User:Bron766/ECG/Rhythm

Subject: Medicine - - - Level: Tertiary - - - Resource type: Active learning exercises

The rhythm is the pattern in which the heart is activated. Normally this rhythm starts at the SA node and includes one P wave (atrial activation) and then one QRS complex (ventricular activation).

Skills:

• Identify sinus rhythm and explain the normal sequence of heart activation/depolarisation.
• Identify key arrest rhythms and describe them as shockable (VT and VF) or non-shockable.
• Identify and describe a broad range of ventricular rhythms including Ventricular Tachycardia (VT), polymorphic VT / Torsades de Pointes, Ventricular Fibrillation and Ventricular Flutter.
• Identify and describe a broad range of Supraventricular Tachycardia (SVT) rhythms such as Sinus tachycardia, Atrial flutter, Atrial fibrillation (AF), AV Nodal Reentrant Tachycardia (AVNRT), Junctional tachycardia, Atrial Tachycardia and AVRT.
• Analyse wide complex tachycardias using tools such as the Brugada algorithm to help differentiate VT from SVT with aberrancy.
• Identify and describe AV blocks including First degree, Second degree (Mobitz 1 / Wenckebach and Mobitz 2) and Third degree.
• Identify and describe ectopic (premature and escape) rhythms including atrial, junctional and ventricular (VEBs, idioventricular rhythm and AIVR).
• Identify and describe a broad range of sinus variations, bradycardias and pauses including sinus bradycardia, sinus arrhythmia, sinus arrest, sinoatrial exit block, (sick sinus syndrome) and escape rhythms.
• Analyse artificially paced rhythms for capture, false capture, artifacts and single / dual chamber pacing.
• Analyse complex rhythms with ladder diagrams
• Explain the use of a Lewis Lead to detect atrial activity
• Define and use the terms: VT, VF, fibrillation, flutter, SVT, AF, AVNRT, AVRT, aberrancy, Mobitz, Wenckebach, VEB, AIVR, capture beat, fusion beats, MAT, Bigeminy, lewis lead...

How to use this page:

• Explore the sections below by clicking on Process, Review, Apply or Contribute to find a variety of educational exercises. Click again to hide the same content.
• Read the suggestions for each type of activity.
• Choose your learning goals using the list of skills on the previous slide.
• Make this page better by editing it or leaving comments on the talk page.

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

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Exercises:

Process

Active learning exercise: Can you process some new information and transform it into something different? Help: Learning by connectivism involves remixing information to create new connections and links. Start by choosing materials from the collection above that are most relevant to you. Keep a record of which materials you have accessed (suggested ways of doing this can be found here). Transform the information from one format to another. A traditional example of this learning exercise might be taking a lecture and processing it to make dot point notes, but also consider other formats like diagrams, mind maps, short movies and more. Revise your notes by transforming them again rather than just passively reading them. The theory is that this exercise helps you to engage elements of active learning and learning by teaching to increase the quality of your own learning while also creating something useful for others to learn with if you choose to share it.

Review
Active learning exercise: Can you review your knowledge by trying this quiz? Play the 6 Second ECG Simulator Download and use the simECG: ECG simulator Play the ECG Activity from m2hnursing

Apply

Active learning exercise: Can you apply this information to these clinical examples? Can you identify these key arrest rhythms? (What is the rhythm? Is it shockable or non-shockable?) Chest pain then collapse - 63 yo male (Answer) Cardiac arrest Cardiac arrest + CPR Arrest and shock Arrest with and without CPR. (Full case series here) Three shocks: which was not indicated? This one, this one or this one? (Answer here) 56 yo female - palpitations, subsequent deterioration and improvement after treatment. (Answer) Ectopic beats: What is the rhythm? (Answer here) What is the rhythm? #2 Would you like a full 12 lead ECG? (Answer here) P wave problems: (Look closely) Collapse - 79 yo female Anxiety attack - 24 yo male (Answer and case series) 5 hours chest discomfort - 57 yo male (with further discussion and answers) No clinical details (Answer) 88 year old female: Weakness – EMS 12lead (Answer) 2 rhythm strips from EZG: Case 1 and Case 2 (Answer) 60'ish male with weakness and 2 weeks of intermittent chest pain, (Answer) A young person with palpitations, on no medications, and with no known heart disease, (Answer) 88 yo male with pre-syncope on a background of hyperlipidaemia, hypertension, atrial fibrillation, and CVA, (Answer). Wide complex tachycardias: is it VT or SVT with aberrancy? 40's male with sudden dizziness and chest pain on a background of coronary disease, (Answer) 40's male with palpitations, but no previous heart disease, (Answer) 20yo female with palpitations, (Answer) Challenges: Rhythm and 12-lead with discussion What is this narrow complex tachycardia? (9 min video) HR 230, but what is the rhythm? (Answer here.) HR 300!, (Answer) What is this irregular rhythm? (Answer here.) More rhythm challenges here (scroll down to Rhythm challenge) Help: For each skill, here is a collection of relevant cases and clinical examples. You can practise these skills and exercises in any order, but the coloured icons () should help you to find examples of a similar difficulty level. Planned future versions of this page should allow you to keep track of which exercises you have completed, for example by exporting the list to Learnist where you can mark each item as 'done'. You can also review the concepts, theory and background knowledge in the 'Review' section above.

Connect

Active learning exercise: Can you connect with the online medical community to share your growing knowledge? Wikiversity is a community devoted to collaborative learning. We build learning resources from the ground up and also link to existing internet resources. By getting involved, you can benefit from powerful educational models including active learning to strengthen your own knowledge, while also helping others around the world to access medical education. Join in the community: Create your own portfolio of medicine study notes for free on Wikiversity - just add {{med portfolio}} to your Wikiversity user page to get started. Add links to this page by learning how to edit Wikiversity pages. Help to improve the quality of Wikipedia medicine articles and consider joining WikiProject Medicine - Contribute clinical images to Wikimedia Commons or help to sort and classify these resources. Join the FOAM community discussions on Twitter by summarising what you have learned, using the hashtags #FOAMed or #MedEd. Create a free blog or consider guest posting on an established medical blog. You can also learn more about the projects that this page is designed to support, including FOAM, and

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