Heart Beats: Rhythm self-quiz: Fast and deadly
Karen Jean Craig BS, RN

Nursing2015 Critical Care
January 2013 
Volume 8  Number 1
Pages 5 - 6
  PDF Version Available!

Mr. M, 52, comes to the ED complaining of intermittent palpitations, shortness of breath, and lightheadedness. Triage takes Mr. M back into the treatment area after a quick evaluation. His vital signs are BP, 140/80; pulse, 148 and regular; respirations, 18; and SpO2, 97% on room air.While a colleague obtains peripheral I.V. access, you attach a cardiac monitor, which shows sinus tachycardia with frequent premature ventricular contractions (PVCs). Next, you use the SAMPLE mnemonic to conduct a secondary survey:Signs and symptoms: palpitations, shortness of breath with exertion; lightheadedness when changing from a supine to a sitting position; no chest pain, nausea, or other signs and symptomsAllergies: none knownMedications: nonePast medical history: noneLast meal: light breakfast 2 hours agoEvent history: signs and symptoms started about a half-hour ago while working in his basement.Mr. M says that now his chest "feels funny," and he feels as if he's "going to pass out." Mr. M becomes unresponsive, apneic, and pulseless and the monitor shows a wide-complex tachycardia.In a previous Heart Beats, we reviewed the five basic steps of rhythm analysis: * Determine the rhythm by measuring the distance between R waves and noting any variations in R-wave regularity. Determine if a 0.12-second or greater variance exists between the shortest and longest R-wave variations. * Calculate the heart rate, using the rapid rate calculation (counting the number of R waves in a 6-second strip and multiplying by 10 to calculate the heart rate per minute), for regular or irregular rhythms. For a regular rhythm, you can also use the precise rate calculation: Count the number of small squares between two consecutive R waves, and divide this number into 1,500 (the number of small squares in a 1-minute rhythm strip) to obtain the heart rate in beats per minute. Report the atrial and ventricular rates separately if they're different. * Identify and examine P waves to see if one precedes each

Purchase Now !

To purchase this item, follow the instructions below. If you’re not already logged in, be sure to enter your login information below to ensure that your item is saved to your File Drawer after you purchase it.

Not a member? Join now for Free!

1) If you're not already logged in, enter your information below to save this item in your File Drawer for future viewing.

User name:


Forgot your user name or password?
2)  If you have a coupon or promotional code, enter it
here.(If not, just click Continue.

Digital Coupon: (optional)

3)  Click Continue to go to the next screen, where
you'll enter your payment details.

jQuery UI Accordion - Default functionality

For life-long learning and continuing professional development, come to Lippincott's NursingCenter.

Nursing Jobs Plus
Featured Jobs
Recommended CE Articles

Blunt Chest Trauma
Journal of Trauma Nursing, November/December 2014
Expires: 12/31/2016 CE:2 $21.95

The School Age Child with Congenital Heart Disease
MCN, The American Journal of Maternal/Child Nursing, January/February 2015
Expires: 2/28/2017 CE:2.5 $24.95

Understanding multiple myeloma
Nursing Made Incredibly Easy!, January/February 2015
Expires: 2/28/2017 CE:2 $21.95

More CE Articles

Subscribe to Recommended CE

Recommended Nursing Articles

Comprehensive Care: Looking Beyond the Presenting Problem
Journal of Christian Nursing, January/March 2015
Free access will expire on March 2, 2015.

Pain and Alzheimer dementia: A largely unrecognized problem
Nursing Made Incredibly Easy!, January/February 2015
Free access will expire on February 16, 2015.

Glycemic control in hospitalized patients
Nursing2015 Critical Care, January 2015
Free access will expire on February 16, 2015.

More Recommended Articles

Subscribe to Recommended Articles

Evidence Based Practice Skin Care Network NursingCenter Quick Links What’s Trending Events