EKG Recognition - Ccma

What is the correct escalation action for asystole on an EKG strip?

Confirm leads; activate emergency response; CPR per protocol. Asystole is non-shockable, so lead confirmation ensures accuracy before initiating CPR to address potential reversible causes.
Identify the rhythm: regular narrow-complex tachycardia at $150$ - $250$ bpm with no visible P waves.

Supraventricular tachycardia (SVT). High rate and absent P waves indicate reentrant supraventricular mechanism, with narrow QRS confirming origin above the ventricles.
What immediate troubleshooting step is required before calling asystole on an EKG?

Check patient and leads; confirm in $2$ leads; increase gain if needed. Troubleshooting rules out artifacts or disconnections, ensuring true asystole before non-shockable protocol initiation.
What is the appropriate escalation for bradycardia with syncope, hypotension, or shock signs?

Escalate emergently; treat as symptomatic bradycardia. Symptoms reflect inadequate cardiac output, necessitating emergent atropine or pacing to increase heart rate.
What is the correct escalation action for pulseless electrical activity (PEA) on EKG?

Activate emergency response; CPR; treat reversible causes. PEA shows organized electrical activity without pulse, requiring CPR and identification of underlying causes like hypovolemia or tension pneumothorax.
Identify the block: progressive PR lengthening until a QRS drops (grouped beating).

Second-degree AV block type I (Wenckebach). Progressive PR prolongation signals fatiguing AV node, culminating in a dropped beat before resetting.
What is the key immediate action when atrial fibrillation is accompanied by hypotension or chest pain?

Escalate urgently; treat as unstable tachyarrhythmia. Symptoms like hypotension indicate instability, prompting urgent intervention to prevent hemodynamic collapse in rapid atrial fibrillation.
Identify the rhythm: no P waves, irregularly irregular R-R intervals, narrow QRS.

Atrial fibrillation. Absence of P waves with irregular R-R intervals indicates chaotic atrial activity, while narrow QRS suggests supraventricular origin.
Identify the block: PR interval $> 0.20$ s with every P followed by QRS.

First-degree AV block. Prolonged PR reflects delayed AV conduction, but consistent P-QRS relationship indicates all impulses conduct.
What is the correct escalation action for ventricular fibrillation (VF) on an EKG strip?

Activate emergency response; defibrillation/CPR per protocol. VF is a shockable rhythm requiring immediate defibrillation to restore organized activity, combined with CPR to maintain circulation.
Identify the abnormality: tall, peaked T waves diffusely across multiple leads.

Hyperkalemia pattern. Peaked T waves result from potassium-induced repolarization changes, appearing symmetrically tall across precordial leads.
Identify the block: P waves and QRS complexes are independent (AV dissociation).

Third-degree (complete) AV block. Complete AV dissociation shows no conduction between atria and ventricles, with independent escape rhythms.
Identify the block: constant PR intervals with intermittent dropped QRS complexes.

Second-degree AV block type II (Mobitz II). Fixed PR with sudden drops indicates infranodal block, often in His-Purkinje system, without progressive changes.
What EKG finding defines sinus bradycardia?

Sinus rhythm with rate $< 60$ bpm. Normal sinus mechanism persists, but slowed rate below 60 bpm may indicate vagal tone or medication effects.
What is the correct escalation action when Mobitz II is recognized on an EKG?

Escalate urgently; high risk for complete heart block. Mobitz II often involves bundle branch disease, with potential progression to complete block requiring pacemaker evaluation.
Identify the abnormality: horizontal ST depression with symptoms of ischemia.

Possible myocardial ischemia (NSTEMI/unstable angina). Horizontal ST depression during ischemia reflects subendocardial injury, distinguishing from benign variants.
Identify the rhythm: sawtooth flutter waves with a regular ventricular response.

Atrial flutter. Sawtooth waves reflect rapid atrial reentry, with regular ventricular rate due to consistent AV node conduction block.
What is the correct escalation action for pulseless ventricular tachycardia (VT) on EKG?

Activate emergency response; CPR and defibrillation per protocol. Pulseless VT is shockable, necessitating prompt CPR and defibrillation to convert the rhythm and support vital functions.
What is the correct escalation action for SVT with hypotension, altered mental status, or chest pain?

Escalate emergently; treat as unstable tachycardia. Unstable symptoms signal compromised perfusion, requiring emergent cardioversion or medications to restore sinus rhythm.
What is the correct escalation action when hyperkalemia pattern is suspected on EKG?

Escalate urgently; notify provider immediately. Hyperkalemia risks lethal arrhythmias, requiring immediate provider intervention for treatments like calcium or insulin.
What is the correct escalation action for third-degree AV block on EKG?

Escalate emergently; prepare for pacing per protocol. Complete block causes hemodynamic instability, often requiring temporary pacing to maintain adequate heart rate.
Identify the rhythm: wide-complex regular tachycardia; assume VT until proven otherwise.

Ventricular tachycardia (VT). Wide QRS and regularity suggest ventricular origin, treated as VT to avoid risks of assuming supraventricular tachycardia with aberrancy.
What is the appropriate escalation when ST elevation is seen and the patient has ischemic symptoms?

Activate urgent provider/EMS; treat as possible STEMI. ST elevation with symptoms suggests acute coronary occlusion, warranting rapid catheterization or thrombolysis activation.
What EKG change most strongly suggests acute myocardial injury requiring urgent escalation?

ST-segment elevation in contiguous leads. ST elevation in contiguous leads indicates transmural ischemia, signaling STEMI and need for reperfusion therapy.

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