Practice EKG Strips 435

Identify the following rhythms.

1. What medications or interventions are indicated for the following rhythm?

a. Atropine and Epinephrine
b. Epinephrine and transcutaneous pacing
c. Defibrillation and Vasopressin
d. Vasopressin and Epinephrine

2. What medications or interventions are indicated for the following rhythm? The patient has a pulse.

a. Atropine 0.5 mg IV and transcutaneous pacing
b. Epinephrine 1mg IV and vasopressin 40 units
c. Adenosine 6mg IV and cardioversion at 50 J
d. Amiodarone and Dopamine at 20 mcg/kg//min

3.

a. Failure to capture
b. Failure to sense
c. Demand ventricular pacing
d. Demand atrial pacing


4.

a. Sinus bradycardia with sinus arrest
b. Complete heart block
c. Idioventricular rhythm
d. 2nd degree heart block type II

5.

a. First degree block with a pause
b. Sinus arrhythmia
c. Second degree heart block type I
d. Second degree heart block type II

Answers

1. d. Vasopressin and Epinephrine

2. a. Atropine 0.5 mg IV and transcutaneous pacing.  The use of atropine in a third degree block is not completely contraindicated. Recall that a third degree block can occur at various levels: the level of the AV node, the level of the His bundle, or in the distal conduction system. In the strip above the block is at the level of the AV node. You can tell this because the QRS complex is narrow, not wide as when the block occurs lower in the conduction system. The AHA says that the provider should avoid "relying on atropine" when the third degree block is likely to be in the His bundle or more distal conduction system. These blocks are not likely to respond to atropine and are preferably treated with TCP or beta adrenergic agents. However, "atropine may be beneficial in the presence of AV block when the block occurs at the level of the AV node."

3. a. Failure to capture.  Those sense markers (small triangles) will disappear once you obtain electrical capture. With failure to sense the pacer spikes would fall on the QRS complexes or randomly around the QRS complexes.

4. a. Sinus bradycardia with sinus arrest. Some artifact is seen in lead II. Notice that the small artifact before the 2nd complex is missing from the V1 lead. Extreme sinus bradycardia. I doubt that there was much tissue perfusion going on with this rhythm.

5. a. First degree block with a pause. The rhythm is irregular. The rate is 60/min. The P waves are uniform and upright. The PR interval is prolonged. The QRS complex is wide. No ectopic beats are seen. PR: .28 sec, QRS: .10 sec, QT: .40 sec.