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7/26/2019 EKG GUIDELINES.pdf
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EKG GUIDELINES
NSR
R-R regular; rate of 60-100
P-P regular; rate of 60-100
P before and for every QRSPRI: 0.12-0.20 seconds
QRS: 0.04-0.12
SINUS BRADYCARDIA
R-R regular; rate of
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SINUS ARREST
R-R irregular
P-P irregularP before and for every QRS
PRI: 0.12-0.20 seconds
QRS: 0.04-0.12Missing P/QRS complexes
Rhythm continues off time
PREMATURE JUNCTIONAL CONTRACTION
R-R irregular because of early beat; regular underlying rhythm
P-P irregular because of early beat; regular underlying rhythm
P before and for every QRS of underlying rhythmPRI: 0.12-0.20 seconds of underlying rhythm
QRS: 0.04-0.12 seconds of underlying rhythm
Early junctional beat and P-wave will be inverted if seen at all
Will not reset rest of rhythm
JUNCTIONAL ESCAPE RHYTHM
R-R regular; rate of 40-60P-P regular; rate of 40-60
P-wave inverted, may come before, during or after QRS
PRI not measurable or short
JUCTIONAL TACHYCARDIA
R-R regular; rate >100
P-P regular; rate >100 (may or may not have visible P-wave at fast rate)P-wave inverted, may come before, during or after QRS
If P-wave is with T-wave, it will not peak the T-wave
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PREMATURE ATRIAL CONTRACTION
R-R irregular because of early beat; regular underlying rhythm
P-P irregular because of early beat; regular underlying rhythmP before and for every QRS of underlying rhythm
PRI: 0.12-0.20 seconds of underlying rhythm
QRS: 0.04-0.12 seconds of underlying rhythmEarly atrial beat will have P-wave, but may have different morphology
and PRI will differ from PRI of underlying rhythm
Early P-wave may be hidden in preceding T-wave
MULTIFOCAL/WANDERING PACEMAKER
R-R may be a little irregular due to different foci in atria conduction
P-P may be a little irregular due to different foci in atria conductionP before and for every QRS of underlying rhythm
Different shaped P-waves due to changes in conduction foci
PRI: usually within 0.12-0.20 seconds
QRS: 0.04-0.12 seconds
ATRIAL TACHYCARDIA/PAT
R-R regular; rate of 161-250
P-P regular; rate of 161-250
P before and for every QRS
PRI: 0.12-0.20 secondsQRS: 0.04-0.12
Can come in runs or bursts
ATRIAL FLUTTER
R-R can be either regular or irregularP-P regular, at a very fast rate
More P-waves than QRS
Saw tooth shaped P-waves
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ATRIAL FIBRILLATION
R-R irregular, may be rapid rate
P-P indiscernible, atria fibrillatingIrregularly irregular
FIRST DEGREE HEART BLOCK
R-R regular; rate of 60-100
P-P regular; rate of 60-100
P before and for every QRSPRI: greater than 0.20 seconds may be constant
measurement from beat to beatQRS: 0.04-0.12
MOBITZ TYPE I SECOND DEGREE HEART BLOCK/WENCKEBACH
R-R irregular; rate may be brady
P-P regular; rate may be brady
More P-waves than QRSP-wave for every QRS
PRI measurement varies; progressively lengthens
QRS 0.04-0.12 secondsMissing QRS complexes after some P-waves
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CLASSIC SECOND DEGREE HEART BLOCK/MOBITZ TYPE II
R-R may be regular or irregular
P-P regularP-wave for every QRS, but not a QRS for every P-wave
More P-waves than QRS
PRI is constant measurement from beat to beatQRS: 0.04-0.12 seconds
THIRD DEGREE HEART BLOCK/AV DISSOCIATION/ COMPLETE HEART
BLOCK
R-R regular, usually at inherent rate of ventricles (20-40)
P-P regular, usually at inherent rate of atria (60-100)
No relationship between P and QRSPRI always varies
More P-waves than QRS
QRS is usually wider then normal
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PREMATURE VENTRICULAR CONTRACTIONR-R irregular because of early beat; regular underlying rhythm
P-P irregular because of early beat; regular underlying rhythmP before and for every QRS of underlying rhythm
PRI: 0.12-0.20 seconds of underlying rhythm
QRS: 0.04-0.12 seconds of underlying rhythmEarly beat will not have P-wave and will be wide and bizarre
Compensatory pause after early beat, underlying rhythm will not continue on time
VENTRICULAR TACHYCARDIA
R-R usually regular and rapid
No P-waves
QRS is wide
IDIOVENTRICULAR/VENTRICULAR ESCAPE
R-R regular at inherent rate of ventricles (usually 20-40)
No P-waves
QRS is wide
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VENTRICULAR FIBRILLATION
Irregular and chaotic
No discernable P-waves or QRS complexes
AGONAL
Rate: usually
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