Monday, February 9, 2015

Practice EKG Strips 405

Identify the following rhythms.

1.













a. Sinus rhythm with multifocal PVCs
b. Sinus rhythm with bigeminal PVCs
c. Sinus rhythm with trigeminal PVCs
d. Sinus rhythm with quadrigeminal PVCs

2.














a. Dual paced
b. Atrial paced
c. Demand ventricular pacing
d. Biventricular pacing

3.








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

4.










a. It's okay, it shows appropriate defibrillation of SVT
b. It's wrong, it shows inappropriate defibrillation of atrial fibrillation
c. It's okay, it shows appropriate synchronized cardioversion of atrial fib
d. It's wrong, it shows inappropriate cardioversion of SVT

5.










a. Ventricular tachycardia
b. Idioventricular rhythm
c. Complete heart block
d. Ventricular paced

Answers
1.d. Sinus rhythm with quadrigeminal PVCs. The rhythm is irregular due to the PVCs. The rate is around 88 bpm. The P waves are upright and are paired with a QRS complex. The sinus QRS complexes are narrow. Unifocal PVCs are seen every fourth beat. PR: .16 sec, QRS: .08 sec, QT: .36 sec.

2. a. Dual paced. The rhythm is regular. The rate is 75 bpm. Atrial and ventricular pacer spikes are seen before the P waves and the QRS complexes. The AV interval is .20 sec. In lead II it looks like there is an underlying complete heart block. Notice the small P waves that appear throughout the strip.

3. b. Complete heart block. The P waves are positive and they occur independently of the QRS complexes. The atrial rate is 100 bpm. The ventricular rate is 60 bp, The QRS complexes are narrow so the block must be higher up in the ventricle, near the AV junction. The faster ventricular rate is compatible with a junctional escape rhythm.

4. b. It's wrong, it shows inappropriate defibrillation of atrial fibrillation. The initial rhythm is atrial fibrillation with RVR. The recommended initial biphasic energy dose for cardioversion of adult atrial fibrillation is 120 to 200 J An unsynchronized shock was delivered at 200 J. After a brief pause the rhythm changes to ventricular fibrillation.

5. d. Ventricular paced. The rhythm is regular. The rate is 75 bpm. The P waves are positive. There are ventricular pacer spikes before each QRS complex. This paced rhythm has a characteristic negative QRS complex with a positive T wave. The AV interval is program at .24 sec.

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