Friday, March 20, 2015

Practice EKG Strips 434

Identify the following rhythms.

1.












a. Atrial fibrillation with slow ventricular response
b. Sinus bradycardia
c. Junctional rhythm
d. Complete heart block

2.









a. NSR with a run of SVT
b. NSR with a run of VT
c. NSR with a run of MAT
d. NSR with a run of AIVR

3. Which of the following medications is NOT indicated to control the rate of this rhythm?











a. Cardizem 0.25mg/kg IV
b. Lidocaine 1 - 1.5 mg/kg IV
c. Metoprolol 5mg IV
d. Verapamil 2.5 - 5mg IV

4.











a. Coarse ventricular fibrillation
b. Ventricular tachycardia
c. Torsades de pointes
d. Polymorphic ventricular tachycardia

5.











a. Atrial paced
b. Biventricular paced
c. Dual paced
d. Ventricular paced


Answers
1. c. Junctional rhythm. No P waves are seen. The rate is around 46/min. There is an rSR complex in the V1 lead. So, normally you would probably want to call this an accelerated idioventricular rhythm but in this case the patient has a known RBBB which is the cause of the wide QRS complex.

2. b. NSR with a run of VT

3. b. Lidocaine 1 - 1.5 mg/kg IV is the incorrect dose.

4. c. Torsades de pointes. IV magnesium 1 - 2 gms. Discontinue any meds known to increase the QT interval. If symptomatic: defibrillate at 200 J. You don't attempt synchronized cardioversion on polymorphic VT. If pulseless, defibrillate at 200

5.  b. Biventricular paced. The two pacers pikes are very close together. Much too close for dual pacing. We are trying to resynchronize the depolarization and contraction of the ventricles in order to improve CO.

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