1. A nursing student’s guide
EKGs
A nursing student’s guide

2. 1 2 3 4 5 Agenda The Pointy Things All These Wires
Making sense of the strip 3
Normal Rhythms 4
DRT Rhythms 5

3. Normal Sinus Rhythm

4. NSR Originates from SA node NSR Rate Atrial and Ventricular equal
BPM
Rhythm
Atrial and Ventricular
Regular
P Wave
Present
Consistent
One ‘P’ before every QRS
PR interval
0.12 to 0.20 seconds
Constant
QRS duration
0.4 to 0.10 seconds

5. Dysrhythmias
A disturbance between electrical conductivity and the mechanical response of the muscle
A disturbance in impulse formation (either from an abnormal rate or from an ectopic focus)
A disturbance in impulse conduction
Combination of several mechanisms

6. Tachydysrhythmias Sinus Tachycardia Compensatory response
Rate: >115 bpm
PR interval: 0.12 seconds
QRS complex 0.08 seconds
Compensatory response
Decreased Cardiac Output or BP
Hypovolemic shock MI
Infection HF

7. SVT Supraventricular Tachycardia 100-280 bpm in adults No “P” wave
May occur in healthy young people
especially women

8. SVT
Symptoms--dependent on duration and rate of the ventricular response
Palpitations
Chest pain
Weakness
Fatigue
SOB
Hypotension
Syncope

9. SVT Treatments Valsalva Maneuver Carotid Massage Adenosine—6-12-12
Electrocardioversion

10. A-fib Atrial fibrillation Most common dysrhythmia Atria 250-600 bpm
Ventricle bpm
No clear P waves
Loss of atrial kick
Increased risk of inadequate CO
Thrombus formation, PE
Treatment
CCB, B-blockers, Anticoagulants
Cardioversion
Ablation
Bi-Atrial or Bi-Ventricular Pacing

11. PVCs Premature Ventricular Contractions Multifocal/Unifocal
Repetitive rhythms
Bigeminy
Trigeminy
Quadrigeminy
Couplet (two sequential PVCs)
3 or more PVCs=Nonsustained V-Tach
Common and increase with age
“flutter in the chest”

12. PVCs
Causes
Can be insignificant or may occur secondary to MI, Chronic HF, COPD, and anemia
Hypokalemia, Hypomagnesaemia
Sympathomimetic agents, anesthesia drugs, nicotine, stress, caffeine, alcohol, and surgery can also cause PVCs

13. Bradydysrhythmias Sinus Bradycardia <60 bpm
Can be normal for some patients
Excessive vagal stimulation
Carotid sinus massage
Vomiting
Suctioning
Valsalva maneuver

14. V-Fib V-Tach Asystole PEA
DRT Rhythms
V-Fib V-Tach Asystole PEA
Dead Right There

15. V-fib
Ventricular Fibrillation
Electrical chaos
Pulseless

16. V-Tach Ventricular Tachycardia 140-180 bpm May/May not have pulse
Typically 1st rhythm in cardiac arrest
Sustained (15-30 seconds) or Nonsustained

17. Asystole
If you shock a flat line, I swear I will come to your home and beat you with a wet chicken!

18. PEA Pulseless Electrical Activity NSR on monitor without pulse
Continue ACLS

20. Putting it Together

22. Paced Rhythms

23. Sample slide – Questions and answers
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