Advent Health EKG
1. Afib The impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]
• No discernable P waves - PRI & Atrial rhythm cannot be
measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
if the Ventricular rate is > 100 the rhythm is uncontrolled A-
fib
• This is a chronic rhythm for some patients
Treatment: controlled patients: anticoagulants and
antiarrythmics; uncontrolled but stable patients: Beta
blockers, calcium channel blockers, or digoxin; Unstable
patients: cardioversion
2. Junctional Impulse starts in the AV junction
Rhythm • P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
3. Accelerated Junc- Accelerated Junctional tional Rhythm Same criteria as Junctional
Rhythm, except the Ventricular rate is 60-100 For stable patients: IV access, vagal
maneuvers, adenosine, O2, Beta blockers, calcium channel blockers
4. Idioventricular Impulse originates in the ventricles
, Advent Health EKG
Rhythm (IVR) ªRhythm: Ventricular is
usually regular ªRate:
Ventricular between 20-40
ªQRS: 0.12e
ªAtrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart,
transcutaneous pacing, atropine. NEVER GIVE ANTI-
ARRYTHMICS MEDICATIONS
5. Accelerated Follows the same criteria as IVR, except Ventricular rate is 40-
100. Idioventricular • If no intervention happens, the patient will deteriorate.
Rhythm - Treatment: assess pt, atropine, transcutaneous pacing.
NEVER GIVE ANTI-ARRHYTHMIC MEDICATIONS
6. Ventricular Pac- • The pacemaker lead is placed in to right ventricle.
ing • The pacemaker generator fires an impulse Initiating ventricular activity.
• The right ventricle will contract first followed by the left
ventricle. This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm,
rate, and PRI are non-
measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from
pacer spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured
from pacer spike to end of QRS
, Advent Health EKG
7. Atrial-ventricular One pacemaker lead is placed into the right atria and another is
placed into the
Pacing right
ventricle.
• The pacemaker generator fires an impulse to the atria and
then to the ventricle sequentially causing atrial then
ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P
waves may or may not be seen
(lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
8. Failure to capture A pacer spike note followed by the appropriate atrial or
ventricular response • Can be a potentially lethal situation!
9. Failure to pace Absence of pacer activity (spikes) when the pacemaker generator
should have fired an impulse.
•
1. Afib The impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]
• No discernable P waves - PRI & Atrial rhythm cannot be
measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
if the Ventricular rate is > 100 the rhythm is uncontrolled A-
fib
• This is a chronic rhythm for some patients
Treatment: controlled patients: anticoagulants and
antiarrythmics; uncontrolled but stable patients: Beta
blockers, calcium channel blockers, or digoxin; Unstable
patients: cardioversion
2. Junctional Impulse starts in the AV junction
Rhythm • P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
3. Accelerated Junc- Accelerated Junctional tional Rhythm Same criteria as Junctional
Rhythm, except the Ventricular rate is 60-100 For stable patients: IV access, vagal
maneuvers, adenosine, O2, Beta blockers, calcium channel blockers
4. Idioventricular Impulse originates in the ventricles
, Advent Health EKG
Rhythm (IVR) ªRhythm: Ventricular is
usually regular ªRate:
Ventricular between 20-40
ªQRS: 0.12e
ªAtrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart,
transcutaneous pacing, atropine. NEVER GIVE ANTI-
ARRYTHMICS MEDICATIONS
5. Accelerated Follows the same criteria as IVR, except Ventricular rate is 40-
100. Idioventricular • If no intervention happens, the patient will deteriorate.
Rhythm - Treatment: assess pt, atropine, transcutaneous pacing.
NEVER GIVE ANTI-ARRHYTHMIC MEDICATIONS
6. Ventricular Pac- • The pacemaker lead is placed in to right ventricle.
ing • The pacemaker generator fires an impulse Initiating ventricular activity.
• The right ventricle will contract first followed by the left
ventricle. This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm,
rate, and PRI are non-
measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from
pacer spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured
from pacer spike to end of QRS
, Advent Health EKG
7. Atrial-ventricular One pacemaker lead is placed into the right atria and another is
placed into the
Pacing right
ventricle.
• The pacemaker generator fires an impulse to the atria and
then to the ventricle sequentially causing atrial then
ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P
waves may or may not be seen
(lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
8. Failure to capture A pacer spike note followed by the appropriate atrial or
ventricular response • Can be a potentially lethal situation!
9. Failure to pace Absence of pacer activity (spikes) when the pacemaker generator
should have fired an impulse.
•
