Practice EKG Strips 424

Identify the following rhythms.

1.

a. Normal sinus rhythm
b. Sinus bradycardia
c. First degree block
d. Sinus arrhythmia

2.

a. Complete heart block
b. Ventricular standstill
c. Agonal rhythm
d. Junctional rhythm

3.  Which of the following medications is indicated for this pulseless rhythm?

a. Vasopressin and Epinephrine
b. Epinephrine and Lidocaine
c. Amiodarone and Vasopressin
d. Sodium bicarbonate and Procainamide

4.

a. Sinus arrhythmia
b. Second degree heart block type I
c. NSR with PACs
d. Complete heart block


5.

a. Atrial fibrillation changing to AIVR
b. Atrial fibrillation changing to VT
c. Atrial fibrillation changing to SVT
d. Atrial fibrillation changing to MAT

Answers
1. c. First degree block. The rhythm is regular. The P waves are upright and associated with a QRS complex. The PR interval is prolonged. The QRS looks wide. No ectopic beats are seen. PR: .24 sec. QRS: .12 sec, QT: .36 sec.

2. c. Agonal rhythm. Not good. Call a code. Hopefully a DNR.

3. a. Vasopressin and Epinephrine.  Vasopressin 40 units or Epinephrine 1 mg IV q3 - 5 minutes.

4. b. Second degree heart block type I. On the first group of beats it is easy to see the progressive prolongation of the P waves and the dropped beats. On the second group of beats you can see the progression on the 3rd and 4th beats but it is not evident on the fifth and 6th beats. On the monitor this patient would transition in and out of the type I block in a similar pattern that is seen on the strip. The P - P interval stays fairly regular throughout the strip.

5.  b. Atrial fibrillation changing to VT OR Sinus rhythm changing to VT. You can make a case for sinus rhythm if you enlarge the strip. It looks like you can see what looks like small biphasic P waves. The are obscured by some of the artifact between the QRS complexes. They do seem to measure out from beat to beat. The R to R interval is also fairly regular. Look and see