EKG CHEATSHEET

Sinus Bradycardia:
 Rate: <60 bpm.
 Cause may be unknown or d/t Vagal Stimulation.
o Coughing, Vomiting, Straining during BM, Sudden exposure of the face to cold water,
Carotid sinus pressure
 Interventions:
o No tx if Asymptomatic
o Symptomatic: hypotensive, AMS, shock, chest discomfort acute HF.
 VS, Maintain Airway, if O2 <94% give O2.
 Ensure IV Access, you’re gonna be slamming meds.
 Try and find out what the cause is. If you can fix it, then do it!
 ATROPINE! WHEN A PT IS BRADY WE GIVE ATROPINE!
 Atropine is an antiarrhytmic that will increase the HR.
 Give 0.5mg Q3-5 minus to 3mg.
 If Atropine doesn’t work we need:
 Transcutaneous Pacing
 Dopamine 2-20 mcg/kg/min (2nd line drug)
 Epinephrine 2-10 mcg/min (alternative to dopamine)
Sinus Tachy:
 Rate: 101-180 bpm. QRS <0.11 seconds
 Cause: Drugs, Hyperthyroidism, Meds, Nicotine, caffeine, Shock, sympathetic stimulation, PE-
basically anything that hypes you up!
 Interventions:
o Directed at correcting the underlying cause! If the pt is hypoxia, give oxygen.
Dehydrated? Give fluids. Med related? Hold those meds. Anxious? Relieve it.
o Give Beta Blockers to slow HR.
Supraventricular Tachy (SVT):
 Rate: 150-250 bpm. Narrow QRS. P Waves are not seen before the QRS, therefore the PR
Interval is not measurable. “Narrow and Fast”
 NOT R/T TO ACTIVITY OR EMOTION. Ask, or find out what they were doing when this happened
to know if its just Sinus Tachy or SVT.
 Cause: Hypoxia, Sleep deprivation, COPD, CAD, Valvular heart disease, HF, Dig Toxicity
 Interventions:
o Stable Pt:
 Get VS, give O2 if pulse ox <94%. Establish IV access.
 Adenosine (if regular complex). Slows down HR.
 Adenosine 6mg followed by 10mL NS Flush.
o If this doesn’t work, give 12mg with 10mL NS Flush.
 BB, CCB, Consider expert consult.
 Have pt perform Vagal Maneuvers: Bear down, cough, blow into the syringe,
breath holding, application of a cold stimulus to the face, gagging, vasalva’s
maneuver.
o Unstable and Symptomatic : CARDIOVERSION! ALWAYS!
 Pulse ox, give O2 if <94%. If time permits sedate pt.
 Narrow and Regular QRS: 50-100J
 Narrow Irregular: 120-200J.
AFib:
 Rate: Irregular irregular. Atria rate: 400-600 bpm. “Saw Tooth”
 No clear P Waves. Atria merely quiver. Wavy baseline.
 Causes: After cardiac surgery, HF, Valvular disease, Cardiomyopathy, Chronic lung disease
 Interventions:
o SLOW HR and give Anticoagulants
o If rapid ventricular rate, control ventricular response with Synchronized cardioversion
(120-200J).
 Dilitazem for ventricular rate.
 Amiodarone for rate control- IVP and then a Drip as needed. CCB (Cardizem)
V Tach:
 Rate: 101-250 bpm. Wide, fast. P Waves are absent. Loss of CO.
 Causes: Acid base imbalance, MI, Trauma, Lytes imbalance, Hypokalemia.
 Interventions:
o PULSELESS PT:
 High quality CPR and Defibrillation
 Epi 1mg Q 3-5 mins
 Consider advanced airway
 Amiodarone 300mg (After 3rd shock)
 Treat reversible causes! H’s and T’s
o STABLE, PULSE, SYMPTOMATIC: DRUGS!!
 O2 for <94%
 IV Access and 12 lead ekg to confirm rhythm
 Adenosine only if regular and monomorphic. Or other ventricular antiarrhymics-
Procainamide, Sotalol, Mag Sulfate.
 Get Expert consultation.
o UNSTABLE PT is ALWAYS SYNCHRONIZED:
 Tx Unstable without Pulse as you would Tx VFib!
 Maintain patent airway. O2 for <94%
VFib: LIFE THREATENING! NO PULSE DEFIBRILLATE! NEVER HAS A PULSE!
 Chaotic rhythm that begins in the ventricles. No organized depolarization in the ventricles.
Consuming tremendous amounts of O2. No pulse. No CO. No perfusion. Rapidly fatal if not
successfully fixed within 3-5 mins.
 No discernible P Waves, PR interval, ORS.
 Interventions:
o Perform High Quality CPR! Until a defibrillator is available.
o Perform defibrillation as soon as the machine arrises!
 Want to convert rhythm to VTach.
o Administer meds consistent with current resuscitation guidelines.
 Shock -> 2 mins CPR -> Is there a rhythm? -> No -> Shock Again -> 1 mg Epi IVP -> CPR -> Shock ->
Amiodarone (for refractory V Tach).
o After 2nd shock give Epi
o After 3rd shock give Amiodarone
 1st dose: 300mg
 2nd dose: 150mg
 If it works, pt will be placed on a drip for 24 hrs.
Asystole:
  Complete absence of any ventricular rhythm. No pulse, CO. THIS IS NOT SHOCKABLE! JUST CPR
AND EPI!
 Interventions:
o Check pulse for 10-15 seconds. Start CPR.
o Establish IV Access
o Check rhythm Q 2 MINS.
 Always check the pulse as well, a rhythm could be PEA.
o Cold fluids and blankets to decrease any damage to the brain.
o PT should have a low CO2! Indicates that it is good CPR! An increase in CO2 is a good
thing, indicates a sign of return circulation.

Key points:
 If the pt is in VF or pulseless VT, the immediate priority is to defibrillate.
 CPR must continue at all times, except during defibrillation.
 Older adults are at increased risk for dysrhythmias bc of normal physiological changes. The SA
node has fewer pacemaker cells.
 Side of pacemaker- keep cell phones 6 niches away and use the opposite ear when using it.