ALS Rhythm Interpretation
Apr 01, 2024![](https://kajabi-storefronts-production.kajabi-cdn.com/kajabi-storefronts-production/file-uploads/blogs/2147545446/images/844b40-23c-8f2a-24f-87be7afb167d_Concept_Series_website_YouTube_Banner_-5.png)
Rhythm analysis during ALS must be done quickly and accurately so that interruptions to compressions are brief, and the correct arm of the algorithm is followed. π«π₯
Here's our guide! π
During rhythm analysis, ask yourself these questions:
1οΈβ£ Is there any electrical activity?
π If the trace is completely flat even during compressions, check the connection.
2οΈβ£ What is the rate?
π Normal? Tachy? Brady?
3οΈβ£Is the rhythm regular or irregular?
4οΈβ£ P waves?
π Are they present?
π Any discernible features?
5οΈβ£ QRS complex?
π Normal?
π Wide or narrow?
π Any discernible features?
6οΈβ£ T waves?
π Are they present?
π Any discernible features?
Shockable rhythms: β
1οΈβ£ Ventricular fibrillation (VF)
π Rapid rate
π Chaotic, irregular, varied amplitude
π No discernible P, QRS or T waves
2οΈβ£ Ventricular tachycardia (VT)
π Rapid rate
π Irregular
π Wide complex
π Josephson’s sign - notch near lowest point of S wave
π RSR complex shows taller ‘left rabbits ear’
Non-shockable rhythms: β
1οΈβ£ Torsades de Pointes
π Type of VT
π QRS complexes appear to twist around isoelectric line
2οΈβ£ Pulseless electrical activity (PEA)
π Organised or semi-organised rhythm
π Pulse absent when it would be otherwise expected
3οΈβ£ Supraventricular tachycardia (SVT)
π Fast
π Regular
π Narrow QRS complex (if there is no bundle branch block)
π May show inverted P waves
4οΈβ£ Asystole
π ‘Flatline’, however rarely completely flat
π Be aware of CPR artefact
Check out our ALS Masterclass Advanced Anaesthesia Live Series Session for a full rundown.
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Ref: https://www.ncbi.nlm.nih.gov/books/NBK2214/