1. Ventricular Rhythms
1.1. Ventricular Tachycardia with pulse
1.1.1. Photo
1.1.2. Assessment
1.1.2.1. Rate: 100-125 BPM
1.1.2.2. Rhythm: organized
1.1.2.3. P-wave: hidden in QRS complex
1.1.2.4. PR interval: absent
1.1.2.5. QRS complex: wide, greater that 0.12 and bizarre in appearance
1.1.3. Treatment
1.1.3.1. -CPR
1.1.3.2. -cardiovert 100j
1.1.3.3. Amiodarone 150mg
1.1.3.4. Epi 1/10,000 1mg
1.1.3.5. CPR
1.1.3.6. 100J
1.1.3.7. Amiodarone 150mg
1.2. Ventricular Tachycardia without a pulse
1.2.1. Photo
1.2.2. Assessment
1.2.2.1. Rate: 300-500 BPM
1.2.2.2. Rhythm: disorganized
1.2.2.3. P-wave: not discernible
1.2.2.4. PR interval and QRS complex: not discernible
1.2.3. Treatment
1.2.3.1. CPR
1.2.3.2. defibrillation 200J
1.2.3.3. Amiodarone 300mg
1.2.3.4. Epi 1/10,000 1mg
1.3. Ventricular Fibrillation
1.3.1. Photo
1.3.2. Assessment
1.3.2.1. Rate: 300-500 BPM
1.3.2.2. Rhythm: disorganized
1.3.2.3. P-Wave, PR interval, QRS complex: not discernible
1.3.3. Treatment
1.3.3.1. CPR
1.3.3.2. Defibrillation 200J
1.3.3.3. Amiodarone 300 mg
1.3.3.4. Epi 1/10,000 1mg
2. Asystole/PEA
2.1. Photo
2.2. Assessment
2.2.1. No pulse, it only thing you can see is a little p-wave,
2.3. Treatment
2.3.1. CPR, oxygen, get an airway, Epi every 3-5 minutes
3. Heart Blocks
3.1. 1st Degree
3.1.1. Photo
3.1.2. Assessment
3.1.2.1. Rate: 50-60 BPM
3.1.2.2. Rhythm: regular
3.1.2.3. p-wave: normal
3.1.2.4. PR interval: longer than 0.20
3.1.2.5. QRS: normal
3.1.3. Treatment
3.1.3.1. oxygen, maybe fluids, consider 0.5 of atropine
3.2. 2nd Degree Type 1
3.2.1. Photo
3.2.2. Assessment
3.2.2.1. Rate: 40-50 BPM
3.2.2.2. Rhythm: irregular
3.2.2.3. p-wave: normal but not always followed by QRS complex
3.2.2.4. PR interval: progressively longer in duration until a QRS complex is dropped, then cycle starts again
3.2.2.5. QRS complex: mostly normal, periodically absent
3.2.3. Treatment
3.2.3.1. 0.5mg of atropine, TCP, dopamine drip
3.3. 2nd Degree Type 2
3.3.1. Photo
3.3.2. Assessment
3.3.2.1. Rate: 40-50 BPM
3.3.2.2. Rhythm: regular or irregular
3.3.2.3. p-wave: normal but not always followed by a QRS complex
3.3.2.4. PR interval: are of constant duration for conducted beats
3.3.2.5. QRS: normal, periodically one is absent
3.3.3. Treatment
3.3.3.1. atropine 0.5mg, TCP, dopamine
3.4. Third Degree
3.4.1. Photo
3.4.2. Assessment
3.4.2.1. Rate: 20-30 BPM
3.4.2.2. Rhythm: atrial and ventricular rhythms are regular but not related to one another
3.4.2.3. p-wave: normal but not related to QRS at all
3.4.2.4. PR interval: not measurable
3.4.2.5. QRS: not related to p-wave at all
3.4.3. Treatment
3.4.3.1. consider atropine 0.5mg, TCP, dopamine drip
4. Sinus Rhythms
4.1. Normal Sinus
4.1.1. Photo
4.1.2. Assessments
4.1.2.1. Rate: 60-100 BPM
4.1.2.2. Rhythm: Regular
4.1.2.3. P-wave normal and upright
4.1.2.4. P-R interval is less than .20. Normal
4.1.2.5. QRS is less than 0.12. Normal
4.1.3. Treatment
4.1.3.1. If a patient is in normal sinus rhythm there is really nothing to treat. You can give them oxygen, check their sugar, make sure everything else is fine with the patient.
4.2. Sinus Tachycardia
4.2.1. Photo
4.2.2. Assessments
4.2.2.1. Rate: greater than 100 BPM
4.2.2.2. Rhythm: normal
4.2.2.3. P-wave is normal and upright
4.2.2.4. P-R interval is less than 0.20 normal
4.2.2.5. QRS complex is less than 0.12 normal
4.2.3. Treatment
4.2.3.1. Things that could cause this are pain, anxiety, dehydration, and toxins. You can give pain meds, anti-anxiety meds, fluids for dehydration, and the appropriate antidote for the toxin.
4.3. Sinus Bradycardia
4.3.1. Photo
4.3.2. Assessments
4.3.2.1. Rate: Less than 60 BPM
4.3.2.2. Rhythm: normal
4.3.2.3. P-wave normal and upright
4.3.2.4. P-R interval is less than 0.20. Normal.
4.3.2.5. QRS complex is less than 0.12. Normal.
4.3.3. Treatment
4.3.3.1. There could me multiple things causing this rhythm including; Toxins, organophosphate poisoning, and decompensated shock. If a toxin is the issue you should give an antidote, if organophosphate poisoning you should give atropine, there is nothing you can do for decompenstaed shock.
5. Atrial Rhythms
5.1. Atrial Fibrillation
5.1.1. Photo
5.1.2. Assessments
5.1.2.1. Rate: ventricular rate may be slow, normal or fast: atrial rate is greater than 350 BPM
5.1.2.2. Rhythm: irregularly irregular
5.1.2.3. P-wave: absent, instead there is a chaotic-looking baseline
5.1.2.4. PR interval: not measurable
5.1.2.5. QRS complex: normal
5.1.3. Treatment
5.1.3.1. Oxygen, 20-40 mg of Cardizem, cardiovert at 50J
5.2. Atrial Flutter
5.2.1. Photo
5.2.2. Assessments
5.2.2.1. Rate: Ventricular rate may be slow, normal, or fast: atrial rate is between 250 and 350 BPM
5.2.2.2. Rhythm: Irregularly Regular
5.2.2.3. P-wave: absent, instead there are saw-tooth flutter waves
5.2.2.4. P-R interval: not measurable
5.2.2.5. QRS complex: less than 0.12. normal
5.2.3. Treatment
5.2.3.1. Oxygen, 20-40 mg of Cardizem, cardiovert at 50J
6. Super Ventricular Tachycardia
6.1. Photo
6.2. Assessment
6.2.1. Rate: 150-180 BPM
6.2.2. Rhythm: regular
6.2.3. P-wave: cannot be identified
6.2.4. PR interval: absent
6.2.5. QRS complex: narrower than normal
6.3. Treatment
6.3.1. oxygen, vagal maneuvers, adenosine 6mg, 12mg, 12mg, cardiovert at 50J