EKG Rhythms

This is what we mean when we say that the client is symptomatic.

Normal Sinus Rhythm

Healthy Rhythm. No Treatment necessary

There should be a P wave for every QRS complex. Check
All P waves should look alike. Check
P wave should be measure 0.12 to 0.20.
Each tiny square is 0.04. One big box is 0.20. A P wave should not be longer than 1 big box.
QRS complex should measure 0.08 to 0.12.
To calculate the rate: 300/number of big boxes between QRS complex. Let’s see. There are 3.5 big boxes between each QRS complex. Check. 300/3.5 = 85 bpm is the heart rate.

Sinus Bradycardia

Normal P wave 0.12 to 0.20 or 3 to 5 little tiny boxes.
Normal QRS 0.08 to 0.12
All P waves look the same
The only difference from Normal Sinus rhythm is the rate < 60

Is the client symptomatic?
Symptoms: dizziness, syncope, chest pain, palpitations, nausea, vomiting, and/or dyspnea

Treatment: Only if symptomatic, otherwise, just monitor. Oxygen, Atropine, Prepare for transcutaneous pacemaker, and treat the cause (MI, hyperkalemia, digoxin or beta blocker toxicity, or hypothermia)
Asymptomatic bradycardia may need NO treatment

Sinus Tachycardia

Everything is the same as normal sinus rhythm except the rate is > 100
Treat the cause
Is it pain, exercise, hypoxia, pulmonary embolism, hemorrhage, hyperthyroidism, hypovolemic shock, or fever?

First Degree AV Block

Everything is normal except for the PR interval is > 0.20. Measure this one= maybe around 0.28
A P wave that is > 1 big box = first degree AV block
All P waves and QRS look alike just like NSR.
Usually asymptomatic
Treatment: Monitor for advancing block. Be watchful like a predator.
If symptomatic: treatment is same as symptomatic bradycardia.

Second Degree AV Block Type 1

Also called Mobitz I or Wenckebach I
The PR interval gets longer and longer and then it gets tired and does not conduct or create a QRS complex.
Rhythm is irregular due to the dropped beats.
Some Causes: Digoxin toxicity, heart surgery, & heart attacks.
Treatment if symptomatic: Oxygen, prepared transcutaneous pacemaker, and atropine
Monitor for advancing block or symptoms

Second Degree AV Block Type 2

Also called Mobitz II or Wenckebach II.
There is a P wave to each QRS, but suddenly no QRS, only a non-conducting P wave.
Remember, Type I gets longer and longer and Type II P waves are the same.
Treatment same as Type I

Third Degree AV Block

TOTAL AtrioVentricular Blockage.

There is no connection between the atria and the ventricles. The P wave and the QRS complexes are doing their own thing.
Notice that the P waves and the QRS happen are regular intervals. This is a big difference between 2 and 3rd degree AV blocks. Second degree AV blocks look irregular and 3rd degree AV block looks regular.
Heart rate is usually < 60
This is a sick, symptomatic client.
Treatment: Oxygen, Transcutaneous/Permanent Pacemaker, and Atropine.

Atrial Fibrillation

No identifiable P wave. Fibrillatory waves with irregular QRS complexes. Pulse will feel irregular
Heart rate > 100 = Uncontrolled Atrial Fibrillation
Heart rate < 100 = Controlled Atrial Fibrillation.
Treatment: Antiarrhythmics and Synchronized cardioversion on if symptomatic. Turn on the sync button on the defibrillator when cardioverting this rhythm
Anticoagulation to prevent emboli if client remains in atrial fibrillation > 48 hours.
Meds: Amiodarone, Digoxin, Beta blockers, or Calcium Channel Blockers (Verapamil and Diltiazem)

Atrial Flutter

Flutter waves or “F” waves with a sawtooth appearance.
This one has a 3:1 conduction or 3 “F” waves to every QRS. Conduction may vary. For example, it can be 2:1. That is, 2 Flutter waves to 1 QRS complex.
Treatment: same as atrial fibrillation

Supraventricular Tachycardia

Fast Narrow complex QRS
Treatment Adenosine or a calcium channel blocker such as Verapamil and Diltiazem.
Below is an EKG that shows how Adenosine slows down rhythm.

Ventricular Tachycardia

Irritable ventricle with a rate of 140 to 250 bpm
Can be paroxysmal (comes and goes)
Ventricular Tachycardia with a pulse: Synchronized Cardioversion
Ventricular Tachycardia without a pulse: Defibrillation and CPR
Meds: Amiodarone, Lidocaine, and Procainamide.

Ventricular Fibrillation

Assess client to make sure it is not artifact.
No pulse. Death
CPR and Defibrillation
Meds: Epinephrine 1mg IVP and Vasopressin
Amiodarone 300mg first dose and 150 mg second dose.
Lidocaine first dose 1 to 1.5 mg/kg and second dose give half of the first dose

Fast Knowledge

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1 / 11

1) Name this rhythm and its potential causes. Select all that apply. Total of 5 responses. The name of the rhythm and 4 potential causes.

A) Second Degree AV Block Mobitz Type 1

B) Third Degree AV Block

C) Dopamine drip

D) Hyperkalemia

E) Steroids such as Solumedrol

F) Beta Blockers

G) Sinus Bradycardia

H) Hypothermia

I) Digoxin Toxicity

2 / 11

Name This Rhythm

A) Atrial Fibrillation

B) Supraventricular Tachycardia

C) Atrial Flutter

3 / 11

Name this rhythm.

A) Second Degree AV Block Type I

B) Second Degree AV Block Type II

C) First Degree AV Block

D) Third Degree AV Block

4 / 11

4) Name this rhythm and its treatment. Total of 3 responses. The name of the rhythm and 2 treatments.

A) Atropine IV if heart rate < 60

B) First Degree AV block with a PR interval = 0.08

C) Sinus Bradycardia

D) Monitor for advancing block and client's symptoms

E) Epinephrine IV

F) Have the external pacemaker at the bedside

G) First Degree AV block with a PR interval = 0.32

5 / 11

What is the best treatment for this rhythm?

A) Atropine

B) Epinephrine

C) Adenosine

6 / 11

6) Name this rhythm and its potential treatments. Select all that apply. Total of 5 responses. The name of the rhythm and 4 potential treatments.

A) Ventricular Tachycardia with a pulse

B) Epinephrine IV push

C) Adenosine fast IV pulse

D) Vasopressin IV push

E) Ventricular Fibrillation

F) Defibrillation

G) Verapamil IV push

H) CPR

I) Ventricular Tachycardia without a pulse

7 / 11

Which of the following is the best treatment for an asymptomatic client with this rhythm?

A) Administer Atropine

B) Prepared for surgery. Client needs a permanent pacemaker

C) Monitor for advancing block

D) Apply Transcutaneous Pacemaker

9 / 11

Name This Rhythm and its treatment. Select all that apply. Total of 2 responses. The name of the rhythm and 1 treatment.

A) Atropine

B) Ventricular Fibrillation

C) Supraventricular Tachycardia

D) Unsynchronized Cardioversion if the client has a pulse

E) Ventricular Tachycardia

F) Defibrillation if the client is alert

G) Cardioversion if the client has a pulse

10 / 11

10) Name this Rhythm and its treatment. Select all that apply.

A) Synchronized Cardioversion if client is unstable

B) Atrial Flutter

C) Atrial Fibrillation

D) Ventricular Tachycardia

E) Supraventricular Tachycardia

F) Give Adenosine slow IV push

G) Verapamil IV

H) Give Adenosine fast IV push

11 / 11

11)

Which of the following are potential treatments for this rhythm? Select all that apply. Select 2 treatments

A) Verapamil

B) Unsynchronized Defibrillation

C) CPR

D) Synchronized Cardioversion

Your score is

The average score is 40%

Adult Nursing NCLEX Review