HHC Basic Arrhythmia

Polarization

• Resting state

• High concentration of the potassium

• Low concentration of sodium inside

Depolarization

• Change in electrical charge from negative to positive

• Sodium moves into the cell

• Potassium leaves the cell

Re-polarization

• Recovery state

• Cell returns to resting state

• Sodium moves OUT of the cell

• Potassium moves IN to the cell

EKG Complex: P Wave

Atrial Depolarization

EKG Complex: QRS Complex

Ventricular Depolarization

EKG Complex: T Wave

Ventricular Repolarization

SA Node: Normal Rate

60 -100 bpm

AV Nodes: Normal Rate

40 - 60 bpm

Ventricles: Normal Rate

20 - 40 bpm

one small box is ____ seconds

0.04

25 small boxes is ____ seconds

0.20

Atrial

P wave - P wave

Ventricle

• R wave to R wave

• POINTY WAVES

Rhythm Interpretation: Step 1 - Regularity

• Regularity Options

  • Regular

  • Irregular

  • Regular except

  • Unable to Measure

• Atrial

  • Measure from the START of the P WAVE to the START of the next P wave

• Ventricular

  • Measure from the START of the R WAVE to the START of the next R wave

Regularity Important Notes

Irregularity has to be off by THREE (3) boxes or more

Rhythm Interpretation: Step 2 - Calculate the Rate

• For a REGULAR rhythm ( P waves & R waves)

  • Count the number of small boxes (0.04 seconds)

  • Based on that number use the EKG conversion table for Heart Rate

• For IRREGULAR rhythm ( P waves & R waves)

  • COUNT ONLY WITHIN THE 3 TIK MARK LINES ON THE TOP OF THE STRIP. MUTIPLE BY 10

Rhythm Interpretation: Step 3 - Examine the P Waves

Ask these 4 questions

1. Is there a P wave?

2. Are the P waves upright?

3. Are the P waves uniformed?/

   1. looks the same throughout the entire strip?

4. is there one p wave for each of the QRS?

IF YES

P/U/U/1:1

• Ways to describe the P Wave

p/u/u/1:1

More Ps than QRS

Unable to measure

Inverted

fluttered/ sawtooth

Absent / indiscernible

Rhythm Interpretation: Step 4 - Measure the PR Interval (PRI)

• From the START of the P WAVE to the START of the Q wave

• Normal: 0.12 seconds (3 small boxes) to 0.20 ( 5 small boxes)

Rhythm Interpretation: Step 5 - Measure the QRS

• Measure from the START of the QRS to the END of the QRS

• Normal: 0.12 seconds (3 small boxes) to 0.20 ( 5 small boxes)

Rhythm Interpretation: Step 6 - Measure the QT interval

• DOES NOT DERTERMINE RHYTHM INTERPRETATION

• Measure from the START of the Q wave to the END of the T wave

• Normal: 0.35 to 0.45

• Features

Interprets the underlying rhythm

Ignore the feature and answer the question like normal, but mention the feature

Features of a Rhythm: Pause

• Can be used in an regular except rthym

• how to measure

  • measure the R wave prior to the pause then the R WAVE after the pause

  • count the number of small boxes (0.04 seconds) in between the R WAVES or the number of large boxes (0.20 seconds)

  • mutiple small boxes by 0.04 / muytiple large boxes by 0.20

Features of a Rhythm: Premature Junctional Complex PJC)

• An inverted P wave