EKG Rhythm Lab — Nursing Study Hub

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LEAD II · SIX-SECOND RHYTHM STRIP25 mm/sec · 1 small box = 0.04 sec · simulated waveform

Count QRS complexes × 10 to estimate ventricular rate.When present: P → QRS → T. Look for extra P waves before dropped beats.

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Your interpretation

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Select all six findings. Your treatment should match the patient's condition, not just the waveform.

1. Ventricular heart rate

2. PR interval / P relationship

3. QRS width

4. R–R pattern

5. Identify the rhythm / strip finding

6. Most appropriate initial management

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Study help

Include additional strip findings from the table: ST elevation, ST depression, and ventricular-paced rhythm. (Off by default; they are findings/pacing patterns, not distinct native rhythms.)

Five fast EKG rules

P before every QRS: think sinus rhythm; then judge speed.
Fast + regular + narrow: sinus tachycardia if visible sinus P waves, SVT when P is hidden/obscured and the rate is often very fast.
Irregularly irregular + no P: think atrial fibrillation; sawtooth activity suggests flutter.
Wide, fast, organized: treat as ventricular tachycardia until proven otherwise; ask whether there's a pulse.
No pulse: start CPR; defibrillate VF/pulseless VT, not PEA or asystole.

Measurement refresher and recognizable waveforms

At 25 mm/sec: 1 small box = 0.04 sec and 1 big box = 0.20 sec. Normal sinus P waves are upright before each narrow QRS with a PR interval of 0.12–0.20 sec. The P wave represents atrial depolarization, QRS ventricular depolarization, and T ventricular repolarization. In PACs, the premature P may have a different shape. In AV blocks, clearly visible P waves help show the conduction failure. In AFib, discrete P waves are absent; in flutter, repeated flutter waves replace normal sinus P waves.

Why pulse and stability matter

An organized ECG alone cannot confirm cardiac output: PEA requires an actual pulse check. VT with a pulse can need synchronized cardioversion when unstable; pulseless VT requires CPR and defibrillation. Unstable polymorphic VT should receive an unsynchronized high-energy shock because synchronized shock timing may be unreliable. SVT and AFib/flutter require assessment for serious signs and symptoms before choosing medications or cardioversion.

Treatments: quick groupings

Stable NSR, stable PACs/PVCs, uncomplicated first-degree block: monitor and address the cause.
Symptomatic bradycardia: atropine; prepare pacing if ineffective.
Sinus tachycardia: treat fever, pain, dehydration, sepsis, or the underlying driver.
Stable, regular SVT: vagal maneuvers then adenosine when appropriate.
Stable AFib/flutter with RVR: diltiazem or beta blocker when not contraindicated, plus stroke-risk assessment.
Unstable tachycardia with pulse: synchronized cardioversion if rhythm permits; unstable polymorphic VT is an exception requiring an unsynchronized shock.
Pulseless VT or VF: CPR + defibrillation. PEA or asystole: CPR + epinephrine, no shock.