Rhythm Strips - ACLS
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ACLS Rhythm Strips

ACLS Review: Cardiac Rhythms
Megacode SurvivalTM
Rhythm Strips Recognition

Cardiac Rhythm Strips Recognition on a monitor is an essential skill in surviving (passing) your simulated megacode.

Other than knowing the algorithms, the most important factor in passing the simulated megacode and ACLS course is quick recognition of the rhythm strips.

Quizzes won't help.
You need to thoroughly understand why each rhythm behaves as it does. Dr. Strange's Study Guide makes it easy.


Learn a simple approach to make rhythm strip reading easy. Learn the rhythms the right way - from understanding!

From an understanding of the rhythms, your learning will be permanent! All of this and much more is included in this Study Guide.

What to expect:

 Simplified approach to EKG Reading
 Illustrations with key identification points for each Cardiac Rhythm

 Each algorithm is simplified for easy learning  

 Effective memory techniques
 Insights and Pearls
 Helpful Hints

Click here:
ACLS Study Guide

After you have mastered the rhythms in the study guide, recognition on the monitor is EASY!

DO NOT wait until the day before your first ACLS class to start learning to recognize the cardiac rhythm strips.

DO NOT try to memorize the strips by looking at them over and over. This the WRONG WAY!

  WHY??? Because of two very important reasons:
      1) The same rhythm can look very different
          on different EKG's.
      2) The same rhythm can look very different
          on the SAME EKG. Different leads look very different.

DO LEARN the right way! Learn the easier and more permanent way to recognize and remember all of the rhythms: Cardiac Rhythm Strips made easy through understanding.
      (See the box on the right)

Click below for "YouTube Monitors"

        Normal Sinus Rhythm .

        Sinus Tachycardia .

        Pulseless Ventricular Tachycardia

        Torsades de Pointes

        Ventricular Fibrillation

        Agonal Rhythm .

        Asystole .

        PEA - Pulseless Electrical Activity

        Sinus Bradycardia .

        First-degree AV Block .

        Second-degree AV Block, Type I (Mobitz I)

        Second-degree AV Block, Type II (Mobitz II)

Cardiac Rhythm Strips         Third-degree AV Block, Complete Heart Block

        SVT - Supraventricular Tachycardia .

        Ventricular Tachycardia with Pulse

        Atrial Fibrillation .

        Atrial Flutter WITH 4:1 BLOCK.

Basic ACLS Cardiac Rhythms Strips Review

ACLS Rhythm Strips When reviewing ACLS Cardiac Rhythm Strips. there are a few important concepts to to recall. During a simulated megacode, you will usually not be looking at a strip of paper the evaluate the rhythm. During the simulated megacode, ACLS Rhythm Strip Indentification means looking at a monitor on the defibrillator. You can see how the rhythms look on a monitor by clicking on one of the above links. You can follow along in the ACLS Student Manual: Megacode Survival for key identifying characteristics for quick recognition of each of the ACLS Rhythms Strips.

Try thinking about dividing the ACLS algorithms into two groups:
1) pulseless rhythms and
2) rhythms with a pulse.
If then patient is pulseless, you have one mind set. When the patient has a pulse, you think a bit differently. Then, break the groups down into smaller segments. This way, the ACLS algorithms become quite manageable.

The Pulseless ACLS Cardiac Rhythms come in two varieties: Those that are shockable and those that are not. Those that are not shockable include asystole and PEA. Both of these pulseless rhythms have a pumping problem that will not be helped with shocking. For these two you need to find and quickly correct the cause. Since shocking the heart puts it into a temporary asystole, adding more asystole to asystole will do nothing. It simply interrupts chest compressions and uses up valuable time. PEA usually has a filling problem. There is an inadequate preload. Once again, shocking will not change the amount of blood that is coming to the heart. If you do not find and treat the cause of the rhythm, you will probably lose the patient. In the ACLS Study Guide, is an introduction to EKG's. If you are not familiar with EKG's, you will find this section most helpful in understanding ACLS Rhythm Strips.

The Shockable Pulseless ACLS Rhythms are all of ventricular origin. These include ventricular tachycardia, ventricular fibrillation, and torsades de pointes (a form of ventricular tachycardia). You will need to learn to identify these rhythms without question. These rhythms are all treated with unsynchronized defibrillation. In these rhythms, the heart is beating too fast for the heart to fill and pump blood. When the heart is defibrillated, it is momentarily put into a brief period of asystole. Often the heart's normal pacemaking system will takeover and resume a normal beating pattern.

Bradycardia is an ACLS Cardiac Rhythm that has a heart rate of under 60 beats per minute; however, bradycardia usually does not become symptomatic unless the heart rate is in the 40's or less. The patient may also have a relative bradycardia. Relative bradycardia occurs when a patient's heart rate is too slow for their condition. An example of relative bradycardia: A heart rate of 70 in not sufficient for a patient in sepsis. Should the heart fail to pump enough blood to supply the heart muscle with oxygen, bradycardia can lead to cardiac arrest. The patient is symptomatic if the bradycardia starts causing chest pain, hypotension, shortness of breath, and nausea, to mention a few. When the bradycardia is severe enough to cause symptoms, it must be treated. ACLS Algorithm Practice is covered in short video lessons. The bradycardia algorithm is made simple, easy, and covered in detail in the ACLS Study Guide: Megacode Survival.

Of all the ACLS Cardiac Rhythms, the most complicated are those patients with a pulse and have tachycardia. Break you thought process down into two groups: 1) Stable and 2) Unstable. When they are stable you have have time for expert consultation. This is always a suitable answer during the simulated megacode. When the patient is unstable, you will be thinking synchronized cardioversion. The ACLS Megacode Study Guide gives great insights for understanding these ACLS Rhythm Strips.

More Information:

             ACLS Megacode Algorithm Practice
              ACLS Megacode Glossary
              ACLS and PALS Study Guides
              ACLS Written Test Exam

The videos and study guides available on this site are intended to compliment, clarify, and simplify basic concepts of the Advanced Cardiac Life Support Course (ACLS). They do not take the place of state or federal laws, any certified training course, reasonable clinical judgement, or specific practices and procedures established by your facility.

Clinical practice is a dynamic process and new information becomes available daily. Prudent practice dictates that the clinician consult further sources prior to applying information, whether in printed or video, obtained from this or any program. StrangeMD.com disclaims any liability, loss, injury or damage incurred as a consequence, directly or indirectly, from the use of any information contained within any videos or manuals.

© 2012, 2013 John E. Strange, M.D.  ♦  All rights reserved

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