ADVANCED DYSRHYTHMIAS EXAM
GRADED A+
P dwave:
PR dinterval:
QRS dcomplex:
(ST dsegment)
T dwave:
QT dinterval: d- dcorrect danswers d-• dP dwave d- datrial ddepolarization dand dcontraction
• dPR dinterval d- dtime dof dtravel dfrom dthe dSA dnode dto dAV dnode d(.12-.2)
• dQRS d- dventricular ddepolarization dand dcontraction d(.08-.12)
- dNote: dAtrial drepolarization doccurs dduring dthis dtime, dbut dcannot dbe dseen don
dEKG
• dT dwave d- dventricular drepolarization
• dQT dinterval d- dstart dof dventricular dcontraction dto dend dof drelaxation
Systematic dApproach dto danalyzing dEKG d(7 dsteps) d- dcorrect danswers d-1.
dDetermine datrial d& dventricular drate dand drhythm.
, 2. dIdentify dP dwaves dand dshape, dand dif dthere dare dP dwaves dfor devery dQRS.
3. dDetermine dPR dinterval d(0.12-.2), dand dif dconsistent, dirregular dbut dwith dpattern
dto dirregularity, dor djust dirregular.
4. dDetermine dQRS dduration, dconsistency, dand dshape. d(<0.12)
5. dIdentify dT dwave dand dshape.
6. dIdentify dST dsegment, dand dany delevation/depression.
7. dIdentify dany dectopic dbeats doccurring doutside dunderlying drhythm.
Determining dHR dfrom dEKG dstrip d- dcorrect danswers d-Typical dheart drhythm dstrips
dwill dcontain d6 dseconds d(30 dbig dboxes)
• dRates din da d6 dsecond dstrip dcan dbe dobtained dby
- dVentricular drate d= dQRS d(QRS dto dQRS-the dgaps) dx d10
- dAtrial drate d= dP dwaves dx d10
OR dVentricular drate d= d1500 d/ d# dof dsmall dboxes dbetween d2 dQRS; dAtrial drate d=
d1500 d/ d# dof dsmall dboxes dbetween d2 dP dwaves
• d1 dsmall dbox d= d.04sec, d5 dboxes/large dbox d= d0.2sec; d5 dlarge dboxes d= d1
dsecond, d15 dlarge d= d3sec
To dimprove dlead dconduction... d(4) d- dcorrect danswers d-- dClean dand ddry dskin dwith
dsoap dand dwater
- dRemove dexcess dhair
- dGentle dabrasion dof dskin dwith dclean dgauze dto dexpose depidermis d(dry dgauze,
dnot dalcohol dwhich dacts das dbarrier, dskin dis da dnatural dconductor)
- dHave dpatient dremain dstill dand dsupine
Normal dSinus dRhythm d- dcorrect danswers d-• dVentricular dand datrial drate: d60 dto
d100 dbpm
• dVentricular dand datrial drhythm: dRegular
• dQRS dshape dand dduration: dUsually dnormal, dbut dmay dbe dregularly dabnormal
• dP dwave: dNormal dand dconsistent dshape; dalways din dfront dof dthe dQRS
• dPR dinterval: dConsistent dinterval dbetween d0.12 dand d0.20 dseconds
• dP:QRS dratio: d1:1
Sinus dBradycardia d- dcorrect danswers d-• dAtrial/ventricular drate dand drhythm: d< d60
dand dregular
• dP dwave: dNormal dand dconsistent dshape; dalways din dfront dof dQRS
• dPR dinterval: dConsistently dbetween d0.12 dand d0.2 dseconds
• dQRS dshape dand dduration: dUsually dnormal, dbut dmay dbe dregularly dabnormal
• dConcern d- ddecreased dcardiac doutput dand dtissue dperfusion
Etiology dof dSinus dBrady d(causes) d- dcorrect danswers d-• dLower dmetabolic dneeds d-
dSleep, dAthletes, dHypothyroidism
• dVagal dstimulation d(triggers dparasympathetic) d- dVomiting, dSuctioning, dPain
• dMedications d- dCCB, dBB, dAmiodarone
• dIdiopathic dsinus dnode ddysfunction
• dIncreased dintracranial dpressure
GRADED A+
P dwave:
PR dinterval:
QRS dcomplex:
(ST dsegment)
T dwave:
QT dinterval: d- dcorrect danswers d-• dP dwave d- datrial ddepolarization dand dcontraction
• dPR dinterval d- dtime dof dtravel dfrom dthe dSA dnode dto dAV dnode d(.12-.2)
• dQRS d- dventricular ddepolarization dand dcontraction d(.08-.12)
- dNote: dAtrial drepolarization doccurs dduring dthis dtime, dbut dcannot dbe dseen don
dEKG
• dT dwave d- dventricular drepolarization
• dQT dinterval d- dstart dof dventricular dcontraction dto dend dof drelaxation
Systematic dApproach dto danalyzing dEKG d(7 dsteps) d- dcorrect danswers d-1.
dDetermine datrial d& dventricular drate dand drhythm.
, 2. dIdentify dP dwaves dand dshape, dand dif dthere dare dP dwaves dfor devery dQRS.
3. dDetermine dPR dinterval d(0.12-.2), dand dif dconsistent, dirregular dbut dwith dpattern
dto dirregularity, dor djust dirregular.
4. dDetermine dQRS dduration, dconsistency, dand dshape. d(<0.12)
5. dIdentify dT dwave dand dshape.
6. dIdentify dST dsegment, dand dany delevation/depression.
7. dIdentify dany dectopic dbeats doccurring doutside dunderlying drhythm.
Determining dHR dfrom dEKG dstrip d- dcorrect danswers d-Typical dheart drhythm dstrips
dwill dcontain d6 dseconds d(30 dbig dboxes)
• dRates din da d6 dsecond dstrip dcan dbe dobtained dby
- dVentricular drate d= dQRS d(QRS dto dQRS-the dgaps) dx d10
- dAtrial drate d= dP dwaves dx d10
OR dVentricular drate d= d1500 d/ d# dof dsmall dboxes dbetween d2 dQRS; dAtrial drate d=
d1500 d/ d# dof dsmall dboxes dbetween d2 dP dwaves
• d1 dsmall dbox d= d.04sec, d5 dboxes/large dbox d= d0.2sec; d5 dlarge dboxes d= d1
dsecond, d15 dlarge d= d3sec
To dimprove dlead dconduction... d(4) d- dcorrect danswers d-- dClean dand ddry dskin dwith
dsoap dand dwater
- dRemove dexcess dhair
- dGentle dabrasion dof dskin dwith dclean dgauze dto dexpose depidermis d(dry dgauze,
dnot dalcohol dwhich dacts das dbarrier, dskin dis da dnatural dconductor)
- dHave dpatient dremain dstill dand dsupine
Normal dSinus dRhythm d- dcorrect danswers d-• dVentricular dand datrial drate: d60 dto
d100 dbpm
• dVentricular dand datrial drhythm: dRegular
• dQRS dshape dand dduration: dUsually dnormal, dbut dmay dbe dregularly dabnormal
• dP dwave: dNormal dand dconsistent dshape; dalways din dfront dof dthe dQRS
• dPR dinterval: dConsistent dinterval dbetween d0.12 dand d0.20 dseconds
• dP:QRS dratio: d1:1
Sinus dBradycardia d- dcorrect danswers d-• dAtrial/ventricular drate dand drhythm: d< d60
dand dregular
• dP dwave: dNormal dand dconsistent dshape; dalways din dfront dof dQRS
• dPR dinterval: dConsistently dbetween d0.12 dand d0.2 dseconds
• dQRS dshape dand dduration: dUsually dnormal, dbut dmay dbe dregularly dabnormal
• dConcern d- ddecreased dcardiac doutput dand dtissue dperfusion
Etiology dof dSinus dBrady d(causes) d- dcorrect danswers d-• dLower dmetabolic dneeds d-
dSleep, dAthletes, dHypothyroidism
• dVagal dstimulation d(triggers dparasympathetic) d- dVomiting, dSuctioning, dPain
• dMedications d- dCCB, dBB, dAmiodarone
• dIdiopathic dsinus dnode ddysfunction
• dIncreased dintracranial dpressure
