Thursday, March 12, 2015

Practice EKG Strips 428

Identify the following rhythms.

1.












a. Atrial fibrillation with RVR
b. Atrial flutter with RVR
c. Supraventricular tachycardia
d. Sinus tachycardia

2.










a. Sinus rhythm with unifocal PVCs
b. Sinus rhythm with multifocal PVCs
c. Sinus rhythm with ventricular escape beats
d. Sinus rhythm with supraventricular ectopy




3. What is the maximum cumulative dose of Vasopressin that can be given to treat this rhythm?










a. 20 unit
b. 40 units
c. 60 units
d. 80 units.

4.









a. Sinus rhythm with sinus arrest
b. Sinus exit block
c. Atrial fibrillation with sinus arrest
d. Sinus arrhythmia


5.












a. Junctional rhythm with bigeminal PVCs
b. Atrial fibrillation with frquent PVCs
c. Sinus bradycardia with frequent pauses
d. Sinus rhythm with PACs every other beat.





Answers
1. b. Atrial flutter with RVR. Looks like a RBBB in the V1 lead. Vagal maneuvers might slow the rate down and clarify it more. Another trick I learned was to decrease the graph paper speed so that any hidden P waves show up more clearly.

2. a. Sinus rhythm with unifocal PVCs.  The PVCs are seen every 4th beat in a quadrigeminal pattern.  The underlying rhythm is sinus in origin.  There are positive, uniform, P waves before each QRS complex.  The QRS complex is wide and has an RSR appearance in lead V1.  The PVCs look uniform and there is a short compensatory pause after each PVC.  PR: .12 sec, QRS: .12 sec, QT: .36 sec.

3. b. 40 units.  Vasopressin is only administered once.  It may be given prior to epinephrine or substituted once as a second dose to epinephrine.  One study found that repeated doses of vasopressin during cardiac arrest did not improve survival rates compared with repeated doses of epinephrine

4. c. Atrial fibrillation with sinus arrest.  The initial rhythm is irregularly, irregular.  No P waves are seen.  The QRS complexes are narrow.  A long 4.2 sec period of arrest follows the 6th complex.  The arrest interval is terminated by a junctional escape beat.

5. a. Junctional rhythm with bigeminal PVCs.  The rhythm is irregular due to the frequent PVCs.  The rate is 80 bpm.  No P waves are seen or associated with a QRS complex.  The QRS complexes in V1 have an rSR appearance typical for a RBBB.  The PVCs are uniform and occur every other beat.  PR: ---, QRS: .12 sec, QT: .40 sec.

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