# Help with calculating a rate with PVCs???



## VirginiaEMT (Nov 30, 2011)

When calculating the rate for a rhythm strip, do PACs,PJCs,and PVCs get used as well as the normal QRS complexes? Let's say it's a irregular rate of 4 normal  QRS complexes and 2 PVC's, would the rate be 60 bpm? To be clear, I am not assessing a patient, I am looking at the strip itself.

Here's another example, let's say I'm looking at a strip that has 5 nice R waves and 2 PVCs, is the rate 50, or is it 70. Is the patient bradycardic or not?


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## abckidsmom (Nov 30, 2011)

VirginiaEMT said:


> When calculating the rate for a rhythm strip, do PACs,PJCs,and PVCs get used as well as the normal QRS complexes? Let's say it's a irregular rate of 4 normal  QRS complexes and 2 PVC's, would the rate be 60 bpm? To be clear, I am not assessing a patient, I am looking at the strip itself.
> 
> Here's another example, let's say I'm looking at a strip that has 5 nice R waves and 2 PVCs, is the rate 50, or is it 70. Is the patient bradycardic or not?



For bare rhythm strip interpretation, you count them, and say the rate is 70.

In real life, you feel the patient's pulse and see if those PVCs are perfusing, and only count the HR as the pulse rate.  Some monitors are able to differentiate the HR on the pulse ox vs the HR on the EKG, which is helpful, and instant feedback on whether the PVCs are perfusing.


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## mycrofft (Nov 30, 2011)

*Here's a scenario:*

Primary Care Physician "A" has an EKG machine with the beta version of the Edinburgh algorithm (or "Algorythmn" if you prefer).
PCP "B" has  machine across the hall with the "gamma" version.

"A" diagnoses "occasional PVC with mild tachycardia" and does not treat. "B" diagnoses "Atrial fibrillation", starts medication, then cardioverts patient successfully.

If it is irregular, dig in, palpate, auscultate, characterize (regularly irregular, irregularly irregular, etc *) but do not just quote the machine.



*Irregulalyl regular...never a good sign, but kind of entertaining.


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## Brandon O (Nov 30, 2011)

There's no universal standard; try to make sure it's clear with your language.


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## MSDeltaFlt (Dec 1, 2011)

VirginiaEMT said:


> When calculating the rate for a rhythm strip, do PACs,PJCs,and PVCs get used as well as the normal QRS complexes? Let's say it's a irregular rate of 4 normal  QRS complexes and 2 PVC's, would the rate be 60 bpm? To be clear, I am not assessing a patient, I am looking at the strip itself.
> 
> Here's another example, let's say I'm looking at a strip that has 5 nice R waves and 2 PVCs, is the rate 50, or is it 70. Is the patient bradycardic or not?



You count all complexes you see.  Also note how many you can palpated.  Some beats perfuse. Some don't.


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## 18G (Dec 1, 2011)

Just because a PVC doesn't produce a palpable pulse doesn't mean it's not generating any cardiac output. Count all complexes for the rate.


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## DV_EMT (Dec 2, 2011)

depends on the application:

ECG interpretation - count the complexes as ventricular beats as they are technically Ventricular.... only premature.

Field - use what you feel on a pulse to determine your rate if no ECG can be utilized as well.


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## MSDeltaFlt (Dec 2, 2011)

18G said:


> Just because a PVC doesn't produce a palpable pulse doesn't mean it's not generating any cardiac output. Count all complexes for the rate.



That's not what I said.  I said "perfusing", not "any cardiac output".  You can have a complex generate some cardiac output, but not enough to palpated a radial pulse.  You can get that With PVC's as well as with some A-Fib rhythms.


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## Aidey (Dec 2, 2011)

When I have patient's with PVCs, A-Fib etc I document the radial pulse as the "perfusing pulse" just to prevent any confusion. Heart rate is simply that, the rate the heart is firing electric impulses. It doesn't have to match the pulse.


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