6 STEPS TO IDENFITY
RHYTHMS
6 second strip Count the R’s x 10
1. Identify the Rate: Key: Verify it is a 6-second strip!
Normal: 60-100bpm
Big Box Method Count the # of big
boxes between R’s / divide by 300 = Normal Rhythm
2. Identify the Rhythm: Distance between R waves
= Some sort of
Is there a P wave? Yes NML SINUS arrythmia, let’s keep going
3. Identify the P-wave: Are they uniform? Yes RHYTHM
Is there a P wave? Yes/No May indicate AFib
Are they uniform? Yes/No or Aflutter
4. Measure PR Interval: Any PR interval >0.20 sec indicates heart block (delay in conduction)
Normal: 0.12-0.20sec
May indicate PVC, BBB,
drug toxicity, electrolyte imbalance
5. Measure QRS Complex: Do they all look alike?
Normal: 0.6-0.12sec : May indicate Wolff-
Parkinson-White Syndrome
6. Interpret EKG findings! (+ Hallmark signs)
COMMON HALLMARK SIGNS
• Saw tooth appearance = Atrial Flutter
• Quivering = Atrial Fibrillation
• Mountain peaks = Ventricular Tachycardia
• ST elevation = may be heart attack or electrolyte imbalance
• ST depression = may be electrolyte imbalance
, ELECTRICAL CONDUCTION SYSTEM OF
THE HEART
1. Impulse begins in the SA Node
(Sinoatrial Node) AKA the
“pacemaker” of the heart
• 60-100bpm
• This is our “P-wave”
2. Travels through internodal
pathways to reach the AV Node
(Atrioventricular Node) AKA the
“gatekeeper” of the heart
• 40-60bpm
3. Travels through the Bundle of
His
4. Branches off into the right and
left bundle branches
5. Travels through the Purkinje
fibers
• 20-40bpm
NORMAL SINUS RHYTHM
Rate: 60–100 bpm (Pictured: 70bpm)
Heart Rate Rhythm P wave PR Interval QRS Complex
Precedes every QRS 0.12-0.20 seconds;
60-100bpm Regular <0.12 seconds; regular
complex regular
Treatment:
None needed. Continue to monitor.
RHYTHMS
6 second strip Count the R’s x 10
1. Identify the Rate: Key: Verify it is a 6-second strip!
Normal: 60-100bpm
Big Box Method Count the # of big
boxes between R’s / divide by 300 = Normal Rhythm
2. Identify the Rhythm: Distance between R waves
= Some sort of
Is there a P wave? Yes NML SINUS arrythmia, let’s keep going
3. Identify the P-wave: Are they uniform? Yes RHYTHM
Is there a P wave? Yes/No May indicate AFib
Are they uniform? Yes/No or Aflutter
4. Measure PR Interval: Any PR interval >0.20 sec indicates heart block (delay in conduction)
Normal: 0.12-0.20sec
May indicate PVC, BBB,
drug toxicity, electrolyte imbalance
5. Measure QRS Complex: Do they all look alike?
Normal: 0.6-0.12sec : May indicate Wolff-
Parkinson-White Syndrome
6. Interpret EKG findings! (+ Hallmark signs)
COMMON HALLMARK SIGNS
• Saw tooth appearance = Atrial Flutter
• Quivering = Atrial Fibrillation
• Mountain peaks = Ventricular Tachycardia
• ST elevation = may be heart attack or electrolyte imbalance
• ST depression = may be electrolyte imbalance
, ELECTRICAL CONDUCTION SYSTEM OF
THE HEART
1. Impulse begins in the SA Node
(Sinoatrial Node) AKA the
“pacemaker” of the heart
• 60-100bpm
• This is our “P-wave”
2. Travels through internodal
pathways to reach the AV Node
(Atrioventricular Node) AKA the
“gatekeeper” of the heart
• 40-60bpm
3. Travels through the Bundle of
His
4. Branches off into the right and
left bundle branches
5. Travels through the Purkinje
fibers
• 20-40bpm
NORMAL SINUS RHYTHM
Rate: 60–100 bpm (Pictured: 70bpm)
Heart Rate Rhythm P wave PR Interval QRS Complex
Precedes every QRS 0.12-0.20 seconds;
60-100bpm Regular <0.12 seconds; regular
complex regular
Treatment:
None needed. Continue to monitor.
