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EKG — rapid rhythms

Rapid rhythms:

• Measure PR interval (< 0.2) and QRS (< 0.12)
• Variable rhythms = sinus arrhythmia, wandering pacemaker, atrial fibrillation
• Extra or skipped beats?
– PAC (early QRS with P)
– PNC (early QRS without P)
– PVC (wide early QRS and compensatory pause)
– There are also atrial, nodal, and ventricular escape beats
• Rapid rhythms
– MAT: changing P waves, seen in COPD
– PAT: normal wave sequence at 150-250, ectopic. Therapy is CSM, edrophonium, propranolol, procainamide
– PAT with block: > 1 P wave per QRS, seen in digoxin toxicity, OHD, low potassium
– PNT: no P waves, 150-250, retrograde P waves possible
– PVT: rapid run of PVC’s, 150-250, therapy is lidocaine, cardioversion, inderal, procainamide
– Atrial flutter: identical P waves at 250-350, ventricular rate about 150, cause is atrial enlargement, therapy is DC cardioversion
– Ventricular flutter: smooth diphasic waves at 200-300
– Atrial fibrillation: jagged baseline, therapy is quinidine, procainamide
– Ventricular fibrillation: ACLS protocol

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