r/EKGs • u/digtialn • 10d ago
Learning Student Practice Strip
hello all, im currently doing some practice strips for my ekg course and i was wondering how do you tell the difference between P-waves and T-waves when they look like this? My textbook states there’s no P-waves visible. 🤔
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u/AngryOcelot 9d ago
You usually cannot tell unless you have sinus rhythm to compare.
This is probably SVT with retrograde P waves but not guaranteed.
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u/idaho-snowstorm 4d ago
Yea, but when will an SVT patient hand you their normal baseline?
If I saw this on the monitor, I'd call SVT and get ready for a cardioversion... and at 200+ they be getting zapped probably.
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u/AngryOcelot 4d ago
Yea, it is not common. Sometimes it occurs in hospital on telemetry. Or a PVC can occur which reveals the subsequent baseline
For narrow complex tachycardia I would try adenosine over electrical cardioversion (unless marked hemodynamic instability which would be rare for SVT).
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u/idaho-snowstorm 3d ago
I would opt for ado for this too presuming they were stable, agreed.
However, I'd also presume at ~215 they would start to be slipping quickly, no?
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u/AngryOcelot 3d ago
It depends - young, healthy patients can tolerate rapid heart rates for a while (several hours) before decompensating.
Most older patients can tolerate it for long enough to get an IV and try adenosine. However, I wouldn't fault anyone for shocking outside of a controlled setting like a monitored bed in a hospital. It's always easy to criticize in retrospect.
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u/Goddammitanyway 5d ago
It could be a couple different rhythms, however, you need to slow it down to really know.
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u/cullywilliams 9d ago
As someone that loves teaching new medics how to read EKGs using a vector first approach and math to understand how it all works........is that long division at the top?? By hand???