Relias Dysrhythmia Basics

Relias Dysrhythmia Basic A Regular Rate: 60-100 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Normal sinus rhythm Sinus Bradycardia Regular Rate: <60 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Sinus Tachycardia Regular Rate: 100-150 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec IRREGULAR Rate: depends on underlying rhythm P wave: Present or hidden in T wave PR Interval: 0.12-0.20 sec QRS: <0.12 sec Premature Atrial Contraction IRREGULAR Atrial rate: UNMEASURABLE Ventricular rate: variable P wave: unable to see PR Interval: N/A QRS: <0.12 sec Atrial Fibrillation IRREGULAR Ventricular rate: 100-175 P wave: unable to see PR Interval: N/A QRS <0.12 sec A fib RVR 1/6 Usually REGULAR can be irregular Atrial rate: 250-350 Ventricular rate: variable BUT < atrial rate P Wave: Flutter PR Interval: N/A QRS: <0.12 sec Atrial Flutter Regular Rate: 150-350 P wave: Hidden in QRS or T wave PR: unable to determine QRS: <0.12 sec Supraventricular Tachycardia Regular Rate: 40-60 P Wave: ABSENT or INVERTED PR Interval: None or <0.12 QRS: <0.12 sec Junctional Rhythm Regular Rate: 60-100 P Wave: NONE or INVERTED PR Interval: None or <0.12 QRS: <0.12 sec Accelerated Junctional Rhythm Regular Rate: >100 P Wave: NONE or INVERTED PR Interval: None or <0.12 QRS: <0.12 sec Junctional Tachycardia IRREGULAR Rate: refer to underlying rhythm P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE , >0.12 sec Premature Ventricular Contraction Regular Rate: >100 P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE, >0.12 sec Ventricular Tachycardia 2/6 Chaotic Coarse: big waves Fine: small waves Rate: unmeasurable P Wave: NONE PR Interval: N/A QRS: N/A Ventricular Fibrillation Regular Rate: 20-50 P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec Idioventricular Regular Rate: 50-100 P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec Accelerated Idoventricular Rhythm Regular Rate: 60-100 P Wave: Present, upright PR interval: >0.20 sec CONSISTENTLY LONG QRS: <0.12 sec Husband stays late till 9 consistently 1st Degree AV Block 2nd Degree AV Block Type I Mobitz, Wenckebach IRREGULAR Rate: 60-100 P wave: Present, upright PR Interval: Progressively longer until drop (PR interval longer and longer until drop) QRS: <0.12 sec Husband stays late till 9, then 11, then 1, then doesn't come home at all 3/6 Irregular or regular Rate: <60 P wave: Present, upright PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop QRS: <0.12 sec 2nd Degree AV Block Type II Husband stays late till 9 consistently, then wife goes out and doesn't come home Atrials and ventricles don't communicate Rate: regular atrial P wave: Present, upright No relationship between P waves and QRS PR Interval: VARIABLE QRS: variable 3rd Degree AV Block P-P ad R-R consistent but NO correlation Husband and wife live separate lives and don't communicate SA Node 1st 60-100 AV Node 2nd 40-60 Bundle of His 3rd 40-45 Right and Left Bundle Branches 4th 40-45 Purkinje Fibers 5th 20-50 1 Small Box 0.04 sec 1 Big Box 0.20 sec Junctional Rhythms SA Node DID NOT FIRE AV Node fired NO P WAVE bc SA node didn't fire Narrow QRS P Wave Amplitude 0.5-2.5 mm Will be shorter than T wave Shows firing of SA node 0.06-0.10 sec SHOULD BE <0.12 sec QRS Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular) Calculate Regular Rate 1500/ # boxes R-R Calculate Irregular Rate # of Rs in 6 sec strip X 10 Unifocal PVCs Only 1 shape PVC 4/6 Bigeminy PVC occurs every OTHER beat Trigeminy PVC occurs every THIRD beat Couplet 2 PVCs together Triplet 3 PVCs together Multifocal Multiple shapes Same Shapes V Tach Monomorphic V Tach Different Shapes V tach Polymorphic V Tach Chopy but not as high as polymorphic V tach Coarse V Fib Fine and fibrillatory Fine V Fib Idioventricular Rhythms Only purkinje fibers firing WIDE QRS always Atrially Paced Spike comes before P Ventricularly Paced Spike comes before QRS and QRS will be wide AV Paced Spike before P and before QR Spikes with no QRS Failure to Capture Spikes happen regardless of QRS on their own Failure to Sense How to determine the rhythm Regular or irregular? Rate? P before every QRS? QRS for every P? QRS wide or narrow? QT Interval 0.34-0.43 P Wave 0.06-0.12 sec PR Interval 0.12-0.20 sec SA Node Firing Rhythms *Fires normally @ 60-100* -SR 60-100 -SB <60 -ST 100-150 -SVT 150-350 AV Node Firing, SA Node Failed Rhythms *Fires normally @ 40-60* -Junctional rhythm 40-60 -Accelerated junctional rhythm 60-100 -Junctional tachycardia 100-150 Only Purkinje Fibers Firing Rhythms (Everything else has failed) *Fires normally @ 20-50* -Idioventricular 20-50 -Accelerated idioventricular 50-100