Normal Electrical Conduction

SA node > AV node > Bundle of His > Bundle Branches > Purkinje fibers.

Small 0.04 seconds per box. Vertically = 0.1 mV. Large Horizontally = 0.20 seconds (5 small boxes). Vertically = 0.5 mV.

Normal P waves, PR, QRS, rhythm: Brady Rate 100 bpm. Often a response to stress.

Atrial Fibrillation (A-fib)

Irregularly irregular rhythm. No discernible P waves. Risk of thromboembolism. Rate control (beta-blockers, digoxin, Ca channel blockers) & anticoagulation.

Sawtooth flutter waves (F waves). Atrial rate 250-350, ventricular rate variable.

Premature Atrial Complex: Early, abnormal P wave. PR interval may vary. Usually benign.

Supraventricular Tachycardia

SVT: Rate 150-250. Regular, narrow QRS. P waves often buried in T wave. Valsalva, adenosine, cardioversion if unstable.

First-Degree AV Block

PR interval >0.20 sec & constant. Every P wave followed by QRS. Benign.

Second-Degree AV Block Type I

Wenckebach. PR progressively lengthens until a QRS is dropped (non-conducted).

Second-Degree AV Block Type II

Constant PR interval. Random non-conducted P waves. QRS often wide. Can progress.

Third-Degree AV Block

Complete heart block. No relationship between P waves & QRS. Ventricular escape rhythm.

Ventricular Tachycardia (V-tach)

Rate 100-250. Wide, bizarre QRS, regular rhythm. May have pulse (assess!). Antiarrhythmics (amiodarone), cardioversion.

Ventricular Fibrillation (V-fib)

Chaotic, wavy baseline. No organized depolarization. No pulse. DEFIBRILLATE.

Flat line. No electrical activity. Confirm in two leads. No pulse. TREAT WITH CPR & EPINEPHRINE.

Pulseless Electrical Activity: Organized electrical activity but NO pulse. Treat underlying cause (Hs and Ts).

Shock timed with R wave (QRS). For unstable tachycardias WITH a pulse (A-fib, SVT, V-tach).

Unsynchronized shock. For pulseless rhythms: V-fib & pulseless V-tach.

Detects & treats life-threatening V-tach/V-fib with pacing or shock. Also has pacing capability.

Post-Pacemaker/ICD Care

CXR to check lead placement, monitor incision, sling for arm, avoid magnets/MRI.

Pacemaker Complication

Hiccups: May indicate pacing of the diaphragm (phrenic nerve stimulation). Report immediately

Cardioversion Complication

Risk of thromboembolism (stroke, PE). Requires anticoagulation prior (if A-fib).

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EKG

Question	Answer
Normal Electrical Conduction	SA node > AV node > Bundle of His > Bundle Branches > Purkinje fibers.
ECG Paper	Small 0.04 seconds per box. Vertically = 0.1 mV. Large Horizontally = 0.20 seconds (5 small boxes). Vertically = 0.5 mV.
Sinus Rhythms	Normal P waves, PR, QRS, rhythm: Brady Rate <60 bpm. Treat if symptomatic. Tach Rate >100 bpm. Often a response to stress.
Atrial Fibrillation (A-fib)	Irregularly irregular rhythm. No discernible P waves. Risk of thromboembolism. Rate control (beta-blockers, digoxin, Ca channel blockers) & anticoagulation.
Atrial Flutter	Sawtooth flutter waves (F waves). Atrial rate 250-350, ventricular rate variable.
PAC	Premature Atrial Complex: Early, abnormal P wave. PR interval may vary. Usually benign.
Supraventricular Tachycardia	SVT: Rate 150-250. Regular, narrow QRS. P waves often buried in T wave. Valsalva, adenosine, cardioversion if unstable.
First-Degree AV Block	PR interval >0.20 sec & constant. Every P wave followed by QRS. Benign.
Second-Degree AV Block Type I	Wenckebach. PR progressively lengthens until a QRS is dropped (non-conducted).
Second-Degree AV Block Type II	Constant PR interval. Random non-conducted P waves. QRS often wide. Can progress.
Third-Degree AV Block	Complete heart block. No relationship between P waves & QRS. Ventricular escape rhythm.
Ventricular Tachycardia (V-tach)	Rate 100-250. Wide, bizarre QRS, regular rhythm. May have pulse (assess!). Antiarrhythmics (amiodarone), cardioversion.
Ventricular Fibrillation (V-fib)	Chaotic, wavy baseline. No organized depolarization. No pulse. DEFIBRILLATE.
Asystole	Flat line. No electrical activity. Confirm in two leads. No pulse. TREAT WITH CPR & EPINEPHRINE.
PEA	Pulseless Electrical Activity: Organized electrical activity but NO pulse. Treat underlying cause (Hs and Ts).
Cardioversion	Shock timed with R wave (QRS). For unstable tachycardias WITH a pulse (A-fib, SVT, V-tach).
Defibrillation	Unsynchronized shock. For pulseless rhythms: V-fib & pulseless V-tach.
ICD Primary Function	Detects & treats life-threatening V-tach/V-fib with pacing or shock. Also has pacing capability.
Post-Pacemaker/ICD Care	CXR to check lead placement, monitor incision, sling for arm, avoid magnets/MRI.
Pacemaker Complication	Hiccups: May indicate pacing of the diaphragm (phrenic nerve stimulation). Report immediately
Cardioversion Complication	Risk of thromboembolism (stroke, PE). Requires anticoagulation prior (if A-fib).

Created by: Wasurenboh

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