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Normal Sinus Rhythm
P for every QRS
PR = 0.12-0.20
P wave is normal
QRS = 0.06-0.10
60-100 /min
Sinus Bradycardia
Rate < 60

Atropine 0.5 mg if symptomatic
Pace if nec
Sinus Tachycardia
Rate > 100
P and T merge at high rates

Treat cause: anxiety, hypoxia, CHF, hypovolemia, etc.
Sinus Arrhythmia
P-P intervals gradually shorten and lengthen with resp.
Normal QRS, unless BBB

Normal
Sinus Pause/Arrest
P-P usually reg. no p during pause
No PQRST during pause
Normal QRS

Possible atropine, pacing usually not necessary
Premature Atrial Contraction (PAC)
Early Ectopic P wave
Different shape than sinus P
PR may vary, but normal
Normal QRS

Normal beat that came early
May indicate possible A-flut or a-fib
may need BB or cardizem
Atrial Fibrillation
No P wave
>400
Irregular
Normal QRS
Regularly irregular

Cardizem, amiodarone, digoxin, cardioversion (<48hrs)
Anticoagulants
IV Lopressor
Atrial Flutter
No P waves
250-400
Saw tooth
VR depends on ratio
Reg or Irreg

Cardizem, amiodarone, corvert, tikosyn, digoxin
Anti-coags
Paroxysmal Atrial Tacycardia (PAT)
AR > 150-250
Regular
P waves same shape
PR intervals constant
VR > 150-250
Regular
QRS normal

Adenosine, Cardizem, vagal man. cardioversion
Premature Junctional Contractions (PJC)
Premature beat from AV node
P and be infront, buried, or after QRS.
QRS normal

No tx
Junctional Rhythm
AR 40-60
P wave in any position
WR 40-60
Reg
QRS normal

Atropine if symptomatic, pace if nec.
Juctional Tachycardia
AR and VR >100
P in any 3
Normal QRS

May req. cardioversion
Vagal, BB, adenosine, amiodarone
Supraventricular Tachycardia (SVT)
No P waves
>100
Normal QRS

Adenosine or cardioversion
Premature Ventricular Contractions (PVC)
No premature P
Premature, wide QRS
>0.12 QRS
T wave often opposite

Treat per physician order, amiodarone, beta blocker, lidocaine
Ventricular Tachycardia
Might see P
No conduction from P
> 100 (120-300)
reg to slightly irreg
>0.12

if pulseless CPR and defib
if pulse epi, or vasopressin, amiodarone or lidocaine.
Torsades de Pointes
Usually no P
Different shaped QRS >100-300
Varying R-R intervals

IV Mag or pacing
Defib if unconcious
Ventricular Fibrilation
No P
Too rapid to count
Grossly irreg.
QRS u/d

CPR and d-fib
External pace
atropine, epinephrine
Idioventricular rhythm
Usually no P
No P conduction
VR 20-40
Reg, QRS > 0.12

Ex pace, atropine, epi
Accelerated Idioventricular Rhythm
independent atrial or no P
> 40-100
reg, >0.12

bengin, NO lidocaine as asystole can occur
Agonal Rhythm
No P
Wide slurred QRS
Dying heart pattern
Asystole
No atrial activity
no vent activity

CPR, IV epi or vasopressin
First degree AV block
PR > 0.20
Reg
QRS normal

No tx
Second Degree AV Block type 1
AR = normal
Regular rhythm
PR lengthens until QRS is dropped
VR irreg
QRS normal

Atropine 0.5-1 mg
Second Degree AV block type 2
Normal atrialĀ  rate and rhythm
PR may be prolonged
Sudden absence of QRS
QRS normal, but may be wide

Atropine, cardiac pacing, temp or perm.
Second Degree AVB 2:1
Two P for every QRS
AR double VR
PR may be prolonged
VR usually reg

Atropine, possible pace
3rd degree block/complete
AR faster than VR, regular, P marches through, QRS narrow if junctional, wide if ventrical

Atropine, epi, or pacemaker
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