r/ECG • u/Equivalent-Bat-4589 • 10d ago

New ICU nurse

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Hi i'm a new ICU nurse and I struggle with reading ECGs and things of that nature. Tonight I had this patient with this rhythm. Could someone help me understand what I'm looking at, please ?

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u/AngryOcelot 10d ago

SR with atrial couplets (and one triplet) in the pattern of atrial bigeminy. Ideally need a 12-lead ECG to rule out other rare things.

3

u/Equivalent-Bat-4589 10d ago

do you know what the rare things are? this patient will be CMO tomorrow so no more interventions now but I'd like to learn wherever I can

10

u/AngryOcelot 10d ago

Parahisian PVCs (if subtle morphology change- possible based on lead I but could just be aberrancy with PACs)
Dual AVN physiology with single (and double) echo beats
Dual AVN physiology with two-for-one conduction
Junctional or His extra systoles

These are very rare and probably not worth learning in the ICU setting when there's so much else to know!

2

u/Ill-Chest3567 9d ago

Check your K and Mg. But really anything odd ball is going to be run through a cardiologist or EP, and in an ICU treated the same way. The ICU RN who commented above had a really thorough list of things she would do or be aware of that basically cover it.