EKG Rhythm Strips 33
Identify the following rhythms
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Answers
1.
The rhythm is very irregular with a heart rate of 102/min. No P waves are seen but there is some fibrillatory waves between the QRS complexes. Multifocal PVCs are seen. PR: ---, QRS: .12 sec, QT: .36 sec.
2.
The rhythm is regular with a rate of 115/min. The P waves are negative and precede the QRS complexes. No ectopic beats are noted. PR: .12 sec, QRS: .08 sec, QT: .32 sec.
3.
The rhythm is regular with a ventricular rate of 188/min. The P waves are not seen. No ectopic beats are seen. The QRS complex is narrow suggesting a supraventricular origin. PR: ---, QRS: .08 sec, QT: .20 sec.
4.
The rhythm is a regular monomorphic ventricular tachycardia but it deteriorates into a coarse ventricular fibrillation. The primary treatment for the rhythm is immediate defibrillaton beginning at 200 J (biphasic). CPR should be initiated immediately after the shock is delivered. After two minutes evaluate the rhythm and if it is unchanged, deliver a 2nd shock at a higher energy level, usually 300 J and resume CPR. Epinephrine or vasopressin may be given. A third shock at the same or higher energy level may be given, usually 360 J followed by either another dose of the vasoconstrictors and an antiarrhytmic: Amiodarone or lidocaine, if the amiodarone is unavailable. Continue with high quality CPR and do a rhythm check every two minutes. If the ventricular fibrillation remains, then continue to defibrillate at 360 J. At all times, consider what reversible causes may have contributed to the rhythm and treat them accordingly.
5.
The rhythm is regular with a rate of 83/min. The P waves are absent. No ectopic beats are noted. PR: ---, QRS: .08 sec, QT: .38 sec.
Reviewed 3/1/16
1.
5.
Answers
1.
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| Atrial fibrillation with multifocal PVCs |
The rhythm is very irregular with a heart rate of 102/min. No P waves are seen but there is some fibrillatory waves between the QRS complexes. Multifocal PVCs are seen. PR: ---, QRS: .12 sec, QT: .36 sec.
2.
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| Junctional tachycardia |
The rhythm is regular with a rate of 115/min. The P waves are negative and precede the QRS complexes. No ectopic beats are noted. PR: .12 sec, QRS: .08 sec, QT: .32 sec.
3.
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| Supraventricular tachycardia |
The rhythm is regular with a ventricular rate of 188/min. The P waves are not seen. No ectopic beats are seen. The QRS complex is narrow suggesting a supraventricular origin. PR: ---, QRS: .08 sec, QT: .20 sec.
4.
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| Ventricular tachycardia changing to ventricular fibrillation |
The rhythm is a regular monomorphic ventricular tachycardia but it deteriorates into a coarse ventricular fibrillation. The primary treatment for the rhythm is immediate defibrillaton beginning at 200 J (biphasic). CPR should be initiated immediately after the shock is delivered. After two minutes evaluate the rhythm and if it is unchanged, deliver a 2nd shock at a higher energy level, usually 300 J and resume CPR. Epinephrine or vasopressin may be given. A third shock at the same or higher energy level may be given, usually 360 J followed by either another dose of the vasoconstrictors and an antiarrhytmic: Amiodarone or lidocaine, if the amiodarone is unavailable. Continue with high quality CPR and do a rhythm check every two minutes. If the ventricular fibrillation remains, then continue to defibrillate at 360 J. At all times, consider what reversible causes may have contributed to the rhythm and treat them accordingly.
5.
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| Accelerated junctional rhythm |
The rhythm is regular with a rate of 83/min. The P waves are absent. No ectopic beats are noted. PR: ---, QRS: .08 sec, QT: .38 sec.
Reviewed 3/1/16
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