Prophecy ECG With Complete Solutions 2022

steps for interpreting rhythms 1. Regular/Irregular 2. Rate? 3. P before every QRS and a QRS for every P wave? 4. P-R interval measurement and is it consistent? 5. QRS wide or narrow? where to put limb leads on 12 lead EKG on wrists and ankles best lead for atrial rhythms lead II best lead for ventricular rhythms V1 SA node intrinsic rate 60-100 AV node intrinsic rate 40-60 atrial depolarization P wave PR interval measured BEFORE P WAVE and AT THE Q norm: 0.12-.20s ***its too long if it is longer than 5 little boxes or one big box normal PR Interval 0.12-0.20 seconds ventricular depolarization QRS complex ventricular repolarization T wave absolute refractory period The minimum length of time after an action potential during which another action potential cannot begin -toilet theory -problem when QT interval increases 5 large boxes 1 second 15 large boxes 3 seconds 30 large boxes 6 seconds normal P wave less than 0.12 normal QRS 0.04-0.12s QT interval BEGINNING OF Q TO END OF T -normal 0.34-0.43 how to calc rate in regular rhythm 1500/number of small boxes between R's -should have little to no variation (less than 0.12s variation) how to calc rate in irregular rhythm count R waves in 6 second strip and multiply by 10 normal sinus rhythm rate 60-100 sinus bradycardia rate 60 sinus tachycardia rate 100-150 *if regular and 150 = SVT *if irregular and 150 = A-fib with RVR Sinus Arrest *if there is no P wave before flat line then this is arrest *if there is a P wave before flat line then it is a block premature atrial contractions a full PQRST that is early -this rhythm will be irregular -PAC is a beat, not a rhythm -determine underlying rhythm and then say with PACs bigeminy PACs PACs that occur every second beat trigeminy PACs PACs that occur every 3rd beat Atrial Fibrillation NO DISTINGUISHED P -electricity is going like a pinball then transmits to ventricle -rhythm is irregular -if than 150bpm then a-fib RVR if irregular and greater than 150bpm a-fib with RVR Atrial Flutter USUALLY REGULAR atrial rate i.e. 3:1 P wave is flutter/sawtooth Atrial or Supraventricular Tachycardia umbrella term rate 150 SVT if 150 and regular A-fib with RVR if 150 and irregular Junctional Rhythm P waves inverted P waves or P waves after the QRS or no P waves Junctional Rhythm Rates Junctional/Junctional Escape Rhythm: 40-60bpm Accelerated Junctional Rhythm: 60-100bpm Junctional Tachycardia: 100bpm Junctional Rhythms Regular or Irregular Regular clue for ventricular rhythms all QRS complexes will be wide 3 boxes Premature Ventricular Contraction irregular rhythm see underlying rate QRS WIDE AND BIZARRE Unifocal Premature Ventricular Contraction wide and bizarre QRS come from the same origin Multifocal Premature Ventricular Contraction wide and bizarre QRS come from different origins Couplet PVCs 2 PVCs in a row Triplet PVCs 3 PVCs in a row V-tach Regular 100 wide and bizarre QRS HIGH AND WIDE types of v-tach monomorphic (lady fingers) polymorphic (arthritic fingers) torsades de pointes V-fib chaotic rhythm unable to measure rate can be course or fine **course v-fib can look like v-tach but not high and wide enough idioventricular rhythm Regular Rhythm BOTH ATRIAL AND VENTRICULAR RHYTHM NO P WAVE + WIDE QRS Rate is 20-50 min