ACLS Rhythms Cheat Sheet Amanda Hooper 2008-2009

Normal Sinus Rhythm

Asystole PEA Vfib/pulseless Vtach Arrest Rhythms Asystole PEA Vfib/pulseless Vtach

Agonal Rhythm/Asystole

Pulseless Electrical Activity (PEA) Note that PEA can look like any rhythm (any organized electrical activity), but if no pulse it is PEA

Course Ventricular Fibrillation

Fine Ventricular Fibrillation

Non-Arrest Rhythms

One very important thing that seems like it should be easy but I always have to remember how to do: determine the rate… Find a QRS complex that is closest to a dark vertical line. Then count the number of “big boxes” until the next QRS complex. For each “big box” you pass, select the next number off the mnemonic "300-150-100-75-60-50" to estimate the rate. Alternatively, you can count the number of big boxes between two QRS complexes and divide 300 by that number.

Note the rate is > 100 bpm Sinus Tachycardia Note the rate is > 100 bpm

Note it is “irregularly irregular” and there are no definite p waves Atrial Fibrillation Note it is “irregularly irregular” and there are no definite p waves

Note the “saw-tooth” pattern Atrial flutter Note the “saw-tooth” pattern

Reentry Supraventricular Tachycardia This is a regular, narrow complex tachycardia without P waves, usually with a sudden onset and cessation

Monomorphic Ventricular Tachycardia With ventricular rhythms, QRS is usually wide. V tach is more organized electrical activity than v fib, but v tach often deteriorates into v fib so both are very bad!

Polymorphic Ventricular Tachycardia

Torsades de Pointes A special type of polymorphic Vtach- Note the “spindling” in the QRS complexes

Sinus Bradycardia Note the rate <60 bpm. Could be physiologic or symptomatic depending on the patient.

Note the increased PR interval 1st Degree AV Block Note the increased PR interval

2nd Degree AV Block: Mobitz type I (Wenckebach) Note the progressive lengthening of the PR interval until one P wave (arrow) is not followed by a QRS

2nd Degree Block: Mobitz type II Note the regular PR interval until beats are dropped.

3rd Degree AV Block Note the regular P waves and regular ventricular “escape beats” but no relationship between the P waves and escape beats.