EKG Rhythm Strips 12- ventricular rhythms

Identify the following rhythms

01.

02

03.

04.

05.                                                                                                             

06.

07.

08.

09.

10. 

Answers

1.

Polymorphic Ventricular Tachycardia

Polymorphic Ventricular Tachycardia.  The rhythm is irregular.  There are no P waves. Notice that the QRS complex morphology changes from beat to beat.  The rhythm could be construed as torsades but if you notice that in the first run of VT that the amplitude of th QRS does not follow the classic pattern of Torsades, that is, it begins small and increases in amplitude then decreases in size again before it terminates. 

02.

Idioventricular Rhythm

Idioventricular Rhythm.  The rate is 35 beats per minute and the rhythm is regular.  There are no P waves present.  The QRS is wide and bizzare in appearance.  A wide slow rhythm is characteristic of a rhythm that arises from the ventricles.   What is the inherent rate of a ventricular rhythm?

3

Torsades de Pointe

03. Torsades de pointe.   Torsades is a form of polymorphic VT.  The rhythm is irregular and there are no P waves before each QRS complex.   The morphology or shape of the QRS complex changes from beat to beat.  The amplitude of the QRS complex begins small and increases and then gets smaller.  What clinical conditions are associated with this rhythm?

04. 

Ventricular Tachycardia

Ventricular tachycardia.  Monomorphic ventricular tachycardia.   The rhythm is regular.  There are no P waves.  The QRS complex is wide (> .12sec).   The rate typically is over 150.  If the patient had a pulse with this rhythm and was only symptomatic, what medications would you consider? 

05. 

Ventricular tachycardia

Ventricular tachycardia.  Ventricular tachycardia. Monomorphic ventricular tachycardia. The rhythm is regular. There are no P waves. The QRS complex is wide (> .12sec). The rate typically is over 150. If the patient had a weak, thready pulse, hypotensive, and had cold clammy skin with this rhythm and was only symptomatic, what electrical intervention considered? 

06. 

Torsades de pointe

Torsades de pointe.  Torsades is a form of polymorphic VT. The rhythm is irregular and there are no P waves before each QRS complex. The QRS complexes are wide and bizzare.  The morphology or shape of the QRS complex changes from beat to beat. The amplitude of the QRS complex begins small and increases and then gets smaller.  What medication is the treatment of choice for this rhythm?

07.

Ventricular fibrillation

Ventricular fibrillation.  The rhythm is very irregular.  There are no P waves and no definable QRS complexes.   Ventricular fibrillation can be described as coarse, fine, or very fine.   The patient is always pulseless and apneic.   What is the inital treatment of this rhythm? 

08.

Agonal rhythm

Agonal rhythm.  The rhythm is regular.  There are no P waves.  The QRS is very wide.  The rate is slow, < 20/minute.  Often seen as a terminal rhythm.  The patient is pulseless and apneic with this rhythm.  If you proceed with the resuscitative efforts using the PEA algorithm, what two medications would you use?

09.

Fine Ventricular Fibrillation

Fine Ventricular fibrillation.  The rhythm is very irregular. There are no P waves and no definable QRS complexes. Ventricular fibrillation can be described as coarse, fine, or very fine. The patient is always pulseless and apneic.   It would be easy to mistake this rhythm for asystole so what adjustments would you make to the monitor to visualize the rhythm better?  

10. 

Accelerated Idioventricular Rhythm

Accelerated Idioventricular Rhythm.  When the rate of an idioventricular rhythm is over 40, then is described as an accelerated idioventricular rhythm.  What is the actual rate?   There are a number of ways to determine the rate:  1.  Look at the rate that is displayed on the ECG monitor (not always accurate).   2.  Count the number of large squares in between the QRS complexes and divide the number into 300.   3.  Count the number of QRS complexes in a six second strip and multiply the number by 10.   4.  Count the number of small squares in between the boxes and divide the number into 1500.  5.  Ask a co-worker what they think. 

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Reviewed 2/28/16