Tuesday, February 24, 2015

Practice EKG Strips 416

Identify the following rhythms.

1.






a. Idioventricular rhythm
b. Demand ventricular rhythm
c. Junctional rhythm
d. Atrial paced

2. After experiencing several episodes of this rhythm, the MD orders an Amiodarone drip beginning with a bolus dose. What is the usual loading dose for an Amiodarone infusion?











a. 150 mg IV over 10 minutes
b. 200 mg IV over 10 minutes
c. 250 mg IV over 10 minutes
d. 300 mg IV over 10 minutes

3. A 75 year old arrives to the ER in cardiac arrest. CPR is in progress. He has received two shocks at 200 J and 300 J as well as two doses of epinephrine 1 mg in route. As he is transferred to the stretcher and placed on the monitor, the following rhythm is observed. What medication is indicated in the treatment of this dysrhythmia?














a. Vasopressin 40 units IV
b. Procainamide 20 mg/min
c. Magnesium 1 -2 gm IV
d. Amiodarone 150 mg IV


4.













a. Sinus bradycardia
b. Junctional rhythm
c. Atrial fibrillation
d. Accelerated idioventricular rhythm

5.











a. Atrial fibrillation
b. Sinus arrhythmia
c. Sinus rhythm with PACs
d. Sinus arrest



Answers
1. b. Demand ventricular rhythm.  The rhythm is irregular.  The rate is 70/min.  No P waves are seen. The first complex is ventricular paced.  This is followed by three native beats.  No P waves are seen with these beats.  The rhythm is regular and the QRS complexes are wide.  This is characteristic of an accelerated idioventricular rhythm- perhaps an escape rhythm in this escape.  Ventricular pacing resumes with the fifth complex. The morphology of the 5th beat is different from the other paced beats.  Probably a fusion beat.
2. A. 150 mg IV over 10 minutes. Then 1 mg/min for 6 hours then 0.5 mg/hr for 18 hr

3. c. Magnesium 1 -2 gm IV

4. b. Accelerated junctional rhythm. The rhythm is regular with a rate of 78/min. No P waves are seen. The QRS is narrow. The is ST about 3 mm ST elevation. No ectopic beats are seen. PR: --, QRS: .08 sec, QT: .40 sec.

5. b. Sinus arrhythmia. Notice the big difference between the R - R interval of the first two complexes as compared to the last two complexes. PR: .12 sec, QRS: .08 sec, QT: .44 sec.

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