Name That Rhythm
The baseline is undulating with no discernible P waves, and the R-R interval is irregularly irregular. Name the rhythm.
Atrial Fibrillation — no organized atrial activity, chaotic baseline, irregularly irregular ventricular response.
Patient in atrial fibrillation, HR 132, BP 118/76, alert and oriented, reports mild palpitations only. Stable or unstable — and what's the priority?
Stable. Priority is rate control (e.g. diltiazem or a beta-blocker) and addressing the underlying cause — no immediate cardioversion needed.
What is the first-line medication class for rate control in a stable patient with atrial fibrillation with RVR?
A calcium channel blocker (e.g. diltiazem) or beta-blocker (e.g. metoprolol) for rate control.
What is the key nursing priority before performing synchronized cardioversion on an awake, symptomatic patient?
Ensure adequate sedation/analgesia is given, and confirm the defibrillator is set to SYNC mode before delivering the shock.
Name the six reversible "H" causes of PEA/cardiac arrest.
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia, Hypoglycemia.
Atrial rate is roughly 250–350/min with a classic sawtooth pattern between QRS complexes. Name the rhythm.
Atrial Flutter — sawtooth flutter waves, often with a fixed conduction ratio (e.g. 2:1, 4:1).
Patient in atrial flutter, HR 150, BP 84/50, new confusion, and chest pain. Stable or unstable — and what's the priority?
Unstable. Priority is synchronized cardioversion — the rhythm is causing hemodynamic compromise and altered mental status.
An unstable patient in atrial flutter with hypotension needs what immediate electrical intervention?
Synchronized cardioversion — timed to the R wave to avoid shocking during the vulnerable T wave.
Name the essential safety check every nurse must perform immediately before defibrillating.
Call and confirm "Clear!" — ensure no one is touching the patient or the bed, and that oxygen source is moved away from the chest.
Name the reversible "T" causes of PEA/cardiac arrest.
Tension pneumothorax, cardiac Tamponade, Toxins, Thrombosis (pulmonary), Thrombosis (coronary), and Trauma.
QRS complexes are wide (>0.12 sec), rate is 150–220, rhythm is regular and monomorphic. The patient still has a pulse. Name the rhythm.
Ventricular Tachycardia (with pulse) — wide-complex, regular, monomorphic tachycardia.
Patient in monomorphic VT with a pulse, HR 180, BP 70/40, diaphoretic and confused. Stable or unstable — and what's the priority?
Unstable. Priority is synchronized cardioversion (with sedation if time/condition allows).
Outline the treatment sequence for pulseless ventricular tachycardia.
Immediate defibrillation (unsynchronized) → high-quality CPR → epinephrine 1mg IV/IO every 3–5 minutes → consider an antiarrhythmic (amiodarone or lidocaine) after the second shock if refractory.
What are the nursing priorities immediately after return of spontaneous circulation (ROSC)?
Obtain a 12-lead ECG, initiate targeted temperature management/post-arrest care bundle, support hemodynamics (fluids/vasopressors as needed), and continue searching for and treating the underlying cause.
A patient in PEA arrest had a massive pulmonary embolism confirmed on recent imaging. Which H or T is responsible, and why does it cause PEA?
Thrombosis (pulmonary) — the clot obstructs right ventricular outflow, causing acute right heart strain and electrical-mechanical dissociation despite organized electrical activity.
The tracing shows chaotic, disorganized waveforms of varying amplitude with no identifiable QRS complexes, and the patient has no pulse. Name the rhythm.
Ventricular Fibrillation — chaotic, disorganized electrical activity with no effective mechanical contraction.
Patient in third-degree heart block, HR 34, BP 82/54, dizzy and near-syncopal. Stable or unstable — and what's the priority?
Unstable. Priority is transcutaneous pacing (atropine is often ineffective in high-degree AV block since the block is usually below the AV node).
After the second defibrillation attempt in V-fib, what medication is given, and how often is it repeated?
Epinephrine 1mg IV/IO, repeated every 3–5 minutes throughout the resuscitation.
What assessment finding should push you to move straight to transcutaneous pacing rather than waiting on repeated atropine doses in complete heart block?
Signs of instability — hypotension, altered mental status, chest pain, or signs of poor perfusion. Don't delay pacing in an unstable, symptomatic patient.
A post-cardiac-catheterization patient suddenly arrests into PEA. What is the most likely "T" cause, and why?
Cardiac Tamponade — likely from a coronary or ventricular perforation during the procedure, causing pericardial fluid accumulation that compresses the heart and prevents filling
P waves march out at their own regular rate, QRS complexes march out at their own separate regular rate, and the two have no relationship to each other. Name the rhythm.
Third-Degree (Complete) Heart Block — complete AV dissociation; atria and ventricles beat independently.
You find a patient unresponsive with no pulse. The monitor shows an organized, narrow-complex rhythm at a rate of 70. What is this called, and what's your very first action?
This is PEA (Pulseless Electrical Activity) — organized electrical activity without an effective pulse. First action: start high-quality CPR immediately and begin searching for a reversible H or T.
A patient with symptomatic third-degree heart block does not respond to atropine. What is the definitive next step, and what does it bridge to?
Transcutaneous pacing, as a bridge to transvenous pacing — atropine is frequently ineffective in complete heart block because the block is usually infranodal.
Name three nursing responsibilities during a code besides performing compressions.
timing/documenting the code (recorder role), administering and timing medications, managing the airway, operating the defibrillator, and communicating with family/team members.
A patient was just intubated, and immediately after starting positive pressure ventilation develops sudden desaturation, hypotension, and PEA. What T should you suspect immediately?
Tension Pneumothorax — positive pressure ventilation can rapidly worsen or cause a tension pneumothorax, especially in a patient with underlying lung pathology or recent trauma.