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![\"\"](\"http:\/\/electricant.net\/ekg\/striptease\/strip42.jpg\")
<\/a><\/p>\nFirst Glance:<\/strong><\/p>\n From across the room it looks like the bradycardic complexes just stop.<\/p>\n Discussion:<\/strong><\/p>\n Even folks with no medical training can tell this isn’t good. We have sparse bradycardic complexes with bizarre wide morphology and no clear P waves (at low gain) that just end halfway through the strip. None of those things are good things, and portend serious cardiac problems even before the heart actually stopped.<\/p>\n Here is a strip from prior in this patient’s ICU stay: Here we see different QRS morphology, probably because the pre-asystolic rhythm I showed you first is an agonal ventricular rhythm. The baseline, seen best in the lower lead at 160%, show no organized atrial rhythm, and the rate is irregularly irregular. This second strip is probably afib.<\/p>\n If the QRS complexes had been similar between the two strips, the first strip would be more consistent with junctional escape failure or sinus arrest without a ventricular escape, but here is more consistent with an idioventricular rhythm.<\/p>\n Final Impression?<\/strong><\/p>\n 1) agonal ventricular bradycardia @ ~35 bpm to asystole Management implications:<\/strong><\/p>\n Asystole is mimicked perfectly by leads falling off or by low gain. Check leads, check other leads, and if you were never able to see any complexes- check pulse (and have someone confirm gain is not down) before you start doing compressions.<\/p>\n \u00a0The Take-home Point:<\/strong><\/p>\n Wide bradycardic rhythms are often termed ‘agonal’ rhythms are they are common terminal rhythms. The QRS’s visualized may or may not actually be pumping any blood, so just because you see an organized rhythm on the monitor doesn’t mean the patient has a pulse, or is perfusing her brain.<\/p>\n <\/p>\n <\/p>\n asystole First Glance: From across the room it looks like the bradycardic complexes just stop. Discussion: Even folks with no medical training can tell this isn’t good. We have sparse bradycardic complexes with bizarre wide morphology and no clear P waves (at low gain) that just end halfway through the strip. None of those things …read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[4],"class_list":["post-515","post","type-post","status-publish","format-standard","hentry","category-cases","tag-1star"],"_links":{"self":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/515","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/comments?post=515"}],"version-history":[{"count":7,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/515\/revisions"}],"predecessor-version":[{"id":517,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/515\/revisions\/517"}],"wp:attachment":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/media?parent=515"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/categories?post=515"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/tags?post=515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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\n2) atrial fibrillation with wide complexes @ ~75 bpm.<\/p>\n<\/a>One star strip. Students should identify the rhythm correctly.<\/em><\/p>\n—> see the next strip<\/a><\/h1>\n","protected":false},"excerpt":{"rendered":"