AIIMS Delhi NO - 2017
Medical Surgical Nursing
Easy
Identify the abnormality in the ECG paper given below image?
![Ventricular Fibrillation: Causes & Treatment [ACLS Algorithm]](https://storage.googleapis.com/nprep-f64b1.firebasestorage.app/admin/1773423209775_final_clean_1.jpg)
Appeared in: AIIMS Delhi NO - 2017
Explanation
- The ECG demonstrates a chaotic, irregular baseline with no discernible P waves, QRS complexes, or T waves.
- This pattern is the hallmark of Ventricular Fibrillation (V-fib), a life-threatening arrhythmia.
- In V-fib, the ventricles quiver ineffectively instead of contracting, which results in no cardiac output and is a form of cardiac arrest.
- Immediate defibrillation is the definitive treatment to restore a normal heart rhythm.
Why Other Options Were Wrong
- Option B: Sinus tachycardia is a regular rhythm with a heart rate over 100 bpm, where each QRS complex is preceded by a normal P wave. The ECG in the image is chaotic and irregular, not fast and regular.
- Option C: Ventricular tachycardia is characterized by a regular rhythm of wide, bizarre-looking QRS complexes at a fast rate. The ECG in the image shows a completely disorganized rhythm, not a regular pattern of wide complexes.
- Option D: Atrial tachycardia is a rapid, regular rhythm originating from the atria, typically with narrow QRS complexes. The ECG in the image lacks any organized atrial or ventricular activity.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing ECG interpretation of life-threatening cardiac arrhythmias in acute care settings.
- Immediate recognition of V-fib on a cardiac monitor is a critical nursing skill, as it is a form of cardiac arrest that requires immediate intervention with CPR and defibrillation.
- V-fib is a 'shockable' rhythm. The chances of survival decrease significantly for every minute that defibrillation is delayed.
- Nurses must be able to differentiate V-fib from artifact (e.g., patient movement, loose electrodes), which can sometimes mimic a chaotic baseline. Checking the patient's responsiveness and pulse is the first step.
How to Approach the Question
- First, analyze the ECG strip in the image systematically. Assess the rhythm, rate, and presence of key waveforms (P wave, QRS complex, T wave).
- Observe the rhythm: It is completely chaotic, irregular, and very fast. There is no repeating pattern.
- Look for distinct waveforms: Note the complete absence of identifiable P waves, QRS complexes, and T waves. The baseline appears to be quivering or fibrillating.
- Compare these findings to the definitions of the arrhythmias in the options.
- Sinus, Atrial, and Ventricular Tachycardia all have some form of organized, repeating QRS complexes, even if they are abnormal or very fast. The image lacks this organization.
- The chaotic, disorganized pattern with no discernible complexes is the classic presentation of Ventricular Fibrillation.
Concept Tested & Keywords
- Concept Tested: ECG interpretation of life-threatening cardiac arrhythmias.
- Stem keywords: ECG paper, abnormality, identify
- Lead-in keywords: Identify
- Clinical cues: The visual appearance of the ECG strip showing a chaotic and irregular waveform is the primary clinical cue.
Question ID
Q3WEadL3ZWYqVTpXAZjQLW
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 234-236
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 642-644
E6 Physiology Review Sembulingam 5e p. 116-118
Practise the full AIIMS Delhi NO - 2017
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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