Tuesday, December 30, 2014

Practice EKG Strips 378

Identify the following rhythms.

1.











a. Sinus tachycardia
b. Ventricular tachycardia
c. Atrial fibrillation with RVR
d. Supraventricular tachycardia

2.











a. Atrial paced
b. Ventricular paced
c. Dual paced
d. Biventricular paced

3.











a. Normal sinus rhythm
b. First degree block
c. Sinus bradycardia
d. Second degree heart block type II

4.









a. NSR with sinus arrest and an atrial escape beat
b. NSR with sinus arrest and an junctional escape beat
c. NSR with sinus arrest and an ventricular escape beat
d. NSR with sinus arrest and an supraventricular escape beat



5.









a. Polymorphic VT
b. Coarse VF
c. MAT
d. SVT with aberrancy


Answers
1. c. Atrial fibrillation with RVR. The rhythm is irregular with a rate of 140 bpm. No P waves can be readily identified. Some fibrillation is seen, especially in the V1 lead, between the QRS complexes. If the patient is symptomatic, consider rate slowing medications such as Diltiazem (Cardizem) as a bolus then followed by an infusion.

2. c. Dual paced. The AV interval, the interval between the atrial paced beat and the ventricular paced beat, is prolonged at .24 sec. This gives the ventricle plenty of time to initiate an native beat and delays the onset of a pacemaker induced cardiomyopathy.

3. b. First degree block. Those P waves are way out there. The PR interval is about .44 sec. I say we hold the beta blocker or the calcium channel blocker for another day.

4. a. NSR with sinus arrest and an atrial escape beat. The underlying rhythm is sinus as there is one upright P wave for each QRS complex. A 1.72 second period of sinus arrest follows the 5th complex. An atrial escape beat concludes the first period of arrest. This is followed by a 1.04 second period of sinus arrest. Sinus rhythm resumes and finishes out the rhythm strip.

5. a. Polymorphic VT. If the patient is unstable with this rhythm consider giving an unsynchronized shock. The irregular rhythm makes it hard for the defibrillator to properly synchronize on the R waves so you probably end up giving an unsynchronized shock anyway

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