Objectives -A must have to get ready for ACLS or to work with telemetry.  Even experienced people will be challenged. This is not just memorizing rhythm strips, you will understand why things look the way they do.

Instructions: Choose the ONE BEST ANSWER.

Upon completion of the challenging cardiac rhythm test the participant will be able to:

1.     Identify the P-wave; P-R interval; Q-, R-, and S-waves, QRS complex; QRS interval; S-T segment; and T-wave, and describe how each relates to normal electrical conduction in the heart

2.     Compare and contrast the normal electrical conductive wave through the heart and the expected normal mechanical response

3.     State the normal time intervals for the electrical wave to pass through the heart

4.    Discuss the method for determining heart rate using an ECG rhythm strip

5. Given a rhythm strip, determine the atrial and ventricular rates

6. Identify the following cardiac rhythms, given a representative strip

a.      Atrial Rhythms

• Normal Sinus Rhythm
• Sinus Bradycardia
• Sinus Tachycardia
• Sinus Arrhythmia
• Premature Atrial Contraction
• Atrial Flutter
• Atrial Fibrillation

b.     Ventricular Rhythms

• Premature Ventricular Contraction
• Idioventricular Rhythm
• Ventricular Tachycardia
• Ventricular Fibrillation
• Ventricular Standstill (Asystole)

c.      Junctional Rhythms

d.     Heart Blocks and Conduction Disturbances

• Bundle Branch Blocks
• First Degree AV Block
• Second Degree AV Block – Type I (Wenkebach)
• Second Degree AV Block – Type II
• Third Degree AV Block (Complete Heart Block)

e.      Escape Beats

• Sinus Escape
• Junctional Escape
• Ventricular Escape

f.       Pulseless Electrical Activity

7. Identify a pacemaker rhythm and differentiate between an atrial paced, ventricular paced, or atrio-ventricular (A-V sequential) paced rhythm

“The views expressed in this Spaced Case material are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Army, Department of Defense, nor the U.S. Government”

"I certify that all individuals who qualify as authors have been listed; each has participated in the conception and design of this work, the analysis of data (when applicable), the writing of the document, and the approval of the submission of this version; that the document represents valid work; that if we used information derived from another source, we obtained all necessary approvals to use it and made appropriate acknowledgements in the document; and that each takes public responsibility for it. 

Healthcare providers and students in the health professions who have (1) a basic understanding of cardiovascular physiology and (2) a basic ability to read an EKG and rhythm strip.