Practice EKG Rhythm Strips 175
Identify the following rhythms.
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Answers
1.
The rhythm is irregular due to the PVCs. The rate is 60/min. P waves are present, upright, and associated with a QRS complex. There are unifocal PVCs occurring every other beat. The PVCs are followed by a compensatory pause. A fusion beat, the last complex, is formed as a PVC occurs as a sinus impulse is initiated. PR: .16 sec. QRS: .10 sec. QT: .44 sec.
2.
The rhythm is irregular due to the PVCs. The rate is 80/min. The P waves are upright and precede the QRS complexes. The PR interval is prolonged. There are unifocal PVCs that occur every third beat. These PVCs are preceded by a P wave. The P-P interval is very consistent across the strip. PR: .24 sec, QRS: .12 sec, QT: .44 sec.
3.
Notice how the P wave changes in morphology following the first PAC. It tends to take on biphasic characteristics. So by the 6th and 7th complex it appears to almost junctional. Can you have a temporary lose of conduction to one side of the atrium, say a blockage of the Bachmann's bundle?
4.
The rhythm is irregular due to the PVCs. The rate is 80/min. No P waves are present, just flutter waves. There are unifocal PVCs every third beat. PR: ---, QRS: .08 sec, QT: .28 sec.
5.
The rhythm starts out as a monomorphic ventricular tachycardia and deteriorates into ventricular fibrillation. Both are shockable rhythms. Initial joule setting for a monophasic defibrillator is 360 J and 200 J (or according to the manufacturers recommended setting) for biphasic. Increase the joule setting in a step wise fashion for subsequent defibrillations.
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2.
3.
4.
5.
Answers
1.
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| Normal sinus rhythm with bigeminal PVCs |
The rhythm is irregular due to the PVCs. The rate is 60/min. P waves are present, upright, and associated with a QRS complex. There are unifocal PVCs occurring every other beat. The PVCs are followed by a compensatory pause. A fusion beat, the last complex, is formed as a PVC occurs as a sinus impulse is initiated. PR: .16 sec. QRS: .10 sec. QT: .44 sec.
2.
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| Trigeminal fusion complexes |
The rhythm is irregular due to the PVCs. The rate is 80/min. The P waves are upright and precede the QRS complexes. The PR interval is prolonged. There are unifocal PVCs that occur every third beat. These PVCs are preceded by a P wave. The P-P interval is very consistent across the strip. PR: .24 sec, QRS: .12 sec, QT: .44 sec.
3.
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| Junctional rhythm with changing P wave morphology |
Notice how the P wave changes in morphology following the first PAC. It tends to take on biphasic characteristics. So by the 6th and 7th complex it appears to almost junctional. Can you have a temporary lose of conduction to one side of the atrium, say a blockage of the Bachmann's bundle?
4.
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| Atrial flutter with trigeminal PVCs |
The rhythm is irregular due to the PVCs. The rate is 80/min. No P waves are present, just flutter waves. There are unifocal PVCs every third beat. PR: ---, QRS: .08 sec, QT: .28 sec.
5.
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| Ventricular tachycardia changing to ventricular fibrillation |
The rhythm starts out as a monomorphic ventricular tachycardia and deteriorates into ventricular fibrillation. Both are shockable rhythms. Initial joule setting for a monophasic defibrillator is 360 J and 200 J (or according to the manufacturers recommended setting) for biphasic. Increase the joule setting in a step wise fashion for subsequent defibrillations.
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