ekg rhythms

must understand how to identify and what to do

what is priority number 1 with EKGs?

we assess and TREAT THE PATIENT, NOT the monitor!

how do we know when to treat the pt?

is the pt. symptomatic?

→ low BP

→ low O₂ sat (SOB)

→ dizziness

→ any change in status

→ pale skin

→ disorientation, confusion

if pt is symptomatic, treat and notify the provider!

how do we interpret strips?

read strip left to right when pt is still to avoid artifact

what does each wave represent?

→ P wave = atrial depolarization

→ PR interval = time it takes for the impulse to reach ventricles

→ QRS complex = ventricular depolarization + atrial repolarization

→ T wave = ventricular repolarization

→ U wave = purkinje fiber repolarization (usually not visible)

what are ekg characteristics about sinus rhythm?

→ HR = 60-100

→ regular rhythm

→ P wave = QRS (1:1)

→ PR interval & ORS normal

how do we treat sinus rhythm?

we do nothing! it is perfectly normal

what are ekg characteristics for sinus bradycardia?

→ HR < 60

→ regular rhythm

→ P wave = QRS complex (1:1)

→ PR interval & QRS normal

what causes sinus bradycardia?

→ normal in some athletes

→ carotid massage, valsalve,

→ parasympathetic meds

→ hypothyroidism

→ increased ICP

→ MI

how do we treat sinus bradycardia if the pt. is symptomatic?

→ external pacing = electrical impulses to the heart through the skin, when atropine fails and in medical emergencies

→ atropine which increases heart rate

what are some ekg characteristics for sinus tachycardia?

→ HR is 100 < x > 180

→ regular rhythm

→ P wave = QRS complex (1:1)

→ PR interval & QRS normal

what causes sinus tachycardia?

→ SNS stimulation

→ anxiety

→ pain

→ alcohol, nicotine

→ dehydration

→ fever

how do we treat sinus tachycardia?

if they're symptomatic, determine the CAUSE then treat it!

→ beta-blockers

→ anxiety meds

what are ekg characteristics for supra-ventricular tachycardia?

→ atrial rate 100-280 bpm

→ regular rhythm

→ P wave not very visible (P and T waves are combined)

→ PR interval & QRS normal

what causes supra-ventricular tachycardia?

→ eliminate the cause

→ ablation

→ vagal

→ adenosine

→ calcium channel blockers

→ cardioversion

→ this is a medical emergency

what are ekg characteristics of a-fib?

→ atrial rate as high as 350-600 and ventricular rate between 50-180

→ P wave is indiscernible

→ P wave = QRS complex (1:1) IRREGULAR

→ PR interval & QRS normal INRREGULAR

what cause a-fib?

atrial fibrosis, loss of muscle mass, HTN, HF, CAD, ETOH

what is the significance of a-fib?

→ loss of atrial kick = loss of cardiac output

→ pt. is at risk for clots!

how do we treat a-fib?

→decrease ventricular rate

→ CCB, BB, digoxin, amiodarone, HEPARIN

→ cardioversion

what are ekg characteristics for atrial flutter?

→ “saw-tooth”

→ atrial rate = 2:1/3:1 for QRS complex

→ ventricular rate usually 50-180

what is the significance of atrial flutter?

→ loss of atrial kick = loss of cardiac output

→ pt. is at risk for clots!

what are some causes for a-fib?

atrial fibrosis, loss of muscle mass, HTN, HF, CAD, ETOH

how do we treat a-flutter?

→decrease ventricular rate

→ CCB, BB, digoxin, amiodarone, HEPARIN

→ cardioversion

what are ekg characteristics for premature ventricular contractions?

→ HR varies

→ regular rhythm

→ P wave is absent

→ QRS wide/bizzare and distorted x > 0.12 seconds

→ can be bigeminy, trigeminy, or quageminy

what causes premature ventricular contractions?

→ stimulants

→ electrolyte imbalance

→ emotional distress

→ exercise

→ hypoxia

what is the significance of premature ventricular contractions?

→ they are experiencing non-perfusing beats, causing no pulse

how do we treat premature ventricular contractions?

→ treat the cause (K⁺ if thats the cause)

→ amio

what are ekg characteristics of ventricular tachycardia?

→ ventricular rate 100-200

→ QRS is greater than 0.12

what causes ventricular tachycardia?

→ almost always in diseased hearts

→ MI

→ ischemic heart disease

→ HF

→ cocaine

how do we treat ventricular tachycardia?

→ check patient

→ start CPR

→ pulseless v tach, defibrilate cardioversion if

→ pulse w/ v. tach use epi/vasopressin and amiodarone

can you shock asystole?

NO there is nothing to shock

what are ekg characteristics for v-fib?

ventricular rate is greater than 300

fibrillary waves notes

what are come causes for v-fib?

→ CAD

→ MI

→ hypokalemia, hypomagnesemia

→ hemorrhage

→ drug therapy

→ shock

what is the significance of v-fib?

there is no coordinated atrial or ventricular contractions

what is the treatment for v-fib?

→ check pt.

→ start cpr

→ pulseless v tach, defibrilate cardioversion if

→ pulse w/ v. tach use epi/vasopressin and amiodarone