Cardiac Dysrhythmia Overview to help with ACLS Precourse ...
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry
20 rhythm strips on precourse assessment with the following matching choices:
Agonal rhythm/asystole Atrial Fibrillation Atrial Flutter Ventricular Fibrillation Monomorphic Ventricular Tachycardia Normal Sinus Rhythm Polymorphic Ventricular Tachycardia
Pulseless Electrical Activity Supraventricular Tachycardia Second-degree atrioventricular block (Mobitz I, Wenckebach) Second-degree atrioventricular block (Mobitz II block) Sinus bradycardia Sinus tachycardia Third-degree atrioventricular block
RHYTHM &
ETIOLOGY
***Normal Sinus Rhythm
Normal, None
CRITERIA OVERVIEW RHY ? Regular R ? 60-100 P ? Upright PRI ? 0.12 ? 0.20 QRS ? 0.04 ? 0.10
UNIQUE CRITERIA None, normal rhythm
SAMPLE STRIPS
***Sinus Tachycardia
Exercise Anxiety Caffeine Nicotine Fever Shock CHF Hypotension Pain Hypoxemia Anterior MI
RHY ? Regular R ? 100 - 160 P ? Upright PRI ? 0.12 ? 0.20 QRS ? 0.04 ? 0.10
Rate 100 - 160
***Sinus
RHY ? Regular Rate below
1
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.
Heart Block Tricks from Terry
RHYTHM & ETIOLOGY
Bradycardia
Damage SA Normal sleep
athletes Vagal Glaucoma Hypothermia Inferior MI Drugs ? MS,
digoxin, Inderal IICP
CRITERIA OVERVIEW R ? below 60 P ? Upright PRI ? 0.12 ? 0.20 QRS ? 0.04 ? 0.10
UNIQUE CRITERIA 60
SAMPLE STRIPS
***PVC/PVD
Premature Ventricular Contraction/Depolarizati
on Hypoxia, Hypotension anemia Ischemic hrt dis Electrolytes M.I. Myocarditis,
pericarditis CHF Stress, fatigue,
smoking, overeating, caffeine Hypoglycemia Sepsis Cyclic antidepressants Acidosis
Supraventricular Tachycardia
Not visible sudden start or stop.
AN ECTOPIC BEAT RHY ? Irregular R ? 60-100 P ? Upright PRI ? 0.12 ? 0.20 QRS? 0.04 ? 0.10
RHY ? Regular R ? 160 - 250 P ? Upright PRI ? 0.12 ? 0.20 QRS? 0.04 ? 0.10
SR, early beat has VENT beat (wide & bizarre)
Rate above 160 - 250
***Atrial Flutter RHY ? Regular or Regular or 2
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.
Heart Block Tricks from Terry
RHYTHM & ETIOLOGY Ischemic heart disease MI Dig toxicity Mitral, Tricuspid valve disease Stress PE Hyperthyroid Often temp
Atrial Fibrillation
Ischemic heart disease
Dig toxicity CHF MI Mitral or Tricuspid
valve disease
***PEA Pulseless Electrical Activity
CRITERIA OVERVIEW Irregular R? Atrial 250?400 Vent: 70 - 150 P ? none, F's PRI ? none QRS ? 0.04 ? 0.10
RHY ? Irregular R? atrial 350-600 Vent. ? below 100 controlled, above 100 uncontrolled. P ? None f's PRI ? none QRS ? 0.04? 0.10
UNIQUE CRITERIA Irregular, no P's (called F's) Saw tooth
Irregular, no P's (called f's)
SAMPLE STRIPS
Looks like any
rhythm that should
have a pulse but
does not
***2nd degree AV Block Type I ? Mobitz I, Wenckeback
RHY ? Irregular PRI ? vary QRS? 0.04 ? 0.10
Irregular EXTRA Ps PRI longer & longer, Dropped QRS
3
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.
Heart Block Tricks from Terry
RHYTHM &
ETIOLOGY
***2nd degree AV Block Type II or Mobitz II
CRITERIA OVERVIEW RHY ? Regular or Irregular PRI ? constant QRS ? normal or wide
UNIQUE CRITERIA Regular or Irregular EXTRA Ps
SAMPLE STRIPS
3rd degree AV Block, Complete
Heart Block
Same as 1st degree
RHY - Regular PRI ? vary QRS ? usually wide
Regular EXTRA Ps PRI varies greatly
***Ventricular Tachycardia monomorpic
All complexes are the same shape and look the same
Wide complex tachycardia
***Ventricular Fibrillation
Following V Tach Acute MI Electrolyte
Imbalance
RHY ? Regular R ? Above 100 P ? None PRI ?None QRS ? Wide, Bizarre
RHY ? Chaotic R ? None P ? None PRI ?None QRS ? none, fibrillatory line
R over 100 All Vent beats
Chaotic wavy line. No pulse.
4
Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria.
Heart Block Tricks from Terry
RHYTHM &
ETIOLOGY
Torasades de Pointes
Polymorphic ventricular tachycardia Best Treated with magnesium
CRITERIA OVERVIEW RHY ? Chaotic waves R ? None P ? None PRI ?None QRS ? points twist
UNIQUE CRITERIA Chaotic wavy line. No pulse.
Points twist
SAMPLE STRIPS
***Agonal
RHY ? Regular
Dying heart
R ? Slow
Drugs used in cardiac arrest provide some electrical waves.
***Asystole
P ? None PRI ? None QRS ? very very wide RHY ? None
Primary event in unless only Ps
cardiac arrest.
R ? No Vent rate
Untreated V-tach or P ? may be
V-fib
present
PRI ? None
QRS ? None
Slow wide bizarre stretched out waves. No Pulse
Straight line or only Ps No Pulse
Calculating Heart Rate - note strips on pretest are longer than 6 seconds.
Table for Small Box Method To calculate the heart rate, count the number of 0.04 squares (or small boxes) between two QRS complexes (1500 divided by X = HR)
Small Boxes from R to R
5 = 300 6 = 250 7 = 214 8 = 188
9 = 168
10 = 150 11 = 136 12 = 125 13 = 115
14 = 107
15 = 100 16 = 94 17 = 88 18 = 83
19 = 79
20 = 75 21= 72 22 = 68 23 = 65
24 = 63
25 = 60 26 =58 27 = 56 28 = 54
29 = 52
30 = 50 31 = 48 32 = 47 33 = 45
34 = 44
35 = 43 36 = 42 37 = 41 38 =40
39 = 38
40 = 37 41 = 37 42 = 36 43 = 35
44 = 34
45 = 33 46 = 33 47 = 32 48 = 31
5
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