The following ECG represents:

DSSSB 13 August 2024

Medical Surgical Nursing

Medium

Appeared in: DSSSB 13 August 2024

Explanation

The ECG displays a heart rate of approximately 150-250 beats per minute, which is a tachycardia.
The rhythm is regular, as indicated by the consistent distance between the QRS complexes.
The QRS complexes are wide (greater than 0.12 seconds) and uniform in shape (monomorphic), which is a hallmark of an impulse originating in the ventricles.
There are no visible P waves preceding the QRS complexes, indicating the rhythm is not originating from the sinoatrial node.
This combination of a fast, regular, wide-complex tachycardia is the classic presentation of Ventricular Tachycardia (VT).

Option A: Atrial fibrillation is characterized by an 'irregularly irregular' rhythm and typically narrow QRS complexes. The ECG in the image shows a regular rhythm with wide complexes.
Option B: Atrial flutter is identified by its characteristic 'sawtooth' flutter waves and usually has narrow QRS complexes. The ECG in the image lacks sawtooth waves and has wide QRS complexes.
Option C: Ventricular fibrillation is a chaotic, disorganized rhythm with no identifiable QRS complexes, appearing as a quivering line. The ECG in the image shows organized, regular, and distinct QRS complexes.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG interpretation of life-threatening cardiac arrhythmias as background academic context rather than a clinical decision trigger.
Recognizing Ventricular Tachycardia is a critical skill for nurses, as it is a medical emergency that can quickly lead to cardiac arrest.
The first nursing action upon seeing this rhythm on a monitor is to assess the patient for a pulse and level of consciousness. The treatment depends on whether the patient is stable (has a pulse and is conscious) or unstable (pulseless or unconscious).
What if? If the patient with this rhythm was found to be pulseless, the situation would be treated as a cardiac arrest. The nurse should immediately call for help, start high-quality CPR, and prepare for defibrillation, as pulseless VT is a shockable rhythm.

How to Approach the Question

First, analyze the image provided, which is an ECG rhythm strip.
Systematically evaluate the ECG using a standard method. A common approach is the 5-step method: Rate, Rhythm, P wave, PR interval, and QRS duration.
Step 1: Determine the rate. It is clearly fast (tachycardia).
Step 2: Assess the rhythm. The distance between the tall complexes (R-R interval) is regular.
Step 3: Look for P waves. No clear P waves are visible.
Step 4: Measure the QRS duration. The complexes are very wide, clearly greater than 3 small squares (0.12 seconds).

Concept Tested & Keywords

Concept Tested: ECG interpretation of life-threatening cardiac arrhythmias.
Stem keywords: ECG, arrhythmia, electrocardiogram
Lead-in keywords: represents
Clinical cues: The visual evidence of a wide-complex tachycardia on the ECG strip is the primary cue.

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 86-88

E6 Medicine Harrison 22e Part 1 p. 1996-1998