity, heart is unable to pump, call code and defib.

Question 24

Asystole

Answer 24

Flat line, unshockable rhythm, administer epinephrine or atropine

Question 25

Bundle branch block

Answer 25

Widened QRS interval

Question 26

1st degree heart block

Answer 26

PR interval is the same, no extra P waves

Question 27

2nd degree heart block type 2

Answer 27

PR interval is the same, extra P waves are present

Question 28

2nd degree heart block type 1

Answer 28

PR interval is different, ventricular rhythm is irregular

Question 29

3rd degree heart block

Answer 29

PR interval is different, ventricular rhythm is regular

Question 30

Atrial (A) paced (pacemaker rhythm)

Answer 30

Pacer spike before P wave

Question 31

Ventricular (V) paced (pacemaker rhythm)

Answer 31

Pacer spike before QRS

Question 32

Atrial-ventricular (AV) paced (pacemaker rhythm)

Answer 32

Pacer spike on P wave and QRS

Question 33

Pacemaker malfunctions

Answer 33

Failure to pace, failure to capture, failure to sense