RCIS EKG Study Guide and Rhythm Interpretation Matrix

EKG Rhythm Characteristics and Clinical Actions

• Sinus Bradycardia (Sinus Brady)     * Visual Identification: This rhythm is characterized as being slow and regular.     * Required Clinical Action: The first line of treatment is the administration of Atropine. If the patient remains unstable after initial treatment, the clinical team should proceed to initiate Pacing.

• Atrial Fibrillation (A-Fib)     * Visual Identification: Characterized by the absence of P waves and an rhythm that is irregularly irregular.     * Required Clinical Action: Clinical management involves Rate control and a formal anticoagulation (anticoag) assessment.

• Atrial Flutter (A-Flutter)     * Visual Identification: This rhythm presents with a distinctive Sawtooth pattern.     * Required Clinical Action: Focus on Rate control and maintain a state of anticoagulation (anticoag) awareness.

• Junctional Rhythm     * Visual Identification: This rhythm displays either Inverted P waves or the complete absence of No P waves.     * Required Clinical Action: Administer Atropine specifically if the patient is symptomatic.

Distinguishing Atrioventricular (AV) Blocks

• Mobitz I (Wenckebach)     * Visual Identification: The rhythm displays a progressive lengthening of the PR interval described as "Longer, longer," until there is a "drop" of the QRS complex.     * Required Clinical Action: The appropriate action is to Monitor the patient.

• Mobitz II     * Visual Identification: Features a "Drop" of the QRS complex occurring with a "fixed PR" interval, meaning the PR interval remains constant before the dropped beat.     * Required Clinical Action: The required clinical intervention is to Pace the patient.

• 3rd Degree Heart Block (Complete Heart Block)     * Visual Identification: In this state, the P waves and QRS complexes "dissociate" from one another and beat independently.     * Required Clinical Action: The required action is to Pace the patient.

Ventricular Arrhythmias and Emergency Defibrillation Protocols

• Ventricular Tachycardia (VT) with a Pulse     * Visual Identification: The rhythm pattern is Wide and fast.     * Required Clinical Action: The indicated medical intervention is Cardioversion.

• Ventricular Tachycardia (VT) without a Pulse     * Visual Identification: Like-wise Wide and fast, but characterized by "no perfusion," meaning the patient has no pulse.     * Required Clinical Action: The immediate emergency action is to DEFIBRILLATE.

• Ventricular Fibrillation (VFib)     * Visual Identification: This is a "Chaotic" rhythm with no discernible pattern or organized electrical activity.     * Required Clinical Action: The immediate emergency action is to DEFIBRILLATE.

• Torsades de Pointes     * Visual Identification: Characterized by a "Twisting" of the points around the isoelectric line.     * Required Clinical Action: Administer Magnesium. If the patient becomes pulseless, the practitioner must DEFIBRILLATE.

Non-Shockable Cardiac Arrest Rhythms

• Asystole and Pulseless Electrical Activity (PEA)     * Visual Identification: Asystole is identified as a Flatline. PEA refers to a situation where there is an electrical rhythm on the monitor but there is no pulse present.     * Required Clinical Action: There is NO shock allowed for these rhythms. Management consists of the administration of Epinephrine (Epi) and continuous Cardiopulmonary Resuscitation (CPR).

Myocardial Infarction (MI) Localization and Arterial Correlation

• Inferior MI     * EKG Lead Localization: Identified in leads $II$, $III$, and $\text{aVF}$.     * Arterial Association: Typically involves the Right Coronary Artery ($RCA$).

• Anterior MI     * EKG Lead Localization: Identified in leads $V1$, $V2$, $V3$, and $V4$.     * Arterial Association: Typically involves the Left Anterior Descending ($LAD$) artery.

• Lateral MI     * EKG Lead Localization: Identified in leads $V5$, $V6$, Lead $I$, and $\text{aVL}$.     * Arterial Association: Typically involves the Left Circumflex ($LCx$) artery.

• Posterior MI     * EKG Lead Localization: Identified by the presence of ST Depressions specifically in leads $V1$, $V2$, and $V3$.     * Arterial Association: Associated with either the Right Coronary Artery ($RCA$) or the Left Circumflex ($LCx$) artery.

Clinical Methodology and Daily Practice

• The Daily Drill     * Step 1: Identify — Determine the specific rhythm and characteristics seen on the EKG.     * Step 2: Localize — Determine the anatomical location of any detected infarct and identify the likely culprit artery.     * Step 3: Decide Treatment — Based on the identification and localization, select the appropriate clinical action (e.g., Atropine, Pacing, Defibrillation, Cardioversion, Magnesium, or CPR/Epi).

• Study Resources     * The EKG Study Packet includes a Quiz Answer Key for verification of the Daily Drill exercises.