What rhythm is this?

CharleeFoxtrot, BSN, RN · Aug 1, 2020

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.

BSN-to-MSN, ADN, BSN, RN · Aug 1, 2020

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.

chare · Aug 1, 2020

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.

Editorial Team / Admin · Aug 1, 2020

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 · Aug 1, 2020

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 · Aug 2, 2020

"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.

amoLucia · Aug 2, 2020

Grumpy - hey! When you got it, you GOT it! And the fine art of subtle sarcasm to boot.

I was figuring that was your intent with your post, but I was never super duper interpreting strips way back in the dark ages. And that was in the 'dinosaur days' for me. (Remember when it used to be a hot stylus that would 'burn' the tracing onto the ekg strip paper's waxy surface?) Your interpretation did sound impressive though! But I would shiver to see the pt's clinical picture.

Sad that today so many seem to only want just 'the answer'; NO interest on how it was obtained, nor any concern for any need for the next time. And it's scarey ANY response might do the trick!

ladyinwaiting · Aug 2, 2020

why do nurses have to interpret this? would not this be a cardiologist's job???

Editorial Team / Admin · Aug 2, 2020

4 minutes ago, ladyinwaiting said:
why do nurses have to interpret this? would not this be a cardiologist's job???

All our 12-lead ECGs are officially read by a Cardiologist, you are correct there, ladyinwaiting. The rhythm presented above is a rhythm strip. Nurses working in specialty areas and in the ICUs and Tele units must be able to recognize potentially dangerous rhythms in order to know recognize changes, when to assess the patient with a new change, when to notify the doctor, and when to call a code.

I have worked in the Cath Lab, and in Interventional Radiology, as well as in the Stress Lab now. We work as a team to identify various rhythms (yes we do an unofficial "read" of the 12-lead EKGs before proceeding with the Stress Test) that may impact what study should be done for this patient, and how urgent is the study/procedure.

Keep asking questions. ?

amoLucia · Aug 2, 2020

If on a tele unit and that strip ran on the screen, you'd better be checking out the pt super quick and figure it out just as quickly just to know what's up next.

Can you spell 'pacemaker'?

BSN-to-MSN, ADN, BSN, RN · Aug 3, 2020

On 8/1/2020 at 1:15 PM, chare said:
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.

I suggest reading the question: " What rhythm is this?"

There is plenty of training ECG strips out there without us "showing the way". Thank you.

Kebner · Aug 3, 2020

It's a type 2 HB, or 3rd degree. Can't tell if the p waves are marching through, if they are marching through, it's 3rd degree. 3 is bad. There are two type 2 HB..Mobitz and Wenkebach...

Basically,

Wider the complex, the sicker the patient. Less effective pump (heart) to circulate the blood throughout the resistance of the body. Especially, with bradycardia. Ventrical is doing all the work..

To dx this properly, I'd prefer to have this strip in my hand.