I need your comment on my EKG assignment

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meen2603

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I'm not quite sure with the answer I have so I need your comment and if I am wrong feel free to correct me. I need to learn from that.. By the way, you will have to click the link below in order to see the EKG Strip because the file is too big for this site... You can either response here or send me a e mail..
Thank you in advance..

P.S. It would be good if I have it by tomorrow.. XD
[email protected]
http://www.thaiheart.org/board_doctor/board.php?id=755&use_file=view

Here's the answer
1. Multiple paroxysmal ventricular contraction (Multiple PVC)2. Ventricular Tachycardia
3. Sinus Arrythmia
4. Paroxysmal Junctional Tachycardia or should I just put AV Node Reentry Tachycardia (AVNRT). My professor said that I shoule be specific so in this case should I put AVNRT?
5. Normal sinus rhythm
6. S[FONT='Cordia New','sans-serif']inus Bradycardia .
7. Non-conducted premature atrial beat (PAB)[FONT='Cordia New','sans-serif'] The reason why I said non-conducted because of no ventricle response after P wave.
8. [FONT='Cordia New','sans-serif'] I have no idea about this one but I would say .PVC.. ( even no compensate pause)
9. Atrial Fibrillation
10. Ventricular Trigeminy PVC
11. Atrial Flutter
12. Sinus rhythm with run of 2 PVC’s... This one I'm not sure either... Please comment
Feel free to correct me, teach me, yell at me... do whatevery you want in order to make me learn from my mistake...
:idea:

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your link doesn't work, but I'd say if it is all "squiggly" and stuff you should just shock it.
 
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I'm not quite sure with the answer I have so I need your comment and if I am wrong feel free to correct me. I need to learn from that.. By the way, you will have to click the link below in order to see the EKG Strip because the file is too big for this site... You can either response here or send me a e mail..
Thank you in advance..

P.S. It would be good if I have it by tomorrow.. XD
[email protected]
http://www.thaiheart.org/board_doctor/board.php?id=755&use_file=view

Here's the answer
1. Multiple paroxysmal ventricular contraction (Multiple PVC)2. Ventricular Tachycardia
3. Sinus Arrythmia
4. Paroxysmal Junctional Tachycardia or should I just put AV Node Reentry Tachycardia (AVNRT). My professor said that I shoule be specific so in this case should I put AVNRT?
5. Normal sinus rhythm
6. S[FONT='Cordia New','sans-serif']inus Bradycardia .
7. Non-conducted premature atrial beat (PAB)[FONT='Cordia New','sans-serif'] The reason why I said non-conducted because of no ventricle response after P wave.
8. [FONT='Cordia New','sans-serif'] I have no idea about this one but I would say .PVC.. ( even no compensate pause)
9. Atrial Fibrillation
10. Ventricular Trigeminy PVC
11. Atrial Flutter
12. Sinus rhythm with run of 2 PVC's... This one I'm not sure either... Please comment
Feel free to correct me, teach me, yell at me... do whatevery you want in order to make me learn from my mistake...
:idea:

These are my answer changes IMHO. (I just finished Cardio)

2- more specifically = Non-sustained VT w/ normal QT
4- I think AVNRT is the better answer
5- PR intervals too wide = 1st degree AV block
7- Mobitz type II AV block, b/c consistant PR interval
8 - I'd call this 3rd degree AV block due to the complete disconnect b/w atrial and ventricle depolarizations (thanks)
12- two PVCs together are called a PVC couplet (i don't know how specific you want to be)
 
your link doesn't work, but I'd say if it is all "squiggly" and stuff you should just shock it.

:laugh: Thanks for the laugh. I am having a HORRIBLE morning and this post for some reason just made it all better.:love:
 
Oh, I see, it's 12 different strips. I glanced at the answers you typed in and was thinking "Gee, this guy's in a world of hurt." And I was wondering how "normal sinus rhythm" fit in with all the other badness going on.
 
Thank you for all comments..
No.8 what would you say about RHYTHM.. My professor has not taught me block yet.. So he said just be specific on RATE and RHYTHM.. That's why..
No.4 How can you tell from EKG that's non- sustained. I know that less than 30s is non sustained but how can I look at the ekg? I really don't know..
Thank you in advance ...
 
Thank you for all comments..
No.8 what would you say about RHYTHM.. My professor has not taught me block yet.. So he said just be specific on RATE and RHYTHM.. That's why..
No.4 How can you tell from EKG that's non- sustained. I know that less than 30s is non sustained but how can I look at the ekg? I really don't know..
Thank you in advance ...

Quick tip:
For rate, for a std ECG tracing strip w/o modification (so, traveling at 25mm/sec output from the machine):

Rate = 1500/# of small boxes between beats

4. No, you can not tell if sustained or not. But since you witnessed it, this is where the term "paroxysmal" comes from. I'd label this as PSVT, as you can see consistent P waves preceding each QRS.
Fast with P waves happening as you watch = PSVT. I'd shy away from AVNRT as the P waves seem to be driving the QRS and not a reentrant cycle.

7. "High degree AV block" - not a true Mobitz II, this puppy's beyond that with imminent 3rd degree approaching. See 8, as this will most likely decay into it in a clinical scenario.

8. With the strip given, the atrial impulse rate (remember ECG is ***not*** the pulse rate/contractile rate, as this is just an electrical tracing and not the mechanical beating... you have to physical check to see if the pulses correspond to the tracing!!! ;) ) is regular at about 80 per minute. With only two ventricular impulses shown, you can not determine regularity, but if regular it'll be at about 1500/12 = 25.

11. Specifically, ""4:1 atrial flutter" as there are a consistent 4 flutter waves for each QRS.

Here's a very important question:
What ventricular rate would you observe in a 2:1 atrial flutter?
SO, if you take a pulse and feel this precise rate, you HAVE to think flutter instead of any other tach. If you walk up to a patient, take their pulse, feel THIS RATE, turn to your preceptor and say "I think we have to rule out a 2:1 atrial flutter", you will be most impressive in their eyes!

Just my $0.02
:)
 
Sorry my bad.. He has already taught me AV block... Now I have one more question...
no.7 How can you distinguish non0conducted premature atrial beat and Mobitz type II AV block.? At first, I thought it was premature atrial beat but it seems to be Mobitz type II just as you said...
 
For #7 it is definitely a 2nd degree block with 2:1 conduction. There is no real way to say if it is type 1 or 2 with any certainty. It is most likely type 2 though and likely to degenerate. Get out the cordis and place the transvenous pacemaker.
 
Jeez, if I'd known you guys were gonna help with homework, I would have been in here when I was doing EKG!
 
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