Dysrhythmia Exam Helpful Hints

• Hover the cursor over the strip and that part of the strip will magnify to make it easier to count the number of “little” boxes   
• Check the Basic Refresher document provided by your recruiter to review how to measure PR, QRS & QT intervals

• 6- second method (quickest & most basic way – sufficient for Relias exam) 
• Count number of R’s then multiply by 10   
• Use the rate chart after counting the number of little boxes between R’s (see Basic Refresher document for rate chart – have this handy when you take the exam)  

The answers to each step will help rule out certain rhythms and steer you to the correct rhythm 

1. What is the RATE?  
2. REGULAR or IRREGULAR 
3. Is there a P WAVE?  
4. What is the PR INTERVAL?  
5. What does the QRS look like?  

 This will help reduce confusion & speed up process.

Blocks  

• First Degree – PR is prolonged >.20, NO dropped QRS  
• Second Degree Type I - PR gets progressively longer then a QRS is dropped (Longer, longer, longer, drop, now you have a Wenckebach)  
• Second Degree Type II – PR interval is constant with randomly dropped QRS (PR interval may be < .20)  
• Third Degree – no correlation between P’s and QRS’s, P waves usually march out consistently, even if buried in another wave (Think of this like the P & QRS are getting a divorce – no communication whatsoever, no pattern to it)

Junctional Rhythms  

• P wave is absent or inverted  
• If P wave is present, the PR interval will be short (< 0.12)  
• Know rates to determine the correct Junctional rhythm
  • Junctional rhythm – rate is 40-60 bpm
  • Accelerated Junctional – rate is 61 – 100 bpm
  • Junctional Tachycardia – rate is > 101 bpm

Idioventricular Rhythms  

• NO P waves AND widening of QRS (Remember: So wide you can sit on it) 
• Know the rates to determine the correct Idioventricular rhythm
  • Idioventricular rhythm – rate is < 40 bpm
  • Accelerated Idioventricular – rate is 40 – 100 bpm
  • VTach – rate is >100 bpm

Afib and Aflutter  

• AFIB – Rate is ALWAYS irregular / no distinguishable P waves / Atrial activity won’t always be the same before each QRS
• Aflutter – Sawtooth “like” pattern –may be more rounded than pointed

PACs and PVCs

• PACs - A normal beat but it occurs early / Will have different looking P wave with normal looking QRS / Irregular rhythm is result of the PAC, would be regular otherwise
• PVCs 
  • QRS is always wide and bizarre compared to a “normal” beat ii.
  • P wave will be absent before the PVC

ST with SVT  

• ST – rate is 101-150 bpm  
• SVT – rate is 150 – 250 BPM, P waves and PR intervals not usually discernible  

• Bigeminy – every other beat is a PVC (think biweekly pay (every other week, every other beat) 
• Trigeminy – every 3rd beat is a PVC (TRI means 3, every 3rd beat) 
• Couplets – 2 PVCs in a row (Couples like to stay together) 
• Triplets – 3 PVCs in a row  

• A Paced – Spike comes before P wave 
• V Paced – Spike comes before QRS 
• AV Paced – 2 spikes, one before P wave AND one before QRS 
• Every pacer spike (if capturing) should have either a P wave or a QRS complex following it depending on if the pacer is atrial, ventricular or both  

Here are some links to use:  

• EKG Academy 
• SKILLSTAT - 6 SECOND EKG 
• Rhythm strip flash card practice