Common Emergency Arrhythmias

Hajj Preparedness Program:
Clinical Emergency Nursing Course

COMMON EMERGENCY ARRHYTHMIAS
:Presented by
GAMAR AKALAL SUGALA
NURSE EDUCATOR / SIMULATION SPECIALIST
King Abdullah Medical City, Makkah
At the end of the 45-minute interactive session, participants will
be able to:
1. Analyze ECG strips through rate regularity and rhythm

determination.
2. Recognize most common emergency arrhythmias originating in the
atria and ventricles.
3. Distinguish potentially life-threatening arrhythmias and emergency
interventions approach to treatment.
4. Describe the role of ECG in patient presenting with ACS.
2
Graph paper allows a visual measurement of:
1. Time (Rate)
 Measured on horizontal line
 Each large square: 0.2 second
 Each small square: 0.04 second
2 Amplitude (Voltage)
 Measured on the vertical line
 Each large square: 0.5 mv ( 5mm)
 Each small square: 0.1 mv (1 mm)
3
Standard Calibration of ECG
 Helps ensure ECG machine is

properly calibrated
 Serves as reference point in ECG
tracing
 1mV standardization is 10 mm tall and
0.20 sec wide
 Normal calibration
 25 mm/sec
 Normal height
4
Components of the ECG Tracing
Wave Description
 Amplitude: 2 to 3 mm high
P Wave
 Duration: 0.06 to 0.12 second
PR Interval  Duration: 3 to 5 small squares (0.12-0.20 s).
QRS  Amplitude: 5 to 30 mm high

Complex  Duration: 0.06 to 0.12 seconds
ST  The isoelectric line between the end of QRS

Segment and the beginning of T wave
 The normal T wave is asymmetrical,

T Wave  Amplitude: 0.5 mm in leads I, II, and III
Up to 10 mm in precordial leads
5
Components of the ECG Tracing
Wave Description
 Amplitude: 2 to 3 mm high
P Wave
 Duration: 0.06 to 0.12 second
PR Interval  Duration: 3 to 5 small squares (0.12-0.20 s).
QRS  Amplitude: 5 to 30 mm high

Complex  Duration: 0.06 to 0.12 seconds
ST  The isoelectric line between the end of QRS

Segment and the beginning of T wave
 The normal T wave is asymmetrical,

T Wave  Amplitude: 0.5 mm in leads I, II, and III
Up to 10 mm in precordial leads
6
Interpreting EKG Rhythm Strips
The Five Step Approach
 The five-step approach, in order of application includes

analysis of the following:
1. Heart Rate
2. Heart Rhythm
3. P Wave
4. PR Interval
5. QRS Complex
7
Step 1
HEART RATE
METHODS TO DETERMINE HEART RATE

1. The 6-second method
 Denotes a 6 second interval on EKG strip
 Strip is marked by 3 or 6 second tick marks on the top or bottom of
the graph paper
 Count the number of QRS complexes occurring within the 6 second
interval, and then multiply that number by 10
8
The 6-Second Method
9
2. The Sequence Method
 To get the ventricular rate, find a R wave that peaks on a heavy

black line and assign the following numbers to the next six heavy
black lines: 300, 150, 100, 75, 60, and 50.
 Then find the next P wave peak and estimate the Ventricular rate,
based on the number assigned to the nearest heavy black line.
10
The Sequence Method
11
Step 2
HEART RHYTHM
12
Measuring a Regular Rhythm
 Measure the intervals between

R waves (measure from R to R)
 If the intervals vary by less
than 0.06 seconds or 1.5
small boxes, the rhythm is
considered to be regular
13
Measuring an Irregular Rhythm
 If the intervals between the R waves (from R to R) are
variable by greater than 0.06 seconds or 1.5 small
boxes, the rhythm is considered to be irregular.
14
Step 3
EVALUATING P WAVE
Step 3: EVALUATING
When examining PaWAVE
rhythm strip for P waves, ask yourself:
1. Are P waves present?
2. Is there one P wave for every QRS complex?
3. Are P waves occurring regularly?
4. Do they all have normal configurations: smooth, rounded,
and upright in appearance, or are they inverted?
5. Do they all have a similar size and shape?
15
Step 4
DURATION OF PR INTERVAL
Now ask yourself:
1. Is the duration a normal 0.12 to

0.20 second?
 Are the PR intervals greater than
0.20 seconds?
 Are the PR intervals less than
0.12 seconds?
2. Is the PR interval constant?
3. Are the PR intervals consistent
across the EKG strip?
16
Step 5
QRS COMPLEX
Now ask yourself?
1. Is the duration a normal 0.06 to

0.12 second.
 Are the QRS complexes greater
than 0.12 seconds (in width)?
 Are the QRS complexes less
than 0.06 seconds (in width)?
2. Are the QRS complexes similar in
appearance across the EKG strip?
3. Does a QRS complex appear after
every P wave?
17
What is the RHYTHM?
Rate to 95 bpm 90
Regularity Regular
P wave
Normal
PR Interval
s 0.16 – 0.12
QRS Duration
s 0.06 - 0.04
Interpretation
Normal Sinus Rhythm
18
What is the RHYTHM?
Rate bpm 55 – 50
Regularity Regular
P wave
Normal
PR Interval
s 0.20 – 0.16
QRS Duration
s 0.06 - 0.04
Interpretation
Sinus Bradycardia
19
20
What is the RHYTHM?
Rate to 150 bpm 140
Regularity Regular
P wave Saw-tooth pattern
PR Interval
Not measurable
QRS Duration
s 0.06 - 0.04
Interpretation
Atrial Flutter
21
What is the RHYTHM?
Rate to 180 bpm 160
Regularity Regular
P wave None discernable
PR Interval
Not measurable
QRS Duration
s 0.12 - 0.08
Interpretation
Supraventricular Tachycardia
22
What is the RHYTHM?
Rate to 100 bpm 90
Regularity Irregular
P wave Fibrillatory waves
PR Interval
Not measurable
QRS Duration
s 0.06 - 0.04
Interpretation
Atrial Fibrillation
23
24
What is the RHYTHM?
Rate to 200 bpm 150
Regularity Regular
P wave Not Discernable
PR Interval
Not measurable
QRS Duration
Wide and bizarre
Interpretation
Ventricular Tachycardia
25
What is the RHYTHM?
Rate to 200 bpm 150
Regularity Irregular and chaotic
P wave Not Discernable
PR Interval
Not measurable
QRS Duration
Fibrillatory Waves
Interpretation
Ventricular Fibrillation
26
Ventricular Fibrillation
Fine VF
Coarse VF
27
What is the RHYTHM?
Rate None
Regularity None
P wave
None
PR Interval
None
QRS Duration
None
Interpretation
Asystole
28
What is the RHYTHM?
Rate to 80 bpm 70
Regularity Regular
P wave
Normal
PR Interval
s 0.20 – 0.16
QRS Duration
s 0.12 - 0.08
Interpretation
Pulseless Electrical Activity
29
30
Sequence of ECG Changes in MI
NSR
Hyper-Acute
Phase
Acute Phase
Evolving
Phase Evolved
Phase
31
32
‫شكًر ا لكم‬
‫‪33‬‬

Common Emergency Arrhythmias

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Hajj Preparedness Program:

Clinical Emergency Nursing Course

1. Analyze ECG strips through rate regularity and rhythm

 Helps ensure ECG machine is

PR Interval  Duration: 3 to 5 small squares (0.12-0.20 s).

QRS  Amplitude: 5 to 30 mm high

ST  The isoelectric line between the end of QRS

 The normal T wave is asymmetrical,

PR Interval  Duration: 3 to 5 small squares (0.12-0.20 s).

QRS  Amplitude: 5 to 30 mm high

ST  The isoelectric line between the end of QRS

 The normal T wave is asymmetrical,

The Five Step Approach

 The five-step approach, in order of application includes

METHODS TO DETERMINE HEART RATE

 To get the ventricular rate, find a R wave that peaks on a heavy

 Measure the intervals between

Now ask yourself:

1. Is the duration a normal 0.12 to

Now ask yourself?

1. Is the duration a normal 0.06 to

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