Thursday, March 5, 2015

Practice EKG Strips 423

Identify the following rhythms.

1.














Lidocaine is a secondary antiarrhythmic that is used in the treatment of pulseless VF/VT. What is the recommended initial dose of Lidocaine that can be used to treat this rhythm?
a. 1.0 - 1.5 mg/kg IV/IO
b. 300 mg IV push
c. 1 mg every 3 - 5 minutes
d. 2 - 10 mcg/kg/min

2.












a. NSR with trigeminal PACs
b. NSR with trigeminal PVCs
c. NSR with trigeminal PJCs
d. NSR with a triplet of PVCs

3.










a. Atrial fibrillation with some bigeminal PVCs
b. Atrial fibrillation with multifocal PVCs
c. Atrial fibrillation with trigeminal PJCs
d. Atrial fibrillation with bigeminal PACs



4.














What is the initial joule setting when defibrillating a patient with this rhythm using a monophasic defibrillator?
 a. 100 J
 b. 200 J
 c. 300 J
 d. 360 J


5.










a. Sinus bradycardia with sinus arrhythmia
b. Sinus bradycardia with sinus arrest
c. Complete heart block
d. Sinus rhythm with PACs




Answers
1. a. 1.0 - 1.5 mg/kg IV/IO. A second dose can be given at 0.5 - .75 mg/kg. A maximum cumulative dose is 3 mg/kg in 24 hours. If the rhythm converts with Lidocaine, then 1 - 4 mg/min.

2. b. NSR with trigeminal PVCs. The rhythm is irregular due to the PVCs. The P waves are upright and are paired with a QRS complex. The QRS complexes are a little wide. Unfocal PVCs can be seen every third beat, trigeminy. PR: .16 sec. QRS: .10 sec. QT: .40 sec

3. a. Atrial fibrillation with some bigeminal PVCs.   The rhythm is irregular.  The rate is 110 bpm. No P waves are seen.  There are unifocal PVCs seen every other beat.  A short pause follows each PVC.

4. d. 360 J monophasic.  Begin at 360 J and continue at 360 J for subsequent shocks

5. a. Sinus bradycardia with sinus arrhythmia. The rhythm is irregular. The rate is around 50 bpm. The P waves have a positive axis and are paired with a QRS complex. The QRS complexes are narrow. A very tall T wave is present. Maybe hyperkalemia or hyperacute T waves. PR: .20 sec, QRS: .08 sec, QT: .40 sec.

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