Rhythm

How do you diagnose a rhythm? 1st: Regular or irregular? 2nd: rate? P wave? QRS?

Normal sinus rhythm, is regular, rate is 60-99, P wave present, precede to each QRS and march out and essentially the same. PR interval is not relevant 0.12 or greater. QRS is present and within normal limits. If it is wide, it will consider as a bundle branch block if it is 0.12 sec or greater. Normal sinus rhythm does not mean anything regarding bundle branch block, unless there is a pre-existing condition, you have to mention it. Sinus arrhythmia, is irregular, rate can be varied, can be anything, can be less than or greater than 60 or 100. the trick is how do you know it’s an arrhythmia. Ps are identically the same, look the same, and they precede to QRS. PR are usually within normal limits. What varies is the arch R varies by difference between the longest and the shortest. arch R is 0.16 or greater. What that means is P are all there, the same and related to QRS, but irregular since it is an arrhythmia. P has to be the same, you need to be careful, what if there is a PAC or premature beats (they don’t look the same). What do you do for arrhythmia. What cause arrhythmia? Like pneumonia at young age or old adults. Because of difficulty breathing due to mucus in alveoli and changes your respiratory rate. What else can change your respiratory pattern? Like CO2 level caused by hypo or hyper capnia, COPD and emphysema. Common cause of changing respiratory pattern is drugs, narcotics which changes the depth and the rates. Digoxin causes negative chronotropic, slow down the heart rate. Slow down and speed up, that causes arrhythmia. How do I treat it? Depends on the cause. If it is a drug problem, give narcan if opiates. Do I worry about a sinus arrhythmia? Only if it is symptomatic, like chest pain, difficulty breathing. 5 cardinal signs of making a patient unstable, you only need one of the five. Chest pain, ALOC, signs and symptoms of congestive failure: crackles, hypotension, signs...