When preparing for the telemetry competency, remember to go back to basics. Analyze each rhythm in the same sequence. Step 1: Is the rhythm regular? Step 2: Calculate the heart rate Step 3: Are there P waves, is there one for each QRS, what is the PR interval? Step 4: Is there a QRS with each P wave, are they all the same? Step 5: Interpret, give the rhythm a name
For each of the following 6 second rhythm strips, determine the rate, PR interval (PRI), QRS interval, interpretation and next course of action. 1.
Rate: PRI: QRS:
Interpretation: Next course of action: 2.
Rate: PRI: QRS:
Interpretation: Next course of action: 3.
Rate: PRI: QRS:
Interpretation: Next course of action:
4.
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Interpretation: Next course of action:
5.
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Interpretation: Next course of action: 6.
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Interpretation: Next course of action:
7.
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Interpretation: Next course of action:
8.
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Interpretation: Next course of action: 9.
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Interpretation: Next course of action:
10.
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Interpretation: Next course of action:
11.
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Interpretation: Next course of action: 12.
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13.
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Interpretation: Next course of action:
14.
Rate: PRI: QRS:
Interpretation: Next course of action: 15.
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Interpretation: Next course of action:
16
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Interpretation: Next course of action:
17.
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Interpretation: Next course of action: 18.
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Interpretation: Next course of action:
19.
Rate: PRI: QRS:
Interpretation: Next course of action: 20.
Rate: PRI: QRS:
Interpretation: Next course of action: ANSWERS 1. Rate: 100-110 PRI: 0.16 QRS: 0.08 Interpretation: Sinus Tachycardia (ST) Next course of action: Check patient, if new onset or patient is symptomatic, notify MD/LIP 2. Rate: Underlying rhythm rate 80 PRI: 0.2 QRS: 0.08 Interpretation: Sinus Rhythm (SR) with a burst of paroxysmal supraventricular tachycardia (PSVT) Next course of action: Check patient, obtain VS and notify MD/LIP 3. Rate: 70 PRI: unable QRS: 0.08 Interpretation: Atrial Fibrillation (a-fib) Next course of action: Check patient, if new onset or patient is symptomatic, notify MD/LIP 4. Rate: 190 PRI: Unable QRS: 0.08 Interpretation: Supraventricular Tachycardia (SVT) Next course of action: Check patient, obtain VS and notify MD/LIP 5. Rate: 80 PRI: 0.2 QRS: 0.06 Interpretation: SR with pause Next course of action: Check patient, obtain VS and notify MD/LIP 6. Rate: 70 PRI: 0.2 QRS: 0.1 Interpretation: SR with peaked T waves Next course of action: Check patient, check potassium 7. Rate: 70 PRI: 0.16 QRS: 0.08 Interpretation: SR with frequent premature atrial complexes (PAC) Next course of action: Check patient, if new onset or patient is symptomatic, notify MD/LIP 8. Rate: 110 PRI: unable QRS: 0.08 Interpretation: Junctional Tachycardia Next course of action: Check patient, obtain VS and notify MD/LIP 9. Rate: 50 PRI: 0.32 QRS: 0.08 Interpretation: SB with 1st Degree AV Block Next course of action: Check patient, if new onset or patient is symptomatic, notify MD/LIP 10. Rate: 30 PRI: Unable QRS: 0.16 Interpretation: 3rd Degree Heart Block Next course of action: Check patient, obtain VS and notify MD/LIP immediately, prepare to pace the patient 11. Rate: 50 PRI: variable QRS: 0.08 Interpretation: 2nd Degree AV block Type 1 (Wenckebach) Next course of action: Check patient, obtain VS and notify MD/LIP 12. Rate: 40 PRI: 0.16 QRS: 0.06 Interpretation: 2nd Degree AV Block Type 2 (Mobitz) Next course of action: Check patient, obtain VS and notify MD/LIP immediately, prepare to pace the patient 13. Rate: 90 PRI: 0.16 QRS: 0.08 Interpretation: SR with PVC Couplets Next course of action: Check patient, obtain VS and notify MD/LIP if couplets persist 14. Rate: 70 PRI: Unable QRS: >0.16 Interpretation: 100% Ventricularly Paced Next course of action: Continue to monitor patient 15. Rate: 70 (underlying) PRI: 0.2 QRS: 0.06 Interpretation: SR with 6 beats of Ventricular Tachycardia (VT) Next course of action: Check patient, obtain VS and notify MD/LIP 16. Rate: 40 PRI: None QRS: 0.4 Interpretation: Idioventricular Next course of action: Check patient, obtain VS and notify MD/LIP immediately, if pulseless, call code 17. Rate: 40 PRI: 0.2 QRS: 0.08 Interpretation: Sinus Bradycardia (SB) Next course of action: Continue to monitor patient 18. Rate: None PRI: None QRS: None Interpretation: Ventricular Fibrillation (VF) Next course of action: Call Code Blue, obtain AED and prepare to shock the patient 19. Rate: None PRI: None QRS: None Interpretation: Asystole Next course of action: Call Code Blue, being CPR 20. Rate: 70 PRI: Unable QRS: 0.06 Interpretation: A-Flutter Next course of action: Check patient, if new onset or patient is symptomatic, notify MD/LIP