ALS Rhythm Interpretation

als ecg non-shockable rhythms patient safety shockable rhythms Apr 01, 2024
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. πŸ«€πŸ’₯
 
Here's our guide! πŸ‘‡
 
During rhythm analysis, ask yourself these questions:
 
1️⃣ Is there any electrical activity?
πŸ‘‰ If the trace is completely flat even during compressions, check the connection.
 
2️⃣ What is the rate?
πŸ‘‰ Normal? Tachy? Brady?
 
3️⃣Is the rhythm regular or irregular?
 
4️⃣ P waves?
πŸ‘‰ Are they present?
πŸ‘‰ Any discernible features?
 
5️⃣ QRS complex?
πŸ‘‰ Normal?
πŸ‘‰ Wide or narrow?
πŸ‘‰ Any discernible features?
 
6️⃣ T waves?
πŸ‘‰ Are they present?
πŸ‘‰ Any discernible features?
 
Shockable rhythms: βœ…
 
1️⃣ Ventricular fibrillation (VF)
πŸ‘‰ Rapid rate
πŸ‘‰ Chaotic, irregular, varied amplitude
πŸ‘‰ No discernible P, QRS or T waves
 
2️⃣ Ventricular tachycardia (VT)
πŸ‘‰ Rapid rate
πŸ‘‰ Irregular
πŸ‘‰ Wide complex
πŸ‘‰ Josephson’s sign - notch near lowest point of S wave
πŸ‘‰ RSR complex shows taller ‘left rabbits ear’
 
Non-shockable rhythms: ❌
 
1️⃣ Torsades de Pointes
πŸ‘‰ Type of VT
πŸ‘‰ QRS complexes appear to twist around isoelectric line
 
2️⃣ Pulseless electrical activity (PEA)
πŸ‘‰ Organised or semi-organised rhythm
πŸ‘‰ Pulse absent when it would be otherwise expected
 
3️⃣ Supraventricular tachycardia (SVT)
πŸ‘‰ Fast
πŸ‘‰ Regular
πŸ‘‰ Narrow QRS complex (if there is no bundle branch block)
πŸ‘‰ May show inverted P waves
 
4️⃣ Asystole
πŸ‘‰ ‘Flatline’, however rarely completely flat
πŸ‘‰ Be aware of CPR artefact
 
Check out our ALS Masterclass Advanced Anaesthesia Live Series Session for a full rundown.
 
Build knowledge βœ…
Improve safety βœ…
 
Ref: https://www.ncbi.nlm.nih.gov/books/NBK2214/
 

 

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