ALS Course
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Rhythm strip four – Walter Smith

Take a look at Mr Smith’s rhythm strip and use the 6-stage approach to help you to answer the questions. This will help you to identify the rhythm and decide what action is needed. Answer the first question then select Confirm. Once you have read the feedback, answer the remaining questions as they become active. Roll over the ECG to see a larger image.
An ECG rhythm strip from Walter Smith
An ECG machine
1. Is there any electrical activity? Yes No
2. Is the ventricular (QRS) rate normal? Yes No
3. Is the QRS rhythm regular? Yes No
4. Is the QRS complex width normal? Yes No
5. Is atrial activity present? Yes No
6. Is the atrial activity related to ventricular activity? Yes No
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References

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See chapter 8 of the ALS manual for further explanation and examples of how to analyse cardiac rhythm from the ECG.

See chapter 11 of the ALS manual for further reading about the management of rhythm abnormalities.

Components of a normal ECG complex

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  • Depolarisation begins in the SA node and then spreads through the atrial myocardium
  • This depolarisation is recorded on the rhythm strip as the P wave. The heart responds to this electrical stimulus byatrial contraction
  • The small isoelectric segment between the P wave and QRS complex represents the delay in transmission through the AV node
  • Depolarisation of the bundle of His, bundle branches and ventricular myocardium is shown on the rhythm strip as the QRS complex
  • The T wave represents recovery of the resting potential (repolarisation) in the cells of the conducting system and ventricular myocardium

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<p>Components of a normal ECG – close up of a rhythm strip.</p><p></p>

The 6-stage approach

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1. Is there any electrical activity?

2. What is the ventricular (QRS) rate?

3. Is the QRS rhythm regular or irregular?

4. Is the QRS width normal (narrow) or broad?

Any cardiac rhythm can be described accurately and managed safely and effectively using the first four steps.

5. Is atrial activity present? (If so, what is it: Typical sinus P waves? Atrial fibrillation? Atrial flutter? Abnormal P waves?)

6. How is atrial activity related to ventricular activity? (e.g 1:1 conduction, 2:1 conduction, etc, or no relationship)

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