EKG Quick View and NCLEX ECG Strips for the NCLEX Guide

Description: This rhythm represents the standard electrical activity of the heart. The beats are normal and evenly spaced across the strip.
Causes: Generally associated with being healthy.
Treatment: No medical intervention is required; continue to monitor the patient.

Definition: A heart rate that is slow, specifically measured as $< 60/min$ .
Memory Tricks:
- BRADY Bunch: Think of the old TV show, representing "slow times."
- BRADYcardia: The prefix "BRADY" indicates a rate "Below" $60/min$ .
Causes:
- Vagal maneuver (e.g., bearing down during a bowel movement or the Valsalva maneuver).
- Medications: Calcium Channel Blockers (CCB) and Beta Blockers.
Treatment:
- Atropine: Administered ONLY if the patient is symptomatic.
- Symptoms of Low Perfusion: Pale skin, cool to the touch, and clammy (diaphoretic).

Description: Represented as a "squiggly line" on the EKG.
Memory Trick: "Fib is flopping."
Causes:
- Untreated Ventricular Tachycardia (V-Tach).
- Post Myocardial Infarction (MI).
- Electrolyte (E+) imbalances.
- Proarrhythmic medications.
Treatment:
- Step 1 - Defibrillation: This is the #1 priority. Defibrillate immediately. You must stop CPR to perform defibrillation and it should be done before administering drugs.
- Synchronization: NO synchronization is needed for V-Fib.
- Step 2 - Medications: Think of the acronym "LAP":
  - L: Lidocaine
  - A: Amiodarone
  - P: Procainamide

Description: Characterized by a sharp, repeating pattern.
Memory Trick: "V-Tach Tombstone pattern."
Causes:
- Post Myocardial Infarction (MI).
- Hypoxia.
- Low Potassium ( $K^+$ ).
- Low Magnesium ( $Mg^{2+}$ ).
Treatment Protocol:
- Early Defibrillation (NCLEX TIP): Apply defibrillator pads, call out and look for everyone to be CLEAR, shock, and IMMEDIATELY continue chest compressions.
When to Shock vs. Cardiovert (NCLEX TIP):
- V-Tach with NO Pulse: Requires Defibrillation.
  - Memory Trick: D-Dead, D-Defib, D-Don't wait. No synchronization required.
- V-Tach with a Pulse: Requires Synchronized Cardioversion.
  - Memory Trick: C-Count a pulse, C-Cardiovert. Requires synchronization first and sedation of the patient.

Description: Characterized by a lack of discernible P waves and an irregular rhythm.
Memory Trick: No P wave = Fibrillation FloPPing.
Causes:
- Valvular disease, Heart Failure, Pulmonary Hypertension ( $HTN$ ), COPD, or occurring after heart surgery.
Treatment:
- Cardioversion: Must be performed after a Transeophageal Echocardiogram (TTE) to rule out clots. The professional must "Push Synch" on the device.
- Digoxin: Used for "Deep Contraction."
  - Check ATP Before Giving Digoxin:
    - A - Apical Pulse: Must be above $60$ .
    - T - Toxicity: Maximum therapeutic range is $2.0$ . Watch for visual disturbances, nausea/vomiting (N/V), and anorexia.
    - P - Potassium: If potassium is below $3.5$ , there is a higher risk for Digoxin toxicity.
- Anticoagulants: Warfarin is used.
  - Monitor International Normalized Ratio (INR).
  - Antidote is Vitamin K.
  - Patient education: Moderate intake of green leafy vegetables.

Description: Defined by a sawtooth pattern on the EKG strip.
Memory Trick: "A FluTTer = sawTooTh."
Causes: Valvular disease, Heart Failure, Pulmonary Hypertension ( $HTN$ ), COPD, or occurring after heart surgery.
Treatment: Identical to Atrial Fibrillation.
- Cardioversion: Execute "Push Synch" after ruling out clots via TTE.
- Digoxin: Use "ATP" checks (Apical Pulse $> 60$ , Toxicity range max $2.0$ , Potassium $> 3.5$ ) to ensure safe administration.
- Anticoagulants: Warfarin therapy with INR monitoring.

Description: An extremely rapid heart rate originating above the ventricles.
Memory Trick: "Super Fast = Supraventricular."
Causes: Stimulants, strenuous exercise, hypoxia, and heart disease.
Treatment:
- Vagal Maneuver: Encouraging the patient to bear down as if having a bowel movement, or using ice-cold stimulation.
- Adenosine: Administered via RAPID PUSH and followed by a flush with Normal Saline ( $NS$ ). Note that the heart rate may briefly stop.
- Cardioversion: Use the "Push Synch" setting.
NCLEX / Kaplan Practice Scenarios:
- Which medication should be held 48 hours prior to an elective cardioversion for SVT? Answer: Digoxin, due to the increased risk of ventricular irritability.
- Priority Action Scenario: If a client with SVT presents with a Heart Rate of $200$ , Blood Pressure ( $BP$ ) of $78/40$ , and Respiratory Rate ( $RR$ ) of $30$ , the priority action is Synchronized Cardioversion.

Description: A specific form of polymorphic ventricular tachycardia that appears to twist around the isoelectric line.
Memory Trick: "Tornado Pointes."
Causes: Post Myocardial Infarction (MI), Hypoxia, and Low Magnesium ( $Mg^{2+}$ ).
Treatment (NCLEX TIP): Magnesium Sulfate ( $MgSO_4$ ).
- Memory Trick: "Magnesium Mellows out the heart."

Description: A total flatline, indicating no electrical activity in the heart.
Memory Trick: "Assist Fully!" because the patient is flatlined.
Treatment:
- Administration of Epinephrine and Atropine.
- Continuous CPR.
NCLEX TIP: NO Defibrillation is used for Asystole; you cannot shock a flatline.

Wave Components:
- P-wave: Indicates Atrial rhythm.
- QRS wave: Indicates Ventricular rhythm.
Identification by Description:
- "Lack of QRS complexes": Asystole.
- "Wide bizarre QRS complexes": Ventricular Tachycardia.
- "Chaotic or unorganized": Fibrillation.
- "Chaotic rhythm with no P waves": Atrial Fibrillation.
- "Chaotic rhythm without QRS complexes": Ventricular Fibrillation.
- "Bizarre": Tachycardia.
- "Bizarre rhythm with wide QRS complex": Ventricular Tachycardia.
- "Sawtooth": Atrial Flutter.

Memory Trick: "All Pigs Eat Too Much."
A - Aortic: Located at the 2nd Intercostal Space at the Right Sternal Border.
P - Pulmonic: Located at the 2nd Intercostal Space at the Left Sternal Border.
E - Erb's Point: Located at the 3rd Intercostal Space at the Left Sternal Border.
T - Tricuspid: Located at the 3rd or 4th Intercostal Space at the Left Sternal Border.
M - Mitral: Located at the 5th Intercostal Space at the Midclavicular Line.

Visual diagram indicates the standard placement of leads on the chest corresponding to the heart sound locations mentioned in the APETM memory trick, ensuring clear monitoring of the electrical activity of the heart.