Thursday, December 25, 2014

Practice EKG Strips Merry Christmas

Identify the following rhythms.

1.











a. NSR with PJCs
b. NSR with PACs
c. NSR with PVCs
d. Sinus rhythm with pauses


2.












a. NSR with sinus arrest
b. 2nd degree heart block type II
c. Sinus arrhythmia
d. NSR with dropped PACs


3.













a. Accelerated idioventricular rhythm
b. Complete heart block
c. Ventricular paced
d. Accelerated junctional rhythm

4.













a. Atrial flutter
b. Atrial fibrillation
c. Atrial tachycardia
d. Atrial paced


5.

















a. Complete heart block
b. Junctional rhythm
c. Sinus arrhythmia
d. Sinus bradycardia with a pause

6.

a. Idioventricular rhythm with a PVC
b. Complete heart block with a PVC
c. Junctional rhythm with a PVC
d. Sinus bradycardia with a PVC

7.










a. Junctional rhythm
b. Atrial fibrillation
c. Sinus bradycardia
d. Complete heart block


8.

a. Supraventricular tachycardia
b. Ventricular tachycardia
c. Multifocal atrial tachycardia
d. Sinus tachycardia

9.














a. Asystole
b. Ventricular fibrillation
c. Ventricular tachycardia
d. Atrial fibrillation

10.






a. Normal sinus rhythm
b. Sinus bradycardia
c. Accelerated junctional rhythm
d. First degree block




Answers

1. b. NSR with PACs. The PACs appear in a bigeminal pattern of every other beat.

2. b. 2nd degree heart block type I. The rhythm is irregular. The P waves are upright. There is progressive increase in the PR interval over successive beats. Some nonconducted P waves are present

3. c. Ventricular paced. The rhythm is regular. The rate is 75 bpm. Up right or positive P waves are seen and have a corresponding QRS complex. An electronic pacer spike appears before each QRS complex. No ectopic beats are noted. PR: .16 sec, QRS: .16 sec, QT: ..52 sec.

4. a. Atrial flutter. I am going to have to go with flutter because the flutter waves are so clear in the V1 lead.

5. d. Sinus bradycardia with a pause. The rhythm is irregular due to the pause. The underlying rate is slow (around 46 bpm) even with the pause. A pause is simply a period of sinus inactivity or absence of a beat. With a pause the rhythm resumes an maintains it's rhythm. Sinus arrest is a period of sinus inactivity but the rhythm does not resume at it's regular pace and rhythm. An inverted T wave is seen and the QT interval is prolonged. No ecopic beats are seen. PR: .16 sec, QRS: .08 sec, QT: .52 sec.

6. b. Complete heart block with a PVC. There is no association between the P waves and the QRS complexes. A P wave can be seen in the ST segment of the first and 4th complexes and on the T wave of the 2nd complex.

7. a. Junctional rhythm.  In this strip the rhythm is regular. The rate is around 40 bpm. There are no P waves seen, In a junctional rhythm this indicates that the atrium and the ventricles are depolarizing at the same time. When a retrograde P wave follows the QRS complex it indicates that the ventricles depolarized before the atria. The QRS complexes are narrow, this indicates normal conduction to the ventricles. There is T wave inversion in lead V1, anterior ischemia. PR: ---, QRS: .08 sec, QT: .56 sec

8. d. Sinus tachycardia The rhythm is regular. The axis of the P waves is positive and they are associated with a QRS complex. The QRS complexes are narrow. A single PVC is seen, the 1st complex. PR: .20 sec, QRS: .08 sec, QT: .28 sec.

9. b. Ventricular fibrillation. The rhythm is irregular with QRS complexes of varying morphology. No P waves are seen. Maybe we should defibrillate at 120 - 200 J (depending upon the defibrillator's manufactures suggested setting). Then a round of vasopressors: epinephrine or vasopressin. You can either continue with the vasopressors or try an antiarrhythmic: amiodarone.

10. a. Normal sinus rhythm.  The rhythm is regular. The rate is 83 bpm. There are upright P waves present and they are associated with a QRS complex. The QRS complexes are narrow. No ectopic beats are seen. PR: .12 sec, QRS: .08 sec, QT: ..36 sec.

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