ekg guidelines.pdf

7/26/2019 EKG GUIDELINES.pdf

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EKG GUIDELINES

NSR

R-R regular; rate of 60-100

P-P regular; rate of 60-100

P before and for every QRSPRI: 0.12-0.20 seconds

QRS: 0.04-0.12

SINUS BRADYCARDIA

R-R regular; rate of


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SINUS ARREST

R-R irregular

P-P irregularP before and for every QRS

PRI: 0.12-0.20 seconds

QRS: 0.04-0.12Missing P/QRS complexes

Rhythm continues off time

PREMATURE JUNCTIONAL CONTRACTION

R-R irregular because of early beat; regular underlying rhythm

P-P irregular because of early beat; regular underlying rhythm

P before and for every QRS of underlying rhythmPRI: 0.12-0.20 seconds of underlying rhythm

QRS: 0.04-0.12 seconds of underlying rhythm

Early junctional beat and P-wave will be inverted if seen at all

Will not reset rest of rhythm

JUNCTIONAL ESCAPE RHYTHM

R-R regular; rate of 40-60P-P regular; rate of 40-60

P-wave inverted, may come before, during or after QRS

PRI not measurable or short

JUCTIONAL TACHYCARDIA

R-R regular; rate >100

P-P regular; rate >100 (may or may not have visible P-wave at fast rate)P-wave inverted, may come before, during or after QRS

If P-wave is with T-wave, it will not peak the T-wave


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PREMATURE ATRIAL CONTRACTION

R-R irregular because of early beat; regular underlying rhythm

P-P irregular because of early beat; regular underlying rhythmP before and for every QRS of underlying rhythm

PRI: 0.12-0.20 seconds of underlying rhythm

QRS: 0.04-0.12 seconds of underlying rhythmEarly atrial beat will have P-wave, but may have different morphology

and PRI will differ from PRI of underlying rhythm

Early P-wave may be hidden in preceding T-wave

MULTIFOCAL/WANDERING PACEMAKER

R-R may be a little irregular due to different foci in atria conduction

P-P may be a little irregular due to different foci in atria conductionP before and for every QRS of underlying rhythm

Different shaped P-waves due to changes in conduction foci

PRI: usually within 0.12-0.20 seconds

QRS: 0.04-0.12 seconds

ATRIAL TACHYCARDIA/PAT



P before and for every QRS

PRI: 0.12-0.20 secondsQRS: 0.04-0.12

Can come in runs or bursts

ATRIAL FLUTTER

R-R can be either regular or irregularP-P regular, at a very fast rate

More P-waves than QRS

Saw tooth shaped P-waves


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ATRIAL FIBRILLATION

R-R irregular, may be rapid rate

P-P indiscernible, atria fibrillatingIrregularly irregular

FIRST DEGREE HEART BLOCK



P before and for every QRSPRI: greater than 0.20 seconds may be constant

measurement from beat to beatQRS: 0.04-0.12

MOBITZ TYPE I SECOND DEGREE HEART BLOCK/WENCKEBACH

R-R irregular; rate may be brady

P-P regular; rate may be brady

More P-waves than QRSP-wave for every QRS

PRI measurement varies; progressively lengthens

QRS 0.04-0.12 secondsMissing QRS complexes after some P-waves


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CLASSIC SECOND DEGREE HEART BLOCK/MOBITZ TYPE II

R-R may be regular or irregular

P-P regularP-wave for every QRS, but not a QRS for every P-wave


PRI is constant measurement from beat to beatQRS: 0.04-0.12 seconds

THIRD DEGREE HEART BLOCK/AV DISSOCIATION/ COMPLETE HEART

BLOCK

R-R regular, usually at inherent rate of ventricles (20-40)

P-P regular, usually at inherent rate of atria (60-100)

No relationship between P and QRSPRI always varies


QRS is usually wider then normal


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PREMATURE VENTRICULAR CONTRACTIONR-R irregular because of early beat; regular underlying rhythm

P-P irregular because of early beat; regular underlying rhythmP before and for every QRS of underlying rhythm

PRI: 0.12-0.20 seconds of underlying rhythm

QRS: 0.04-0.12 seconds of underlying rhythmEarly beat will not have P-wave and will be wide and bizarre

Compensatory pause after early beat, underlying rhythm will not continue on time

VENTRICULAR TACHYCARDIA

R-R usually regular and rapid

No P-waves

QRS is wide

IDIOVENTRICULAR/VENTRICULAR ESCAPE

R-R regular at inherent rate of ventricles (usually 20-40)

No P-waves

QRS is wide


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VENTRICULAR FIBRILLATION

Irregular and chaotic

No discernable P-waves or QRS complexes

AGONAL

Rate: usually

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