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What rhythm is this?

Posted

Has 4 years experience.

I can't figure out this one rhythm. Can you please help me? THANKS!

20200728_090413.jpg

It's a slow one.
How far did you get in your interpretation?

What do you know about this strip? As in, what do you see?

CharleeFoxtrot, BSN, RN

Has 10 years experience.

19 hours ago, Wuzzie said:

https://nursing.com/blog/interpret-ekgs-heart-rhythms/

Not being a snot but to really get this to sink in try doing the steps listed to interpret what the rhythm is.

Yes! Learn the steps to interpretation and practice practice practice. Otherwise you are just guessing and that can have a bad outcome.

j0yegan

Has 4 years experience.

I didn't wanna insert any ideas in your heads.

I was thinking second degree heart block or third degree.

Can you tell me what you think it is??

Edited by j0yegan

9 hours ago, j0yegan said:

[...]

I was thinking second degree heart block or third degree.

[...]

What are the defining characteristics of second degree types 1 and 2, and third degree AV blocks?

9 hours ago, j0yegan said:

[...]

Can you tell me what you think it is??

Why don't you start by telling us specifically what thythm you think it is, and why?

GrumpyRN, NP

Specializes in Emergency Department. Has 39 years experience.

10 hours ago, j0yegan said:

I didn't wanna insert any ideas in your heads.

Yeah.... We don't need ideas inserted into our head. We know how to work out what the rhythm is.

10 hours ago, j0yegan said:

Can you tell me what you think it is??

I think it is VF with a touch of Asystolic AF thrown in. Could also be some Dextrocardia in there.

GrumpyRN, NP

Specializes in Emergency Department. Has 39 years experience.

1 minute ago, GrumpyRN said:

Yeah.... We don't need ideas inserted into our head. We know how to work out what the rhythm is.

I think it is VF with a touch of Asystolic AF thrown in. Could also be some Dextrocardia in there.

😜😜

CharleeFoxtrot, BSN, RN

Has 10 years experience.

1 hour ago, GrumpyRN said:

😜😜

*snerks* I think it'sa bad rhythm. When I was in EMS we'd just keep shocking until we saw a rhythm we knew how to treat.

Edited by CharleeFoxtrot
speeling iz gut.

CharleeFoxtrot, BSN, RN

Has 10 years experience.

12 hours ago, j0yegan said:

I didn't wanna insert any ideas in your heads.

I was thinking second degree heart block or third degree.

Can you tell me what you think it is??

My head already has the solution due to many many many hours of practice. Why do you say that it is a heart block? What are the characteristics of the different degrees of heart block? What caught your eye?

https://ekg.academy/heart-block-rhythms

The EKG academy is a great resource and has lots of practice strips.

https://ekg.academy/

Also lots of good practice strips can be found online by googling.

I used to work in surgical PCU. Used to know all rhythms since we had to read our own strips..

If you don't use it you lose it , so true.

I know what rhythm it is accidentally but they told us not to help solving nursing school questions.

Just trying not to get banned 🙂

7 minutes ago, NewRN'16 said:

I know what rhythm it is accidentally but they told us not to help solving nursing school questions. 

Don’t think the OP is a student anymore but the reasoning stands. Straight up giving the answer does nothing to help the person actually learn. This holds particularly true for medication math and EKGs but also lab and X-ray interpretation.

CharleeFoxtrot, BSN, RN

Has 10 years experience.

25 minutes ago, Wuzzie said:

Don’t think the OP is a student anymore but the reasoning stands. Straight up giving the answer does nothing to help the person actually learn. This holds particularly true for medication math and EKGs but also lab and X-ray interpretation.

^This. Not being snotty or anything but ACLS must be learned by analyzing strips using the step process each and every time. Because IRL strips are not always neat and seldom look exactly like the practice ones in the book.

RN-to- BSN, ADN, RN

Specializes in SCRN. Has 7 years experience.

Geez, OP is looking for an answer, shall receive it.

1 vote for the third degree block: PR interval is not fixed, P-wave and QRS allover the place, brady.

Edited by RN-to- BSN
spelling

16 minutes ago, RN-to- BSN said:

Geez, OP is looking for an answer, shall receive it.

1 vote for the third degree block: PR interval is not fixed, P-wave and QRS allover the place, brady.

While the OP might now know what the rhythm is, this wasn't very helpful as he or she still has no idea how you made this determination.

dianah, ADN

Specializes in Cath Lab/Radiology. Has 46 years experience.

Measure the distance between the P waves. Is this distance consistent/regular (and could some be hidden in T waves or in QRS complex)? (use poor man's calipers: mark on the edge of a piece of paper where one P is, then mark the distance to the next P wave. Move the paper along the rhythm strip, to locate the other P waves, and see if they are the same distance as your original measured distance).

Measure the interval between the QRS complexes. Is this consistent and regular?

Is there one P wave for each QRS?

If the P wave interval is consistent/regular, and the QRS interval is consistent/regular, but they are not related (the P waves march on, unrelated to the QRS) this is likely third degree heart block.

amoLucia

Specializes in LTC.

Grumpy - was that a 'for real' ekg strip interpretation, or were you just treating us to your wry humor?

It's kinda hard sometimes to tell with you. 😜

GrumpyRN, NP

Specializes in Emergency Department. Has 39 years experience.

"I think it is VF with a touch of Asystolic AF thrown in. Could also be some Dextrocardia in there."

16 hours ago, amoLucia said:

Grumpy - was that a 'for real' ekg strip interpretation, or were you just treating us to your wry humor?

It's kinda hard sometimes to tell with you. 😜

Definitely not for real. 😂😂

Would hate to even contemplate what that rhythm would (could) look like. Was trying to show OP that asking for answers instead of asking for help on how to get the answers gets you silly answers. Used the most outrageous rhythms I thought of.

For information, I am ALS qualified although as I am retired it expired last year.