Practice EKG Strips 421

Identify the following rhythms.

1.

a. Sinus rhythm with trigeminal PACs
b. Sinus rhythm with trigeminal PVCs
d. Sinus rhythm with trigeminal PJCs
c. Wenckebach

2.

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

3.

a. Accelerated idioventricular rhythm
b. Demand ventricular pacing
c. First degree block
d. Complete heart block

4.

a. Third degree block
b. Idioventricular rhythm
c. Junctional rhythm
d. Atrial fibrillation with slow ventricular response

5. What is the initial joule setting when defibrillating a patient with this rhythm?

a. 100 J
b. 200 J
c. 300 J
d. 360 J

Answers
1. a. Sinus rhythm with trigeminal PACs. The rhythm is irregular. The rate is around 80 bpm. There are upright P waves seen before the QRS complexes. The QRS complexes are a little wide. There are PACs seen every third beat- trigeminy. The P waves of the PACs may be buried in the T waves of the preceding beats. There is a slight morphological difference between the sinus T waves and the fused T waves. PR: .16 sec, QRS: .10 sec, QT: .40 sec. If there is doubt about whether the ectopic beat is a PAC or PJC then you can use the term premature supraventricular beat. It is kind of like a spork.

2. a. Atrial flutter. The rhythm is regular with a rate of 63/min. No P waves are seen, just some flutter waves. The QRS complexes are narrow. No ectopic beats are seen.

3. b. Demand ventricular pacing. The rhythm is irregular with a rate of around 70 bpm. some ventricular paced beats and intrinsic beats are seen.

4. b. Idioventricular rhythm. The rhythm is irregular with a rate of 30 bpm. There are not any P waves. The QRS complexes are wide so this is escape rhythm arising from the ventricles. PR; ---, QRS: .16 sec. QT: .52 sec

5. b. 200 J for both pulseless Tdp and symptomatic Tdp. You should not attempt to cardiovert a polymorphic VT.