5 Step

EKG INTERPRETATION

Heart rate Rhythm P wave PR interval QRS

(in seconds) (in seconds)
60 -100/min Regular Present before 0.10 - 0.20 Normal shape
each QRS, identical (<5 small squares) < 0.12
P/QRS ratio 1:1

Heart Rate
8 x 10 = 80
1. Normal Sinus Rhythm
1 2 3 4 5 6 7 8
Rate - 60 -100
count the peaks - we have 8 here
multiply by 10 = 80 beats!

Rhythm

2. Rhythm - R peaks are evenly spaced apart. R R-R int. R R R R R R

To quickly measure this simply grab some

paper & mark 2 R peaks then just march it out.
The R peaks should be even every time.

P Wave
R R

3. P wave - which is our atria contracting -

is it present? & does it have its buddy QRS?
P T P T
we need a P with QRS every time
Q Q
S S

PR interval (in seconds)

R

4. PR interval - basically measures the 0.2 sec

time it takes between atrial contractions

0.5 mV
5 mm

& ventricular contractions should be 5 mini P

boxes or less - or .10 - 2.0 seconds here. PR int.

QRS (in seconds) R-R int.

0.2 sec

5. QRS - Ventricles contracting

0.5 mV
5 mm

PR ST
seg. seg.

Is it present, upright & TIGHT? P T

Should NOT be wide, should only be PR int. Q ST int.

S
3 boxes - .12 seconds here. QRS
int.
QT int.
9 ECG Strips on the NCLEX

1. Normal sinus rhythm

Treatment:
None - continue to monitor

Causes:
Being healthy

Memory tricks

Normal beat - evenly spaced

2. Bradycardia

Treatment:
BRADY Bunch Atropine ONLY if symptomatic
old TV show (slow times)
showing low perfusion (pale,
cool, clammy)
<60 Causes: ATROPINE

Vagal maneuver (bearing down),

Memory tricks
meds (CCB, Beta Blockers)
BRADYcardia
Below 60/min

3. Ventricular Fibrillation (V Fib)

Treatment:
1. V Fib - Defib #1 Defibrillation
immediately Stop CPR
to do it & before drugs!
*NO synchronization needed
2. Drugs: LAP - Lidocaine, L A P
Amiodarone, Procainamide
Causes:
Memory tricks Untreated V Tach, Post MI, LIDOCAINE
AMIODARONE
PROCAINAMIDE

E+ imbalance, proarrhythmic meds

Fib is flopping- squiggly line

4. Ventricular Tachycardia (V Tach) Memory tricks

Causes:
Post MI, Hypoxia,
Low potassium, Low magnesium
C
Treatment: C - Count a pulse
C - Cardiovert
1. Early Defibrillation! NCLEX TIP *Synchronize First
Apply defibrillator pads & Sedation
Call out & look for everyone to be

D
CLEAR!
Shock & IMMEDIATELY continue
chest compressions
Memory tricks D - Dead - NO PULSE
2. When to Shock? NCLEX TIP
D - DEFIB!!
V Tach with No pulse = Defibrillation
V Tach Tombstone pattern
*NO Synchronize
V Tach with Pulse = Cardioversion D - Don't wait
9 ECG Strips on the NCLEX II

5. Atrial Fibrillation (A Fib) Digoxin

Causes:
Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg. A T
Treatment:
Max 2.0
1. Cardioversion (after TTE to rule out clots)
*Push Synch 60
2. Digoxin - Deep Contraction
Check ATP Before giving:
A - Apical pulse 60
40 kg

T - Toxicity (Max 2.0 range) visual disturbances,

N/V, Anorexia P
P - Potassium below 3.5 - HIGHER risk for
Memory tricks toxicity
< 3.5
3. Anticoagulants: Warfarin (monitor INR, Vit.
No P wave = Fibrillation FloPPing K antidote, moderate green leafy veggies)
Potassium

K+

6. Atrial Flutter (A Flutter) Causes:

Valvular disease, Heart failure, Pulm. HTN,
COPD, after heart surg.
Treatment:
DIGOXIN

1. Cardioversion (after TTE to rule out clots)

*Push Synch
2. Digoxin - Deep Contraction
Max 2.0
Check ATP Before giving: 60
A - Apical pulse 60 40 kg

T - Toxicity (Max 2.0 range) visual disturbances,

N/V, Anorexia < 3.5
K
P - Potassium below 3.5 - HIGHER risk for
Memory tricks
Potasssium

toxicity
3. Anticoagulants: Warfarin (monitor INR, Vit.
K+
A FluTTer = sawTooTh K antidote, moderate green leafy veggies)

7. SVT - Supraventricular Tachycardia KAPLAN

Which medication should be held 48-hours
Causes: prior to an elective cardioversion for SVT?
Stimulants, Strenuous exercise, hypoxia, Digoxin due to increased ventricular
irritability
heart disease
Client with SVT has the following
Treatment: assessment data: HR 200, BP 78/40, RR 30

1. Vagal Maneuver (bear down like Priority action: Synchronized

cardioversion
having a bowel movement, ice cold
stimulation)
PRIORITY
2. Adenosine - RAPID PUSH & flush
Memory tricks with NS - HR may stop
3. Cardioversion - *Push Synch
Super Fast = Supraventricular

8. Torsades de Pointes Memory tricks

M
Magnesium

Causes: Magnesium

Post MI, Hypoxia, Low magnesium Mg+

Treatment:
Magnesium Sulfate NCLEX TIP
M
Mellows out the heart
Memory tricks

Tornado Pointes
9 ECG Strips on the NCLEX III

9. Asystole - Flatline

Epinephrine, Atropine & CPR

*NO Defibrillation
(NO shock) NCLEX TIP

Memory tricks
Assist Fully! … patient is flatlined

R R
R NCLEX Key Terms
PP PP P

Q
Q Q S
S S

1. P wave = Atrial rhythm 4. “Bizarre” - Tachycardia

3.

Question:
Asystole

2. QRS wave - Ventricular rhythm Ventricular Tachycardia

Question: “Bizarre rhythm with wide QRS complex”

Answer: Ventricular Tachycardia
“Lack of QRS complexes”
R

Q
Answer: Asystole 5. “Sawtooth” - Atrial Flutter
“Wide bizarre QRS complexes”
S

3.
Answer: V Tach

3. “Chaotic or unorganized” - Fibrillation

V Tach

Question:
A FluTTer = sawTooTh

“Chaotic rhythm with no P waves”

Answer: Atrial Fibrillation
Atrial Flutter

“CHAOTIC rhythm without QRS complexes”

Answer: Ventricular Fibrillation
Atrial Fibrillation

If you know these, you will pass the NCLEX! NCLEX TIP

Normal sinus rhythm Bradycardia Ventricular Fibrillation (V Fib)

Ventricular Tachycardia (V Tach) Atrial Fibrillation (A Fib) Atrial Flutter (A Flutter)

3.

SVT - Supraventricular Tachycardia Torsades de Pointes Asystole - flatline