Rhythm Strip Samples to help with ACLS Precourse Assessment with [PDF]

Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry 20 rhythm strips on precourse assessment with the following matching choices: Agonal rhythm/asystole Atrial Fibrillation Atrial Flutter Ventricular Fibrillation Monomorphic Ventricular Tachycardia Normal Sinus Rhythm Polymorphic Ventricular Tachycardia

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RHYTHM & ETIOLOGY

***Normal Sinus Rhythm ♥

Normal, None

***Sinus Tachycardia ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥

Exercise Anxiety Caffeine Nicotine Fever Shock CHF Hypotension Pain Hypoxemia Anterior MI

***Sinus

Pulseless Electrical Activity Supraventricular Tachycardia Second-degree atrioventricular block (Mobitz I, Wenckebach) Second-degree atrioventricular block (Mobitz II block) Sinus bradycardia Sinus tachycardia Third-degree atrioventricular block

CRITERIA OVERVIEW RHY – Regular R – 60-100 P – Upright PRI – 0.12 – 0.20 QRS – 0.04 – 0.10

UNIQUE CRITERIA None, normal rhythm

RHY – Regular R – 100 - 160 P – Upright PRI – 0.12 – 0.20 QRS – 0.04 – 0.10

Rate 100 - 160

RHY – Regular

Rate below

SAMPLE STRIPS

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Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry ♥

RHYTHM & ETIOLOGY

Bradycardia ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥

Damage SA Normal sleep athletes Vagal Glaucoma Hypothermia Inferior MI Drugs – MS, digoxin, Inderal IICP

***PVC/PVD Premature Ventricular Contraction/Depolarizati on ♥ Hypoxia, ♥ Hypotension ♥ anemia ♥ Ischemic hrt dis ♥ Electrolytes ♥ M.I. ♥ Myocarditis, pericarditis ♥ CHF ♥ Stress, fatigue, smoking, overeating, caffeine ♥ Hypoglycemia ♥ Sepsis ♥ Cyclic antidepressants ♥ Acidosis

Supraventricular Tachycardia ♥

Not visible sudden start or stop.

***Atrial Flutter

CRITERIA OVERVIEW R – below 60 P – Upright PRI – 0.12 – 0.20 QRS – 0.04 – 0.10

UNIQUE CRITERIA 60

AN ECTOPIC BEAT RHY – Irregular R – 60-100 P – Upright PRI – 0.12 – 0.20 QRS– 0.04 – 0.10

SR, early beat has VENT beat (wide & bizarre)

RHY – Regular R – 160 - 250 P – Upright PRI – 0.12 – 0.20 QRS– 0.04 – 0.10

Rate above 160 - 250

RHY – Regular or

Regular or

SAMPLE STRIPS

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Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥ ♥

RHYTHM & ETIOLOGY

Ischemic heart disease MI Dig toxicity Mitral, Tricuspid valve disease Stress PE Hyperthyroid Often temp

Atrial Fibrillation ♥ ♥ ♥ ♥ ♥

Ischemic heart disease Dig toxicity CHF MI Mitral or Tricuspid valve disease

CRITERIA OVERVIEW Irregular R– Atrial 250–400 Vent: 70 - 150 P – none, F’s PRI – none QRS – 0.04 – 0.10

UNIQUE CRITERIA Irregular, no P’s (called F’s) Saw tooth

RHY – Irregular R– atrial 350-600 Vent. – below 100 controlled, above 100 uncontrolled. P – None f’s PRI – none QRS – 0.04– 0.10

Irregular, no P’s (called f’s)

RHY – Irregular PRI – vary QRS– 0.04 – 0.10

Irregular EXTRA Ps PRI longer & longer, Dropped QRS

SAMPLE STRIPS

***PEA Pulseless Electrical Activity ♥

Looks like any rhythm that should have a pulse but does not

***2nd degree AV Block Type I – Mobitz I, Wenckeback

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Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry ♥

RHYTHM & ETIOLOGY

***2nd degree AV Block Type II or Mobitz II

3rd degree AV Block, Complete Heart Block ♥

Same as 1st degree

***Ventricular Tachycardia monomorpic ♥ ♥

All complexes are the same shape and look the same Wide complex tachycardia

***Ventricular Fibrillation ♥ ♥ ♥

Following V Tach Acute MI Electrolyte Imbalance

CRITERIA OVERVIEW RHY – Regular or Irregular PRI – constant QRS – normal or wide

UNIQUE CRITERIA Regular or Irregular EXTRA Ps

RHY - Regular PRI – vary QRS – usually wide

Regular EXTRA Ps PRI varies greatly

RHY – Regular R – Above 100 P – None PRI –None QRS – Wide, Bizarre

R over 100 All Vent beats

RHY – Chaotic R – None P – None PRI –None QRS – none, fibrillatory line

Chaotic wavy line. No pulse.

SAMPLE STRIPS

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Rhythm Strip Samples to help elp with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry ♥

RHYTHM & ETIOLOGY

Torasades de Pointes Polymorphic ventricular tachycardia Best Treated with magnesium ***Agonal ♥ ♥

Dying heart Drugs used in cardiac arrest provide some electrical waves.

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Primary event in cardiac arrest. Untreated V-tach or V-fib

***Asystole ♥

CRITERIA OVERVIEW RHY – Chaotic waves R – None P – None PRI –None QRS – points twist

UNIQUE CRITERIA Chaotic wavy line. No pulse.

RHY – Regular R – Slow P – None PRI – None QRS – very very wide RHY – None unless only Ps R – No Vent rate P – may be present PRI – None QRS – None

Slow wide bizarre stretched out waves. No Pulse

SAMPLE STRIPS STRIP

Points twist

Straight line or only Ps No Pulse

Calculating Heart Rate - note strips on pretest are longer than 6 seconds. Table for Small Box Method To calculate the heart rate, count the number of 0.04 squares (or small boxes)

between two QRS complexes (1500 divided divid by X = HR)

Small Boxes from R to R

9 = 168

14 = 107

19 = 79

24 = 63

29 = 52

34 = 44

39 = 38

44 = 34

5 = 300 6 = 250 7 = 214 8 = 188

10 = 150 11 = 136 12 = 125 13 = 115

15 = 100 16 = 94 17 = 88 18 = 83

20 = 75 21= 72 22 = 68 23 = 65

25 = 60 26 =58 27 = 56 28 = 54

30 = 50 31 = 48 32 = 47 33 = 45

35 = 43 36 = 42 37 = 41 38 =40

40 = 37 41 = 37 42 = 36 43 = 35

45 = 33 46 = 33 47 = 32 48 = 31

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Rhythm Strip Samples to help elp with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry Heart Block Blocks and Tricks for Analysis from Terry 2nd degree AV block Type I Mobitz I Wenckeback eback From Terry Extra P's Rhythm is always irregular from QRS to QRS PR intervals get longer and longer 2nd degree AV block Type II Mobitz II From Terry Extra P's PR intervals on conducted beats ts are the same - the only heart block with extra P's that has this. 3rd Degree Heart Block Complete Heart Block From Terry Extra P's Rhythm is always regualr from QRS to QRS PR Intervals different. 6

Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry

http://www.univie.ac.at/cga/courses/BE513/EKG/qrs.gif

http://pspl.technion.ac.il/projects/2004s22/ecg1.JPG

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