ALS Rhythm Interpretation
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. 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/
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