Advent Health EKG
1. Afib The impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]• No
discernable P waves - PRI & Atrial rhythm cannot be
measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
if the Ventricular rate is > 100 the rhythm is uncontrolled
A-fib
• This is a chronic rhythm for some patients
Treatment: controlled patients: anticoagulants and
antiarrythmics; uncontrolled but stable patients: Beta
blockers, calcium channel blockers, or digoxin; Unstable
patients: cardioversion
2. Junctional Impulse starts in the AV junction
Rhythm • P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
3. Accelerated Accelerated Junctional
Junctional Same criteria as Junctional Rhythm, except the Ventricular
Rhythm rate is 60-100
For stable patients: IV access, vagal maneuvers, adeno-
sine, O2, Beta blockers, calcium channel blockers
, Advent Health EKG
4. Idioventricular Impulse originates in the ventricles Rhythm (IVR) Rhythm:
Ventricular is usually regular
Rate: Ventricular between 20-40
QRS: e 0.12
Atrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart,
transcutaneous pacing, atropine. NEVER GIVE ANTI-
ARRYTHMICS MEDICATIONS
5. Accelerated Follows the same criteria as IVR, except Ventricular rate
Idioventricular is 40-100.
Rhythm • If no intervention happens, the patient will deteriorate.
- Treatment: assess pt, atropine, transcutaneous pacing.
NEVER GIVE ANTI-ARRHYTHMIC MEDICATIONS
6. Ventricular Pac- • The pacemaker lead is placed in to right ventricle.
ing • The pacemaker generator fires an impulse Initiating ven-
tricular activity.
• The right ventricle will contract first followed by the left
ventricle. This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial
rhythm, rate, and PRI are non- measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from
pacer spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Mea-
sured from pacer spike to end of QRS
1. Afib The impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]• No
discernable P waves - PRI & Atrial rhythm cannot be
measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
if the Ventricular rate is > 100 the rhythm is uncontrolled
A-fib
• This is a chronic rhythm for some patients
Treatment: controlled patients: anticoagulants and
antiarrythmics; uncontrolled but stable patients: Beta
blockers, calcium channel blockers, or digoxin; Unstable
patients: cardioversion
2. Junctional Impulse starts in the AV junction
Rhythm • P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
3. Accelerated Accelerated Junctional
Junctional Same criteria as Junctional Rhythm, except the Ventricular
Rhythm rate is 60-100
For stable patients: IV access, vagal maneuvers, adeno-
sine, O2, Beta blockers, calcium channel blockers
, Advent Health EKG
4. Idioventricular Impulse originates in the ventricles Rhythm (IVR) Rhythm:
Ventricular is usually regular
Rate: Ventricular between 20-40
QRS: e 0.12
Atrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart,
transcutaneous pacing, atropine. NEVER GIVE ANTI-
ARRYTHMICS MEDICATIONS
5. Accelerated Follows the same criteria as IVR, except Ventricular rate
Idioventricular is 40-100.
Rhythm • If no intervention happens, the patient will deteriorate.
- Treatment: assess pt, atropine, transcutaneous pacing.
NEVER GIVE ANTI-ARRHYTHMIC MEDICATIONS
6. Ventricular Pac- • The pacemaker lead is placed in to right ventricle.
ing • The pacemaker generator fires an impulse Initiating ven-
tricular activity.
• The right ventricle will contract first followed by the left
ventricle. This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial
rhythm, rate, and PRI are non- measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from
pacer spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Mea-
sured from pacer spike to end of QRS
