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EKGs
A nursing student’s guide
Agenda
1
• The Pointy Things
2
• All These Wires
3
• Making sense of the strip
4
• Normal Rhythms
5
• DRT Rhythms
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2
Normal Sinus Rhythm
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3
NSR
Originates from SA node
NSR
Rate
Atrial and
Ventricular equal
60-100 BPM
Rhythm
P Wave
Atrial and
Ventricular
Present
Regular
Consistent
PR interval
0.12 to 0.20
seconds
Constant
QRS duration
0.4 to 0.10
seconds
Constant
One ‘P’ before
every QRS
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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
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Tachydysrhythmias
• Sinus Tachycardia
– 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
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SVT
• Supraventricular Tachycardia
– 100-280 bpm in adults
– No “P” wave
– May occur in healthy young people
• especially women
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SVT
• Symptoms--dependent on duration
and rate of the ventricular response
– Palpitations
– Chest pain
– Weakness
– Fatigue
– SOB
– Hypotension
– Syncope
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SVT
• Treatments
– Valsalva Maneuver
– Carotid Massage
– Adenosine—6-12-12
– Electrocardioversion
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A-fib
• Atrial fibrillation
– Most common dysrhythmia
– Atria 250-600 bpm
– Ventricle 120-200 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
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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”
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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
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Bradydysrhythmias
• Sinus Bradycardia
• <60 bpm
• Can be normal for some patients
• Excessive vagal stimulation
• Carotid sinus massage
• Vomiting
• Suctioning
• Valsalva maneuver
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DRT Rhythms
V-Fib
V-Tach
Asystole
PEA
Dead Right There
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V-fib
• Ventricular Fibrillation
– Electrical chaos
– Pulseless
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V-Tach
• Ventricular Tachycardia
• 140-180 bpm
– May/May not have pulse
– Typically 1st rhythm in cardiac arrest
– Sustained (15-30 seconds) or Nonsustained
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Asystole
If you shock a flat line, I swear I will come to your home and beat you with a wet
chicken!
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PEA
• Pulseless Electrical Activity
– NSR on monitor without pulse
– Continue ACLS
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Putting it Together
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Paced Rhythms
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Sample slide – Questions and
answers
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