I am wondering whether anyone else out there uses the same "cheaters' shortcuts" that I do when interpreting rhythms. I have never seen these in a text book but I have formulated them from watching my colleagues interpret. Although the majority of textbooks take the student through a laborious step by step analysis an experienced RN seems to leap over these steps and straight to pattern recognition.
By watching my colleagues I think I have caught on to some of the subconscious cues we are using to come to an answer in the 2 second or less it usually takes to work out what the rhythm is.
1) Look at the pulse counter on the monitor - if the pulse counter is jumping wildly by 5 to 10 BPM then it is probable the patient is in Atrial Fibrillation. This is only a probability of course and you still need to read the strip but it is a valuable first clue.
2) Pulse counter is also a often a first clue for atrial flutter - knowing that flutter waves are usually 300 minute or thereabouts. If the rate is staying at a division of the 300 or so it is probable that it is an atrial flutter with a block. i.e. rate of 150 atrial flutter with a 2:1 block rate 100 atrial flutter with a 3:1 block. Once again you must check the printed rhythm strip using a step by step process.
3) Instead of counting the little squares in the P-R interval to determine first degree block I look along the strip to find a "p" wave that lines up with the beginning of a large square and then check to see if the QRS falls in the same large square. If it does the P-R is less than 0.2 so is not a first degree block.
Of course with all of these you still have to do the rest of the analysis but these are valuable first clues that can save time.
