NSR
First Glance:
Looks like sinus. Rate looks fine.
Discussion:
How do you call sinus rhythm on a single EKG lead? Technically, you can’t, but we assume that if the P wave axis is normal and everything else is regular it’s the most likely story. P waves should be upright in most of the limb leads, including I, II, III, and AVF, as it is here. Let’s call this sinus rhythm.
So how about the lower tracing?
That’s an A-line trace. You can see the systolic waves following the QRS complexs in the EKG above (they lag behind). The arterial pressure is moseying between an uninspiring 48ish diastolic and 70ish systolic. That’s weak, with the pulse pressure of just over 20 mmHg. But wait- look at the trace.
There is no dicrotic notch. Maybe this is a damped system- perhaps with an air bubble in the line from a faulty flush or a clot. We can look at what the monitor thinks- it reads out (along the top of the strip) that the arterial pressure is 72/46 and the noninvasive BP was last 92/52. I think it’s time to flush this line and see what gives.
Final Impression?
NSR with a concerning arterial trace.
Management implications:
Check A-line.
The Take-home Point:
When the A-line reads a systolic blood pressure of 72, do you automatically jack up the norepi? Check that you’re getting a real number. Don’t treat the monitor, treat the patient.
Two star strip. The meat and potatoes.