Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm...
Transcript of Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm...
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Lake EMS Basic EKG Review:Ventricular Rhythms
The Lake EMSQuality Development Team
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This program is the Intellectual Property ofLake Emergency Medical ServicesUse of this program is limited to training and Quality Education only
Captain Mike Hilliard, Lake EMS Training Officer2761 West Old Highway 441, Mount Dora, FL 32757-3500
352/383-4554 (w); 352/735-4475 (f); [email protected]
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The challenge With respect to the many revered instructors and
authors who teach electrocardiology rhythm assessment, there are many differences in opinion regarding things such as heart rates for rhythms So we defined our own parameters with the blessings of the
Lake County Medical Director, Pushpal R. Banerjee, D.O.
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Our solution Consequently, our Basic EKG Online review meets the
criteria as set forth by our Quality Development Department: John Simpson, Chief Operations Officer Michael R. (Mike) Hilliard, Training Officer Jamie A. Lowery, District Chief, Field Training Coordinator Scott Temple, Clinical Training Officer Julie Treadwell, Clinical Quality Officer
And our Medical Director: Pushpal R. (Paul) Banerjee, D.O.
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Basic stuff When electricity stimulates muscle we witness
depolarization This is an electrical phenomenon We hope mechanically that the muscle contracts
When a muscle relaxes we see repolarization on the monitor If the muscle mass is large enough
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“Hey, that looks like…” Many of us were taught
how to visually recognize EKGs
We were taught a simple process of 5-steps that help define the rhythm characteristics; however, over time we returned to the visual recognition
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Basic wave breakdown Please understand this is an interpretation
review, not a diagnostic patient assessment Always treat the patient and not the monitor
P-wave: Atrial depolarization QRS-complex: Ventricular depolarization T-wave: Ventricular repolarization
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1st Axiom of EMS And if you forget to treat the patient and are
considering treating the monitor, remember the first axiom of EMS:
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1st Axiom of EMS And if you forget to treat the patient and are
considering treating the monitor, remember the first axiom of EMS: If you’re not sure what to do,
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1st Axiom of EMS And if you forget to treat the patient and are
considering treating the monitor, remember the first axiom of EMS: If you’re not sure what to do, ask your EMT what the
other paramedics would do in a similar situation.
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5-Part EKG AssessmentYour key to success
1. Rate: QRS in 6-second strip, multiply x 10
2. Rhythm: QRS distances consistent throughout strip
3. P-waves (in the entire strip being assessed): Are P-waves present? Do they look like a small rounded hill? Is there a P for every QRS? Is there a QRS for every P? Does each P looks like all the others? Is each P the same distance from the QRS?
4. P to R Interval (PRI): 0.12 to 0.20 seconds
5. QRS-Complexes: Narrow: <0.12-seconds (3 small boxes) Wide: >0.12-seconds
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12
Ventricular Rhythms
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Idioventricular A slow rhythm that originates in the ventricles Idioventricular is slow and wide!
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Automaticity and Inherent Myocardial Cell Firings Remember the initiated heart rate from the
Ventricles is a back-up system; it is here to keep us alive: SA Node: 60-150 bpm (beats-per-minute) AV Junction: 40-60 bpm Ventricles: 30-40 bpm
These are normal values, other rates can and do occur at times
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Idioventricular1. Rate:2. Rhythm:
3. P-waves:4. PRI:5. QRS:
< 60 bpm Usually regular, but can be
irregular None None Wide
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Idioventricular
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5-Part EKG Assessment1. Rate:
What is the rate?
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5-Part EKG Assessment1. Rate:
30-bpm
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5-Part EKG Assessment2. Rhythm:
Is the rhythm regular or irregular?
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5-Part EKG Assessment2. Rhythm:
Regular
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5-Part EKG Assessment3. P-waves:
Are P-waves present? Do they look like a small
rounded hill? Is there a P for every
QRS?
Is there a QRS for every P? Does each P looks like all the
others? Is each P the same distance
from the QRS?
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5-Part EKG Assessment3. P-waves:
P-waves? No
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5-Part EKG Assessment4. P to R Interval (PRI):
Is the PRI between 3-5 small boxes?
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5-Part EKG Assessment4. P to R Interval (PRI):
No P-wave; no PRI
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5-Part EKG Assessment5. QRS-Complexes:
Is QRS narrow or wide?
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5-Part EKG Assessment5. QRS-Complexes:
Wide, 0.16-seconds
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This is Idioventricular 1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
30 Regular None None Wide
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Ventricular Tachycardia Ventricular Tachycardia (VT) is defined as three
or more beats of ventricular origin in succession at a rate greater than 150 beats per minute
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Morphology QRS complexes are wide The T-wave is commonly in the opposite
direction as the QRS
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Morphology QRS complexes are wide The T-wave is commonly in the opposite
direction as the QRS Termed contralateral
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Ventricular Tachycardia Ventricular tachycardia may be either:
Monomorphic (all QRS-complexes with the same shape), or
Polymorphic (varying QRS shapes) Regardless: VT is fast and wide!
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Ventricular Tachycardia1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
> 150 bpm Usually regular None None Wide
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Ventricular Tachycardia
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5-Part EKG Assessment1. Rate:
What is the rate?
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5-Part EKG Assessment1. Rate:
210-bpm
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5-Part EKG Assessment2. Rhythm:
Is the rhythm regular or irregular?
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5-Part EKG Assessment2. Rhythm:
Regular
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5-Part EKG Assessment3. P-waves:
Are P-waves present? Do they look like a small
rounded hill? Is there a P for every
QRS?
Is there a QRS for every P? Does each P looks like all the
others? Is each P the same distance
from the QRS?
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5-Part EKG Assessment3. P-waves:
P-waves? No
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5-Part EKG Assessment4. P to R Interval (PRI):
Is the PRI between 3-5 small boxes?
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5-Part EKG Assessment4. P to R Interval (PRI):
No P-wave; no PRI
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5-Part EKG Assessment5. QRS-Complexes:
Is QRS narrow or wide?
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5-Part EKG Assessment5. QRS-Complexes:
Wide, 0.16-seconds
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This is Ventricular Tachycardia1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
210 Regular None None Wide
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Ventricular Tachycardia And what should you immediately do after
seeing VT?
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Ventricular Tachycardia 12-Lead?
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Ventricular Tachycardia 12-Lead? No
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Assess patient If stable, consider medication as per Practice
Parameters
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Assess patient If stable, consider medication as per Practice
Parameters If unstable
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Tincture of Florida Power
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Torsades de Pointes Torsades de Pointes is a form of polymorphic VT
(varying QRS shapes) in which the QRS appears to be constantly changing
VT is fast and wide!
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Torsades de Pointes1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
> 150 bpm Usually regular None None Wide and varying QRS shapes
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Torsades de Pointes
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5-Part EKG Assessment1. Rate:
What is the rate?
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5-Part EKG Assessment1. Rate:
200-bpm
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5-Part EKG Assessment2. Rhythm:
Is the rhythm regular or irregular?
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5-Part EKG Assessment2. Rhythm:
Regular; no matter how you look at it
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5-Part EKG Assessment3. P-waves:
Are P-waves present? Do they look like a small
rounded hill? Is there a P for every
QRS?
Is there a QRS for every P? Does each P looks like all the
others? Is each P the same distance
from the QRS?
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5-Part EKG Assessment3. P-waves:
P-waves? No
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5-Part EKG Assessment4. P to R Interval (PRI):
Is the PRI between 3-5 small boxes?
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5-Part EKG Assessment4. P to R Interval (PRI):
No P-wave; no PRI
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5-Part EKG Assessment5. QRS-Complexes:
Is QRS narrow or wide?
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5-Part EKG Assessment5. QRS-Complexes:
Wide, 0.20-seconds
![Page 64: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/64.jpg)
5-Part EKG Assessment5. QRS-Complexes:
Wide, 0.20-seconds And varying shapes
![Page 65: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/65.jpg)
This is Torsades de Pointes1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
200 Regular None None Wide and varying shapes
![Page 66: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/66.jpg)
Cardiac Arrest Patients in cardiac arrest are classified as
being in 3-categories:1. Ventricular fibrillation2. Pulseless Electrical Activity3. Asystole
![Page 67: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/67.jpg)
Ventricular Fibrillation It is a rhythm in which multiple areas within the
ventricles vary in depolarization and repolarization
There is no cardiac output This is the most common initial rhythm in cardiac
arrest
![Page 68: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/68.jpg)
Ventricular Fibrillation The terms coarse and fine have been used to
describe the amplitude of the waveforms in VF Coarse VF usually indicates the recent onset of
VF, which can be readily corrected by prompt defibrillation
![Page 69: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/69.jpg)
Ventricular Fibrillation1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
None None None None None
![Page 70: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/70.jpg)
Ventricular Fibrillation
![Page 71: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/71.jpg)
Ventricular Fibrillation And what should you immediately do after
seeing VF?
![Page 72: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/72.jpg)
Shock it until you recognize it!
Crew accidently found patient in rhythm and brought them back after a few shocks and subsequent treatments
Great Job!
![Page 73: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/73.jpg)
5-Part EKG Assessment1. Rate:
What is the rate?
![Page 74: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/74.jpg)
5-Part EKG Assessment1. Rate:
None
![Page 75: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/75.jpg)
5-Part EKG Assessment2. Rhythm:
Is the rhythm regular or irregular?
![Page 76: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/76.jpg)
5-Part EKG Assessment2. Rhythm:
None
![Page 77: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/77.jpg)
5-Part EKG Assessment3. P-waves:
![Page 78: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/78.jpg)
5-Part EKG Assessment3. P-waves:
P-waves? None
![Page 79: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/79.jpg)
5-Part EKG Assessment4. P to R Interval (PRI):
Is the PRI between 3-5 small boxes?
![Page 80: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/80.jpg)
5-Part EKG Assessment4. P to R Interval (PRI):
None
![Page 81: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/81.jpg)
5-Part EKG Assessment5. QRS-Complexes:
Is QRS narrow or wide?
![Page 82: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/82.jpg)
5-Part EKG Assessment5. QRS-Complexes:
None
![Page 83: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/83.jpg)
This is Ventricular Fibrillation1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
None, wavy line None None None None
![Page 84: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/84.jpg)
Pulseless Electrical Activity PEA is any rhythm (with a QRS) without a pulse Any rhythm can be categorized as PEA
However, if pulseless VT, treat as VF There is no pulse in PEA!
![Page 85: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/85.jpg)
Pulseless Electrical Activity
![Page 86: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/86.jpg)
PEA usually looks like this
![Page 87: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/87.jpg)
Asystole (Cardiac Standstill) Asystole represents the total absence of
electrical activity Since depolarization does not occur, there is no
ventricular contraction
![Page 88: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/88.jpg)
Asystole (Cardiac Standstill) 1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
None None None None None
![Page 89: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/89.jpg)
Asystole
![Page 90: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/90.jpg)
5-Part EKG Assessment1. Rate:
What is the rate?
![Page 91: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/91.jpg)
5-Part EKG Assessment1. Rate:
None
![Page 92: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/92.jpg)
5-Part EKG Assessment2. Rhythm:
Is the rhythm regular or irregular?
![Page 93: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/93.jpg)
5-Part EKG Assessment2. Rhythm:
None
![Page 94: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/94.jpg)
5-Part EKG Assessment3. P-waves:
![Page 95: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/95.jpg)
5-Part EKG Assessment3. P-waves:
P-waves? None
![Page 96: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/96.jpg)
5-Part EKG Assessment4. P to R Interval (PRI):
Is the PRI between 3-5 small boxes?
![Page 97: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/97.jpg)
5-Part EKG Assessment4. P to R Interval (PRI):
None
![Page 98: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/98.jpg)
5-Part EKG Assessment5. QRS-Complexes:
Is QRS narrow or wide?
![Page 99: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/99.jpg)
5-Part EKG Assessment5. QRS-Complexes:
None
![Page 100: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/100.jpg)
This is Asystole 1. Rate:2. Rhythm:3. P-waves:4. PRI:5. QRS:
None None None None None
![Page 101: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/101.jpg)
Pacer Rhythms Pacers provide a low energy burst of electricity
that can be identified on the EKG by a pacer spike
![Page 102: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/102.jpg)
Pacer Rhythms
![Page 103: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/103.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 104: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/104.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 105: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/105.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 106: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/106.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 107: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/107.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 108: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/108.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 109: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/109.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 110: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/110.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 111: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/111.jpg)
Pacer Rhythms Look for the pacer spikes
![Page 112: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/112.jpg)
Pacer Rhythms Or the friendly reminders to look for pacer
spikes
![Page 113: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/113.jpg)
Ectopi A beat originating from a source of cardiac
stimulus other than the SA node
![Page 114: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/114.jpg)
Ectopi A beat originating from a source of cardiac
stimulus other than the SA node, usually caused by some irritation of the myocardium
![Page 115: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/115.jpg)
Premature VentricularContraction (PVC) A PVC is a depolarization that arises in either
ventricle before the next expected beat This results in a bizarre-appearing QRS
The sequence of repolarization is also altered, usually resulting in a ST segment and T wave in a direction opposite to the QRS complex
![Page 116: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/116.jpg)
PVCs PVCs have 3 primary hallmarks:
![Page 117: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/117.jpg)
PVCs PVCs have 3 primary hallmarks:
1. Regularity: Irregular
![Page 118: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/118.jpg)
PVCs PVCs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
![Page 119: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/119.jpg)
PVCs PVCs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Wide
![Page 120: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/120.jpg)
PVCs PVCs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Wide Because the beat is generated in the ventricles, it is wide
![Page 121: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/121.jpg)
PVCs PVCs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Wide Because the beat is generated in the ventricles, it is wide
3. Compensatory Pause: Yes
![Page 122: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/122.jpg)
PVCs PVCs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Wide Because the beat is generated in the ventricles, it is wide
3. Compensatory Pause: Yes Let me explain
![Page 123: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/123.jpg)
PVCs Regularity:
![Page 124: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/124.jpg)
PVCs Regularity: Irregular
≠
![Page 125: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/125.jpg)
PVCs Regularity: Irregular QRS Complex:
![Page 126: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/126.jpg)
PVCs Regularity: Irregular QRS Complex: Wide
![Page 127: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/127.jpg)
PVCs Regularity: Irregular QRS Complex: Wide Compensatory Pause:
![Page 128: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/128.jpg)
PVCs Regularity: Irregular QRS Complex: Wide Compensatory Pause: Yes
![Page 129: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/129.jpg)
Compensatory/Non-Compensatory Pause Measure the distance between 3 normal/regular
QRSs Compare the distance between the normal QRS
before and after the beat in question If the distance is the same there is a compensatory
pause If the distance is not the same, there is no
compensatory pause
![Page 130: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/130.jpg)
PVCs Measure distance between 3 normal QRS-
waves
![Page 131: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/131.jpg)
PVCs Measure distance between 3 normal QRS-
waves
![Page 132: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/132.jpg)
PVCs This distance is our standard measurement
![Page 133: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/133.jpg)
PVCs This distance is our standard measurement It can only be measured with regular complexes
![Page 134: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/134.jpg)
PVCs This distance is our standard
If a funny looking beat does not disturb this rhythm tempo then it is said to have a compensatory pause
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PVCs Good, now identify the normal QRS-waves
before and after the funny looking beat
![Page 136: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/136.jpg)
PVCs Now measure the distance and compare to the
original measurement
![Page 137: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/137.jpg)
PVCs The distance is the same
![Page 138: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/138.jpg)
PVCs So we have a compensatory pause
Compensatory pause
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PVCs So we have a compensatory pause So this is a PVC because it is wide and has the
compensatory pause
Compensatory pause
![Page 140: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/140.jpg)
Significance of compensatory pause When an electrical discharge occurs within the
ventricles, it depolarizes all of the other cells in both ventricles
![Page 141: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/141.jpg)
Significance of compensatory pause When an electrical discharge occurs within the
ventricles, it depolarizes all of the other cells in both ventricles Basically it reboots their systems
![Page 142: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/142.jpg)
Significance of compensatory pause When an electrical discharge occurs within the
ventricles, it depolarizes all of the other cells in both ventricles Basically it reboots their systems It cannot travel into the atriums to reset them
![Page 143: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/143.jpg)
Significance of compensatory pause When an electrical discharge occurs within the
ventricles, it depolarizes all of the other cells in both ventricles Basically it reboots their systems It cannot travel into the atriums to reset them So the timing is unchanged
![Page 144: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/144.jpg)
Significance of compensatory pause When an electrical discharge occurs within the
ventricles, it depolarizes all of the other cells in both ventricles Basically it reboots their systems It cannot travel into the atriums to reset them So the timing is unchanged And that is why we have a compensatory pause as
the timing is undisturbed
![Page 145: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/145.jpg)
PVCs How about if there are different shaped ectopic
beats?
![Page 146: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/146.jpg)
PVCs Measure distance between 3 normal QRS-
waves Just like before as the process is still the same
![Page 147: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/147.jpg)
PVCs Now measure the distance and compare to the
original measurement
![Page 148: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/148.jpg)
PVCs First funny looking beat is the same distance
Compensatory pause
![Page 149: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/149.jpg)
PVCs They are the same
Compensatory pause
![Page 150: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/150.jpg)
PVCs Even for different looking PVCs
Compensatory pause
![Page 151: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/151.jpg)
PVCs Even for different looking PVCs
Also known as multifocal
Compensatory pause Compensatory pause
![Page 152: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/152.jpg)
PVCs What about back-to-back PVCs?
![Page 153: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/153.jpg)
PVCs Also known as Salvos
![Page 154: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/154.jpg)
PVCs Salvo PVCs
Compensatory pause
![Page 155: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/155.jpg)
Compensatory pause Indicates that the ectopic beat did not interrupt
the atrial firing Subsequently, it occurred south of the AV Node
![Page 156: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/156.jpg)
Premature AtrialContraction (PAC) A beat originating from a source of cardiac
stimulus within the atrium, other than the SA node, usually caused by some irritation of the myocardium Can easily be confused with Sinus Arrhythmia
![Page 157: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/157.jpg)
PACs PACs have 3 primary hallmarks:
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PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular
![Page 159: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/159.jpg)
PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
![Page 160: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/160.jpg)
PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Narrow
![Page 161: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/161.jpg)
PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Narrow Because the beat is generated in the atrium, it follows the
normal pathways to enter the ventricles
![Page 162: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/162.jpg)
PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Narrow Because the beat is generated in the atrium, it follows the
normal pathways to enter the ventricles So it doesn’t disturb the ventricle's response
![Page 163: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/163.jpg)
PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Narrow Because the beat is generated in the atrium, it follows the
normal pathways to enter the ventricles So it doesn’t disturb the ventricle's response
3. Compensatory Pause: No
![Page 164: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/164.jpg)
PACs PACs have 3 primary hallmarks:
1. Regularity: Irregular All ectopic beats cause the underlying rhythm to become
irregular
2. QRS Complex: Narrow Because the beat is generated in the atrium, it follows the
normal pathways to enter the ventricles So it doesn’t disturb the ventricle's response
3. Compensatory Pause: No Termed non-compensatory pause
![Page 165: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/165.jpg)
PACs Hint Easy way to identify if PAC is hidden:
The P-wave does not look like normal P-waves in this complex
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PACs Regularity:
![Page 167: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/167.jpg)
PACs Regularity:
![Page 168: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/168.jpg)
PACs Regularity:
≠
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PACs Regularity: Irregular
≠
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PACs Regularity: Irregular QRS Complex:
![Page 171: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/171.jpg)
PACs Regularity: Irregular QRS Complex: Narrow
![Page 172: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/172.jpg)
PACs Regularity: Irregular QRS Complex: Narrow Compensatory Pause:
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PACs Regularity: Irregular QRS Complex: Narrow Compensatory Pause: No
![Page 174: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/174.jpg)
PACs P-wave does not look like normal P-waves in
either complexes
![Page 175: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/175.jpg)
PACs Measure the distance between 3 normal QRS-
waves Assessment process does not change
![Page 176: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/176.jpg)
PACs Now measure the distance from the normal beat
before and after the questionable beat
![Page 177: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/177.jpg)
PACs They are not the same
NO compensatory pause
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Non-compensatory pause Indicates that the ectopic beat did interrupt the
normal SA Node firing
![Page 179: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/179.jpg)
Non-compensatory pause Indicates that the ectopic beat did interrupt the
normal SA Node firing Subsequently, it occurred inside the atria
![Page 180: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/180.jpg)
Non-compensatory pause Indicates that the ectopic beat did interrupt the
normal SA Node firing Subsequently, it occurred inside the atria
Hence, it “reset or rebooted” the atrium and SA Node
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Non-compensatory pause Indicates that the ectopic beat did interrupt the
normal SA Node firing Subsequently, it occurred inside the atria
Hence, it “reset or rebooted” the atrium and SA Node And thereby changed the timing
![Page 182: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/182.jpg)
Sinus arrhythmia The difference between a rhythm with a PAC
and Sinus Arrhythmia is in Sinus Arrhythmia:
![Page 183: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/183.jpg)
Sinus arrhythmia The difference between a rhythm with a PAC
and Sinus Arrhythmia is in Sinus Arrhythmia: All P-waves look the same to each other
![Page 184: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/184.jpg)
Premature JunctionalContraction (PJC) A premature junctional complex is an electrical
impulse that originates in the AV junction and occurs before the next expected sinus impulse
A retrograde P wave may precede, coincide with, or follow the QRS
![Page 185: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/185.jpg)
PJCs Conduction from the junction to the ventricles
usually occurs along normal pathways Thus the QRS complex is usually narrow The pause following a PJC may be
compensatory or non-compensatory
![Page 186: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/186.jpg)
PJCs Regularity: Irregular QRS Complex: Narrow Compensatory Pause: Can have either
![Page 187: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/187.jpg)
What? Can have either a compensatory or non-
compensatory pause; however…
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PJC Hint No visible P-wave
![Page 189: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/189.jpg)
Special Notes on Ectopi Unifocal
Multifocal
All PVCs have same morphology (shape)
When the QRS morphologies (shape) vary, the PVCs may be arising from different areas within the ventricles
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Special Notes on Ectopi Quadrigeminy
Trigeminy
Bigeminy
Every fourth beat is a PVC (3 normal beats, 1 PVC)
Every third beat is a PVC (2 normal beats, 1 PVC)
Every other beat is a PVC (1 normal beat, 1 PVC)
![Page 191: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/191.jpg)
Special Notes on Ectopi Salvos PVCs that occur
repetitively in pairs, also called coupling. Even though they are paired, they still retain the expected full compensatory pause seen from ectopi starting from the ventricles
![Page 192: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/192.jpg)
Special Notes on Ectopi VT
R on T phenomenon
When three or more PVCs occur in a row, VT is present
PVCs that fall on the T wave (during the so-called vulnerable period of ventricular repolarization) may precipitate VT or VF
![Page 193: Lake EMS Basic EKG Review: Ventricular Rhythms · process of 5-steps that help define the rhythm characteristics; ... Please understand this is an interpretation review, ... Lake](https://reader031.fdocuments.us/reader031/viewer/2022022010/5afc25907f8b9a814d8bb8ce/html5/thumbnails/193.jpg)
When three or more PVCsoccur in a row, VT is present
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R on T phenomenon A PVC can land in the early relative refractory
period of a T-wave and immediately set VT into motion
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R on T phenomenon This would be bad
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R on T phenomenon
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EKG Training
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EKG Training So easy,
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EKG Training So easy, Well, you get
the picture
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As a Department, the Lake EMS Quality Development Team is here to serve youin your educational needs
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This program is the Intellectual Property ofLake Emergency Medical ServicesUse of this program is limited to training and Quality Education only
Captain Mike Hilliard, Lake EMS Training Officer2761 West Old Highway 441, Mount Dora, FL 32757-3500
352/383-4554 (w); 352/735-4475 (f); [email protected]
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Lake EMS Basic EKG Review:Ventricular Rhythms
The Lake EMSQuality Development Team