Rhythm Interpretation: Recognition & Treatment –
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Systematic rhythm interpretation Check regularity - R to R, determine rate - 300 divided by big
boxes or 1500 divided by small boxes, inspect P waves,
measure PR 0.12 to 0.20 sec, assess QRS width less than 0.12
sec or wide, review QT relative to rate, identify origin - sinus -
atrial - junctional - ventricular, correlate with perfusion -
pulses - BP - mentation - skin - EtCO2.
Rate calculation methods Big box method - 300 divided by big boxes. Small box
method - 1500 divided by small boxes. Six second method -
count QRS in 30 large boxes and multiply by 10. Hash marks
indicate 3 second intervals.
Normal intervals PR 0.12 to 0.20 sec. QRS less than 0.12 sec narrow. QT varies
with rate - prolonged QT raises torsades risk. RR tracks
regularity. ST segment is early ventricular repolarization.
Waveforms and physiology P wave - atrial depolarization. PR segment - AV nodal delay.
QRS - ventricular depolarization. ST segment - early
repolarization. T wave - ventricular repolarization. U wave -
Purkinje repolarization - hypokalemia association.
Normal sinus rhythm Regular, rate 60 to 100, upright P before each QRS, PR 0.12 to
0.20, QRS narrow. Severity - benign. Treatment - none.
Sinus bradycardia Regular, rate less than 60, normal P and PR, QRS narrow.
Causes - vagal tone, hypoxia, inferior MI, beta blocker -
calcium channel blocker use. Severity - can cause
hypoperfusion. Treatment - if symptomatic - atropine then
pacing per NYS.
Sinus tachycardia Regular, rate greater than 100, normal P and PR, QRS narrow.
Causes - pain, fever, shock, hypovolemia, hypoxia. Severity -
often compensatory. Treatment - treat underlying cause.
Sinus arrhythmia Irregular rhythm varying with respiration. Severity - benign.
Treatment - none.
, Sinus pause - arrest Dropped beat with pause, no P. Causes - sick sinus, vagal
tone, meds. Severity - may cause syncope. Treatment -
monitor, pacing if unstable.
Premature atrial contraction Early ectopic P with different morphology, normal QRS,
compensatory or noncompensatory pause. Severity - benign.
Causes - stress, stimulants, hypoxia. Treatment - none
prehospital.
Wandering atrial pacemaker Multiple P morphologies, variable PR, rate less than 100,
irregular. Severity - benign. Treatment - none.
Multifocal atrial tachycardia Rate greater than 100, at least three distinct P morphologies,
irregular. Severity - moderate. Causes - COPD exacerbation,
hypoxia. Treatment - treat respiratory cause; avoid
cardioversion.
Atrial flutter Sawtooth F waves 250 to 350, variable conduction, narrow
QRS. Severity - can cause instability. Treatment - unstable -
synchronized cardioversion per NYS; stable - rate control in
hospital.
Atrial fibrillation Irregularly irregular rhythm, no distinct P waves, fibrillatory
baseline. Severity - risk of hypoperfusion and stroke.
Treatment - unstable - synchronized cardioversion per NYS;
stable - monitor and transport.
Supraventricular tachycardia Regular narrow tachycardia 150 to 250, P often hidden.
Severity - may be unstable. Causes - AVNRT or AVRT.
Treatment - vagal maneuvers, adenosine 6 mg then 12 mg IV if
stable; unstable - synchronized cardioversion.
AVNRT - AV nodal reentrant tachycardia Dual pathway reentry within AV node, regular narrow
complex, retrograde or absent P. Treatment - adenosine if
stable; cardioversion if unstable.
AVRT - accessory pathway tachycardia Reentry using AV node and accessory tract. Orthodromic
narrow complex - treat as SVT. Antidromic wide complex -
treat as VT, avoid AV nodal blockers. Treatment - adenosine if
orthodromic and stable; cardioversion if unstable.
WPW syndrome Preexcitation via bundle of Kent - delta wave, short PR, wide
QRS. Risk - AF with rapid conduction to ventricles. Treatment -
avoid AV nodal blockers in AF with WPW, synchronized
cardioversion if unstable.
First degree AV block PR greater than 0.20, all P conducted. Severity - benign.
Memory - If the R is far from P - first degree. Treatment - none
unless symptomatic brady.
Second degree AV block type I - Progressive PR longer until a dropped QRS. Severity - often
Wenckebach benign. Memory - Longer, longer, longer - drop -
Wenckebach. Treatment - monitor, atropine if symptomatic,
pacing if unstable.
Second degree AV block type II - Mobitz II Fixed PR with random dropped QRS, often wide. Severity -
serious, risk of complete block. Memory - If some P waves do
not get through - Mobitz II. Treatment - immediate pacing if
unstable.
Questions With Clear Solutions
Save
Students also studied
Chapter 29- Chest and Abdominal Tr... Chapter 21 Test Ch. 22 Study Guide
348 terms 24 terms 32 terms
anaphylacticshock Preview kenanderson2017 Preview Kendall_Dinning
Terms in this set (83)
Systematic rhythm interpretation Check regularity - R to R, determine rate - 300 divided by big
boxes or 1500 divided by small boxes, inspect P waves,
measure PR 0.12 to 0.20 sec, assess QRS width less than 0.12
sec or wide, review QT relative to rate, identify origin - sinus -
atrial - junctional - ventricular, correlate with perfusion -
pulses - BP - mentation - skin - EtCO2.
Rate calculation methods Big box method - 300 divided by big boxes. Small box
method - 1500 divided by small boxes. Six second method -
count QRS in 30 large boxes and multiply by 10. Hash marks
indicate 3 second intervals.
Normal intervals PR 0.12 to 0.20 sec. QRS less than 0.12 sec narrow. QT varies
with rate - prolonged QT raises torsades risk. RR tracks
regularity. ST segment is early ventricular repolarization.
Waveforms and physiology P wave - atrial depolarization. PR segment - AV nodal delay.
QRS - ventricular depolarization. ST segment - early
repolarization. T wave - ventricular repolarization. U wave -
Purkinje repolarization - hypokalemia association.
Normal sinus rhythm Regular, rate 60 to 100, upright P before each QRS, PR 0.12 to
0.20, QRS narrow. Severity - benign. Treatment - none.
Sinus bradycardia Regular, rate less than 60, normal P and PR, QRS narrow.
Causes - vagal tone, hypoxia, inferior MI, beta blocker -
calcium channel blocker use. Severity - can cause
hypoperfusion. Treatment - if symptomatic - atropine then
pacing per NYS.
Sinus tachycardia Regular, rate greater than 100, normal P and PR, QRS narrow.
Causes - pain, fever, shock, hypovolemia, hypoxia. Severity -
often compensatory. Treatment - treat underlying cause.
Sinus arrhythmia Irregular rhythm varying with respiration. Severity - benign.
Treatment - none.
, Sinus pause - arrest Dropped beat with pause, no P. Causes - sick sinus, vagal
tone, meds. Severity - may cause syncope. Treatment -
monitor, pacing if unstable.
Premature atrial contraction Early ectopic P with different morphology, normal QRS,
compensatory or noncompensatory pause. Severity - benign.
Causes - stress, stimulants, hypoxia. Treatment - none
prehospital.
Wandering atrial pacemaker Multiple P morphologies, variable PR, rate less than 100,
irregular. Severity - benign. Treatment - none.
Multifocal atrial tachycardia Rate greater than 100, at least three distinct P morphologies,
irregular. Severity - moderate. Causes - COPD exacerbation,
hypoxia. Treatment - treat respiratory cause; avoid
cardioversion.
Atrial flutter Sawtooth F waves 250 to 350, variable conduction, narrow
QRS. Severity - can cause instability. Treatment - unstable -
synchronized cardioversion per NYS; stable - rate control in
hospital.
Atrial fibrillation Irregularly irregular rhythm, no distinct P waves, fibrillatory
baseline. Severity - risk of hypoperfusion and stroke.
Treatment - unstable - synchronized cardioversion per NYS;
stable - monitor and transport.
Supraventricular tachycardia Regular narrow tachycardia 150 to 250, P often hidden.
Severity - may be unstable. Causes - AVNRT or AVRT.
Treatment - vagal maneuvers, adenosine 6 mg then 12 mg IV if
stable; unstable - synchronized cardioversion.
AVNRT - AV nodal reentrant tachycardia Dual pathway reentry within AV node, regular narrow
complex, retrograde or absent P. Treatment - adenosine if
stable; cardioversion if unstable.
AVRT - accessory pathway tachycardia Reentry using AV node and accessory tract. Orthodromic
narrow complex - treat as SVT. Antidromic wide complex -
treat as VT, avoid AV nodal blockers. Treatment - adenosine if
orthodromic and stable; cardioversion if unstable.
WPW syndrome Preexcitation via bundle of Kent - delta wave, short PR, wide
QRS. Risk - AF with rapid conduction to ventricles. Treatment -
avoid AV nodal blockers in AF with WPW, synchronized
cardioversion if unstable.
First degree AV block PR greater than 0.20, all P conducted. Severity - benign.
Memory - If the R is far from P - first degree. Treatment - none
unless symptomatic brady.
Second degree AV block type I - Progressive PR longer until a dropped QRS. Severity - often
Wenckebach benign. Memory - Longer, longer, longer - drop -
Wenckebach. Treatment - monitor, atropine if symptomatic,
pacing if unstable.
Second degree AV block type II - Mobitz II Fixed PR with random dropped QRS, often wide. Severity -
serious, risk of complete block. Memory - If some P waves do
not get through - Mobitz II. Treatment - immediate pacing if
unstable.
