ECG Atrial/Ventricular Rhythms

Question 1

Management of bradycardia

Answer 1

Atropine, dopamine, Epi, transcutaneous pacemaker (TCP)

Question 2

Atropine cardiac indication, dose

Answer 2

Bradycardia
0.5 mg bolus, repeat 3-5 min, max 3 mg

Question 3

Dopamine for bradycardia cardiac indication, dose

Answer 3

Bradycardia
2-20 mcg/kg/min infusion, titrate slowly to pt response

Question 4

Epi for bradycardia cardiac indication, dose

Answer 4

2-10 mcg over 1 minute
Titrate to pt response

Question 5

Transcutaneous Pacemaker (TCP)

Answer 5

Bradycardia after atropine
Widespread QRS complex

Question 6

Sinus dysthymia

Answer 6

Slight variation of a sinus rhythm

Question 7

Sinus arrest

Answer 7

SA node fails to initiate impulse for 1 cardiac cycle (missing complex)

Question 8

Premature atrial complex (PAC) traits, ECG traits

Answer 8

SA node fires prematurely, short RR interval
Odd P shape

Question 9

Nonconducted PAC

Answer 9

Early P wave w/o QRS complex
Infrequent, no pattern

Question 10

Supraventricular Tachycardia (SVT) traits

Answer 10

Impulse originates above ventricles
>150 bpm, sometimes missing P waves

Question 11

Difference between SVT and VT

Answer 11

Wide QRS - ventricular origin
Narrow QRS - supraventricular origin (more like normal)

Question 12

Synchronized cardioversion indications

Answer 12

Unstable patient w tachydysrhythmia
Must be sedated

Question 13

Stable pt w/ >150 bpm & narrow QRS complex, drug

Answer 13

Adenosine

Question 14

Adenosine action, dose

Answer 14

Slows conduction through AV node
6 mg + flush, second dose 12 mg

Question 15

Antiarhythmic infusions for stable wide QRS complex tachycardia

Answer 15

Amiodarone, Sotalol, Procainamide

Question 16

Amiodarone dose for tachycardia

Answer 16

150 mg over 10 minutes
Maintenance infusion of 1mg/min

Question 17

Sotalol dose for tachycardia, contraindication

Answer 17

100 mg (1.5 mcg/kg) over 5 min
Contraindication: COPD/asthma

Question 18

Atrial Fibrillation

Answer 18

Many myocardial cells in atrium depolarize independently
No P wave, irregularly irregular
Unstable pt: synchronized cardioversion

Question 19

Atrial flutter

Answer 19

Atrial impulse fires too rapidly for ventricles to keep up
Shows F waves (sawtooth shape) instead of P waves (2:1 conduction)
Unstable pt: synchronized cardioversion

Question 20

Wandering atrial pacemaker

Answer 20

Impulse comes from random atrial cells
60-100 bpm, slightly irregular
Upright P waves with varying shape
Only treatment if bradycardic,

Question 21

Multifocal Atrial Tachycardia

Answer 21

> 100 bpm, tachycardic wandering pacemaker

Question 22

Difference between multifocal atrial tachycardia & SVT

Answer 22

SVT is a regular rhythm
MAT is a irregular rhythm
SVT meds do not work on MAT

Question 23

Rhythms originating from AV junction

Answer 23

40-60 bpm
Inverted P wave before or after QRS, could be nonexistent

Question 24

Premature Junctional Complex (PJC)

Answer 24

An early beat, irregular
P wave (if present) inverted before or after QRS
No prehospital treatment

Question 25

Accelerated Junctional Rhythm

Answer 25

An early beat, irregular, 60 < bpm < 100
P wave (if present) inverted before or after QRS
No prehospital treatment

Question 26

Junctional Tachycardia

Answer 26

Bpm > 100
If >150 bpm and symptomatic, then treat as tachycardia or SVT

Question 27

Rhythms originating from ventricles

Answer 27

No P wave, wide QRS complex

Question 28

Premature Ventricular Complex (PVC)

Answer 28

No P wave, QRS > 0.12 sec
Full pause after PVC
Mostly from ischemia in ventricles

Question 29

Unifocal PVC vs Mulifocal PVC

Answer 29

Unifocal: PVC originates from same area, start of QRS complex look alike
Multifocal: PVC originates from different parts of the ventricle, different QRS complex shapes