Complex Arrhythmias: Lethal or Not

By: Suzan Miller-Hoover, DNP, RN,CCNS

How comfortable are you interpreting EKG strips? Would you be able to recognize lethal arrhythmias? Can you state the first steps to take when you see a lethal rhythm on the monitor?

Many nurses are not comfortable interpreting EKG strips and cannot answer yes to the questions above. Are you one of them?

If you are, you may not be working in a unit where this knowledge is necessary. However, if you work in units where patients are on monitors, you should know the lethal rhythms and how to treat them.

We know patients with known cardiac disease suffer the greatest number of lethal arrhythmias; however, arrhythmias may occur with any patient on any floor at any time.

There are four lethal rhythms that you should be aware of.
  •   Asystole: complete cessation of heart function, straight line on monitor
  •   PEA: complete cessation of heart function, but there is normal electrical activity on the monitor
  •   Ventricular tachycardia: Ventricular rates, may be stable or unstable, wide complexes with no p waves
  •   Ventricular fibrillation: Ventricle quivers, prohibiting contraction

Of the four rhythms mentioned above, ventricular fibrillation is considered the most serious cardiac rhythm disturbance (American Heart Association, 2016).

The first step you should take if you see a rhythm disturbance on the monitor is to check the patient. The disturbance may not be real, examples of this are:
  •   Asystole because the leads have become displaced or dry
  •   Ventricular fibrillation because the patient is brushing his/her teeth
These patients will be awake and alert.

Step two: If the patient is NOT awake and alert, you should check for responsiveness, is there a pulse?
  •   If the patient is responsive and has a pulse, you have time to determine the cause of the arrhythmia, it might be ventricular tachycardia and the patient is stable at this time. Remember, stable can deteriorate to unstable rapidly.

Step three: NO PULSE is a Medical Emergency,
  •   Call for help
  •   Start CPR
When the patient is without a pulse, you do not need to determine the arrhythmia, these patients are at risk of dying or having severe aftereffects, if action is not taken immediately.

If you need to review standard lead selection, placement, and tracings, please refer to the Telemetry Interpretation: Rates, Rhythms, And More course on RN.com.

For more information regarding lethal arrhythmia recognition and treatment, please refer to the Lethal Arrhythmias: Advanced Rhythm Interpretation course on RN.com

You can make a difference. If you want to learn more about arrhythmia recognition and treatment, challenge yourself to take an American Heart Association, Advanced Cardiac Life Support Class (ACLS) (American Heart Association, 2015).

American Heart Association (AHA). (2015). 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers (updated 4/4/2016). Print ISBN 978-1-61669-397-8, AHA Product Number 15-1000. eBook ISBN 978-1-61669-419-7, AHA Product Number 15-3105

AHA. (2016). Ventricular fibrillation. Retrieved from: https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/ventricular-fibrillation

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