Monday, February 23, 2015

Practice EKG Strips 415

Identify the following rhythms.

1.
What initial intervention is appropriate for this pulseless rhythm?











a. Transcutaneous pacing
b. Epinephrine 1 mg IV/IO q 3 - 5 minutes
c. Cardiopulmonary resuscitation
d. Atropine 0.5 mg IV/IO q3 - 5 minutes

2.










a. Demand atrial pacing
b. Demand AV pacing
c. Demand biventricular pacing
d. Demand ventricular pacing

3.











a. Sinus rhythm with unifocal PVCs
b. Sinus rhythm with trigeminy
c. Sinus rhythm with a triplet of PVCs
d. Sinus rhythm with multiform PVCs

4.













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

5.














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


Answers
1. c. Cardiopulmonary resuscitation

2. b. Demand AV pacing. Looks like 100% ventricular paced with demand atrial pacing. It looks like the ventricular - atrial (V - A) interval The period of time between the ventricular initiated beat and the atrial initiated beat is about .84 sec. Note the difference between the R - R interval of the complexes with the native beats and the R - R interval of the complexes with the dual paced beats.

3. Sinus rhythm with unifocal PVCs.  The rhythm is irregular due to the PVCs.  The rate is 93/min. The P waves are upright and are associated with a QRS complex. There is 1 mm ST depression in lead II.  There are unifocal PVCs seen every 4th beat, quadrigeminy.  A compensatory pause follows each PVC.  PR: .08 sec, QRS: .08 sec, QT: .32 sec.

4. c. Ventricular paced rhythm. The rhythm is regular. The rate is 60 bpm. No P waves are seen. There are pacer spikes seen before each QRS complex.

5. B. Atrial fibrillation.  The rhythm is irregular.  The rate is 40 bpm.  No P waves are seen, fibrillation is seen.  No ectopic beats are present. PR: ---, QRS: .12 sec, QT: .40 sec

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