EKG Rhythm Strips

VFlutter

VFlutter

Flight Nurse
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Hey guys, Attached is a PDF of some telemetry strips showing a few different rhythms, nothing too interesting mostly just basic stuff. I finally found a way to capture the strips directly off our monitors instead of printing then scanning them which never turned out right. I will try to get some more interesting rhythms next time I work. If anyone has a specific rhythm they have been trying to get a copy of let me know. We usually get a couple codes a month so I will try to get some arrest rhythms. Sorry if they are not the best quality.
 

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Also, Please let me know your opinions on Page 6 strip #2. Me and the Nurse disagreed on that. She said that they were transferred from the ICU and the report stated they were in A Fib w/ SVR and the EKG showed A Fib however I think it is too regular to be A Fib and some of the T waves look like they may have retrograde P waves buried in them so I charted it as Questionable Junctional Rhythm
 
ChaseZ33 said:
Also, Please let me know your opinions on Page 6 strip #2. Me and the Nurse disagreed on that. She said that they were transferred from the ICU and the report stated they were in A Fib w/ SVR and the EKG showed A Fib however I think it is too regular to be A Fib and some of the T waves look like they may have retrograde P waves buried in them so I charted it as Questionable Junctional Rhythm
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Agreed, I'd personally call it a junctional rhythm not A-Fib with SVR. I don't see how anyone could call it "irregularly irregular", I only saw one beat that was irregular but even then it's pretty close to falling within limits of being "regular" per the text books.

I'd love to see some A-flutter that doesn't beat you over the head with flutter waves haha.
 
Look at the "Guess the EKG" thread, lol.
 
Aidey said:
Look at the "Guess the EKG" thread, lol.
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No that ECG made me cry. :ph34r: I was totally off on what I thought it was and it hurt my feelings :D
 
NVRob said:
Agreed, I'd personally call it a junctional rhythm not A-Fib with SVR. I don't see how anyone could call it "irregularly irregular", I only saw one beat that was irregular but even then it's pretty close to falling within limits of being "regular" per the text books.

I'd love to see some A-flutter that doesn't beat you over the head with flutter waves haha.
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Look at page 4 #3, That is technically Atrial Tachycardia with a Variable AV block due to the atrial rate (150-200ish). If it was around 250-350 it would be A flutter. It took me a minute to figure it out since you only rarely see the extra P waves.

That is the same patient on page 1 #3. They were going in and out of that variable AV block with Runs of Junctional Tach.
 
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ChaseZ33 said:
Look at page 4 #3, That is technically Atrial Tachycardia with a Variable AV block due to the atrial rate (150-200ish). If it was around 250-350 it would be A flutter. It took me a minute to figure it out since you only rarely see the extra P waves.

That is the same patient on page 1 #3. They were going in and out of that variable AV block with Runs of Junctional Tach.
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That's a very angry heart. Ok maybe not angry, lets go with agitated. Ok maybe angry :lol:
 
Torsades de Pointes with an AICD firing.
 

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I think page 6, #2 is a little hard to define based on two leads -- I'd rather see a 12-lead. That being said, I think some consideration needs to be given to whether this is AIVR. The lead II tracing is almost entirely negative, with only a small initial R. This suggests that the axis is somewhere around -120 +/- 30 degrees, which is quite extreme for a supraventricular rhythm, even if aberrantly conducted.

I know if doesn't look that wide, but some of this rhythms look pretty marginal for QRS prolongation, if you just pick a couple of leads.

The T waves look weird. I guess it's possible that there's P waves buried in there (which would exclude AF), but we don't see any appear during the long T-P intervals. So this could also be a junctional rhythm with LAHB, especially if other limbs leads suggest the axis is closer to 90 degrees. But I'm still not quite sure what to make of the T waves. I guess it could be argued that the atrial rate approximately = the ventricular rate. But in practice this is uncommon.
 
ChaseZ33 said:
Also, Please let me know your opinions on Page 6 strip #2. Me and the Nurse disagreed on that. She said that they were transferred from the ICU and the report stated they were in A Fib w/ SVR and the EKG showed A Fib however I think it is too regular to be A Fib and some of the T waves look like they may have retrograde P waves buried in them so I charted it as Questionable Junctional Rhythm
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1:1 VA conduction does not necessarily make it junctional. It could just as easily be ventricular but I agree it's not AF.

Tom
 
Some more strips :beerchug:
 

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Keep them coming. This is great to show to our interns and newer paramedics. I agree on Page 6 #2, but don't forget that you can have a 3rd degree block with a-fib and it will be regular, albeit wider QRS though. Great stuff. Thanks!
 
Pretty straightforward but a good example nonetheless......

18a04719-1068-f249.jpg
 
That's a pretty fast A-Flutter, but gorgeous saw-tooth waves! Looks almost at a rate of 320-340ish.
 
Yea, pt I had on the wards here. Initially wasn't sure if SVT or flutter and gave some adenosine with the above findings.
 
Even better! So what did you do after the experiment proved it was flutter?

Tom
 
Trying I remember, I think in this case we may have ended up chemically converting with ibutilide. Otherwise stable so no need for cardioversion. Lately out cardio folks have enjoyed using ibutilide for fib/flutter.
 
A few from last night :deadhorse:
 

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ChaseZ33 said:
A few from last night :deadhorse:
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Neat.

Looks like some 2:1 2AVB, then a PVC inhibits vent response so you get an escape beat before it finally picks up again. Could be a mix of Type I and Type II, but the first strip certainly looks to have a fixed PRi for all but QRS complexes 5 and 6.

The second strip appears to be 3AVB or a high degree AVB with couplet PVCs at the end (or perhaps reciprocal beats).

Third strip is 3AVB or high degree AVB with various escapes and PVCs.

Fourth strip looks like 2:1 AVB with some degree of ventricular fusion during a run of PVCs. Fifth strip appears to have increasing ST-E from the 4th strip in the V lead.

Sixth strip looks like ST w/ PVCs turning into either PSVT or AF w/ RVR (difficult to tell on this screen).

Seventh/eighth strip looks like AIVR, although I can't explain the slowing and speeding up, before converting to NSR.
 
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