STEP 2: IDENTIFY THE COMMON CATEGORIES OF ACLS RHYTHMS
WITH A FEW EXAMPLES
Sinus rhythms:
• Normal sinus rhythm (NSR)
• Sinus bradycardia
• Sinus tachycardia
Bradyarrhythmia and Conduction Blocks:
• 1st degree AV block
• 2nd degree AV block Type I (Mobitz Type I, Wenckebach’s)
• 2nd degree AV block Type II (Mobitz Type II)
• 3rd degree AV block (complete heart block, CHB)
Tachyarrhythmias:
• Supraventricular tachycardia (SVT)
• Wide-complex tachycardias
Pulseless rhythms:
• Pulseless ventricular tachycardia (vTach)
• Ventricular fibrillation (vFib)
• Pulseless electrical activity (PEA)
• Asystole
Atrial Dysrhythmias:
• Atrial flutter
• Atrial fibrillation (aFib)
STEP 3: IDENTIFY THE MOST COMMON ACLS RHYTHMS
Normal Sinus Rhythm (NSR)
• Normal P-wave
• Normal QRS Complex
• Normal T-wave
• HR: 60-100 BPM (at rest)
• Treatment: None
25 ACLS – Advanced Cardiac Life Support
Sinus Bradycardia
• Normal P-wave
• Normal QRS Complex
• Normal T-wave
• HR: <60 BPM (at rest)
• Treatment (Symptomatic): Atropine, Dopamine (infusion), Epinephrine (infusion)
Sinus Tachycardia
• Normal P-wave
• Normal QRS Complex
• Normal T-wave
• HR: >100 BPM (at rest)
• Treatment: Reverse underlying condition (fever, anxiety, exercise),
b beta-blockers (metoprolol, sotalol)
1st Degree Heart Block
• Prolonged PR interval due to delay in AV signal transmission
• P-wave may be buried in the preceding T-wave
• Treatment: Transcutaneous pacing (only indicated if prolongation of the
c PR interval is >400 ms)
26 ACLS – Advanced Cardiac Life Support
2nd Degree AV Block Type I (Mobitz Type I, Wenckebach’s)
• Progressive lengthening of the PR interval
• Progression occurs until the QRS complex is dropped
• Treatment: Atropine, Dopamine, Transcutaneous pacing
2nd Degree AV Block Type II (Mobitz Type II)
• PR interval is > 0.20 seconds and consistent (not gradually getting longer) but drops a beat,
generally on a pattern of 3:1 or 4:1
• Treatment: Transcutaneous pacing
3rd Degree AV Block (complete heart block, CHB)
• No identifiable relationship between the P-wave and QRS waves
• P-P intervals are normal but do not relate to the QRS complex
• Treatment: Transcutaneous pacing
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Supraventricular Tachycardia (SVT)
• Profoundly rapid atrial rhythm with narrow QRS complexes
• Occurs when the signal impulse originates over the bundle branches
• HR: 150-250 BPM
• Treatment: Vagal maneuvers, Adenosine, synchronized cardioversion
Atrial Fibrillation (aFib)
• Uniquely characterized by an absence of P-waves before the QRS complex
• HR: Highly irregular with significant fluctuation
• Treatment: beta-blockers (Metoprolol, Sotalol, etc.), Ca++ channel blockers
(Diltiazem, Verapamil, etc.), Digoxin, synchronized cardioversion.
Atrial Flutter
• Uniquely characterized by a saw-toothed flutter appearance
• Toothed fluttering represents multiple P-waves for a single QRS complex
• Treatment: synchronized cardioversion, beta-blockers (Metoprolol, Sotalol, etc.),
Ca++ channel blockers (Diltiazem, Verapamil, etc), Digoxin.
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Ventricular Tachycardia (vTach)
• Abnormally-patterned wide QRS complex
• No P-waves
• High likelihood of rapid deterioration to a state of ventricular fibrillation
(vFib)
• HR: >100 BPM
• Treatment: Defibrillation
Pulseless Ventricular Fibrillation (vFib)
• Characterized by a chaotic and disorganized wave pattern
• Patient has no palpable pulse
• Treatment: Defibrillation, epinephrine, amiodarone, lidocaine HCl
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