Flash Cards 605

ix

Preface

There are many ways to learn electrocardiography and

many levels of expertise within this complex field. For ease

of reference, the various levels of knowledge/ability can

be outlined as follows:

Type Level Knowledge/Ability

Single Lead

(Arrhythmias)

I Ability to recognize a

limited number of familiar

patterns, usually the major

life-threatening rhythms. No

understanding of rules or

mechanisms.

II Basic understanding of

the rules and mechanisms

of common arrhythmias

according to pacemaker

sites. No familiarity with

more sophisticated features

that complicate basic

arrhythmias.

III Ability to interpret

arrhythmias that include

more sophisticated features

such as sinus arrest,

pacemakers, aberrancy, and

blocked beats.

12-Leads

(Complexities)

IV Familiarity with 12-lead

EKGs (e.g., bundle branch

block, infarction location,

axis deviation).

V Ability to distinguish

subtle EKG findings

(e.g., concealed conduction,

reciprocal conduction,

trifascicular block, His

bundle recordings).

It is best for a student to move through these levels in a

relatively logical progression from simple to complex.

Unfortunately, new students often lack a solid foundation

upon which to build more sophisticated understanding.

Basic Arrhythmias is designed to provide that sound

conceptual base. Its primary area of concentration is

Level II: basic understanding of common, uncomplicated

rhythms. It is hoped that Basic Arrhythmias will provide an

enjoyable and interesting way for people to develop the

framework that will later support continued learning in

the area of electrocardiography.

Basic Arrhythmias is designed to provide a solid

foundation for ongoing EKG learning. For this reason,

great care has been taken to instill simple, basic concepts

while avoiding misconceptions or erroneous impressions. The driving goal has always been to build a very

strong, but basic, understanding of arrhythmia interpretation. A fair amount of legitimate information was necessarily omitted from the text because it is considered

beyond the scope of a basic foundation. However, over

the years, readers lobbied strongly for some areas to be

added. In those cases, the content was included as appendices, rather than as part of the basic, programmed section of the book. Examples include: Cardiac Anatomy and

Physiology, Pathophysiology and Clinical Implications of

Arrhythmias, 12-Lead Electrocardiography, Basic 12-Lead

Interpretation, and Pacemakers. The Appendices are the

only sections in the book not considered “basic” arrhythmia interpretation.

About the Ninth Edition

Basic Arrhythmias has been well received for many years

and has been used successfully by hundreds of thousands

of students as they begin to study electrocardiography.

It is always a challenge to update and refresh it without

detracting from what makes it such a success. With this

edition, we’ve fixed a few bugs, switched out some troublesome EKG strips, added some new illustrations and

upgraded some old ones, expanded some sections, and

clarified a few ambiguous areas. Please note that a compiled list of learning objectives is presented later in this

section. These objectives outline in depth what you can be

expected to learn and do after completing each chapter.

In addition, we have expanded and improved the

digital learning resources for the Basic Arrhythmias

program. The new Pearson eTextbook integrates an

updated version of our Rhythm Randomizer an innovative

self-study exercise where you can use virtual calipers and

test your strip-reading knowledge against a database of

over 600 strips.

I am very excited about this ninth edition of Basic

Arrhythmias and hope you find it as enjoyable as I do.

With all its upgrades and its fresh new look, it promises to

continue the long tradition of helping students embark on

their studies of electrocardiography.

ALGrawany

x Preface

Acknowledgments

It is impossible to fully acknowledge all the people who

have contributed over the years to making Basic Arrhythmias

what it is today. There have been literally hundreds of

people over the years from all across the country who have

offered ideas and suggestions, contributed strips, provided

clinical reviews, and debated interpretation with me.

Without that clinical help, this book would not have

achieved the reputation for excellence that it enjoys today.

Coupled with the clinical excellence, the team at

Brady Publishing has set the standard for excellence in

the publication of such works. Going all the way back to

the original family members at Brady Publishing, countless publishing professionals have added their mark to this

book. In recent years, Pearson has continually moved us to

new heights with its print and media expertise. It is always

a joy to work with such professionals. Thank you.

GAIL WALRAVEN

La Jolla, California

Instructor Reviewers

The reviewers of Basic Arrhythmias provided excellent suggestions for improving the text. Their reviews were an important aid in the revision and updating of material, and

their assistance is greatly appreciated.

Reviewers of the Ninth Edition

Linda M. Abrahamson, RN, EMT-P, EMS Education

Coordinator, Advocate Christ Medical Center,

Downers Grove, IL

Gary W. Bonewald, EMS Program Director, Wharton

County Junior College, Wharton, TX

Jim Cueno, Paramedic Program Director, Lead

Instructor, Butte Community College, Oroville, CA

Reviewers of Previous Editions

Lauri Beechler, RN, MSN, CEN, Director, Paramedic

Program, Loyola University Medical Center,

Maywood, IL

Ashley Cheryl, BSN, RN, Education Instructor, Saint

Francis Hospital, Department of Education and

Professional Development, Tulsa, OK

Jackilyn E. Cypher, RN, MSN, NREMT-P, Paramedic

Program Course Director, Lead Instructor, Portland

Community College, Cascade Campus, Portland, OR

Deborah Ellis, RN, MSN, NP-C Assistant Professor,

Missouri Western State University, Saint Joseph, MO

Mary Fuglaar, PHRN, NREMT-B Training Lieutenant,

Fort Bend County EMS Rosenberg, TX

Brian Hess, Star Technical Institute Philadelphia, PA

Scott Jones, MBA, EMT-P, EMS Professor, Victor Valley

College Regional Public Safety Training Center,

Yucaipa, CA

Bradley K. Jordan, EMT-P EMT-P/Level 1 EMS

Instructor, Rockingham Community College,

Wentworth, NC

Lawrence Linder, PhD, NREMTP, Program Manager,

Hillsborough Community College, Tampa, FL

Christine Markut, PhD, RN, BC, CNE, Associate

Professor, Stevenson University, Stevenson, MD

Lynette McCullough, NREMT-P, MCH Program

Coordinator, Paramedic Technology, Griffin Technical

College, Griffin, GA

Jeff McDonald, BS, LP Program Coordinator Tarrant

County College, Hurst, TX

Mike McEvoy, EMS Coordinator, Saratoga County, NY

Matthew F. Powers, RN MS CEN MICP EMS Chief,

North County Fire Authority Fire/Emergency

Nursing, Daly City, CA

Trent Ragsdell, MBA, Life Support Program Manager/

EMS Coordinator, 55th Medical Group Education and

Training Department, Offutt AFB, NE

Ken Schoch, Program Director, Yavapai College

Prescott, AZ

Douglas P. Skinner, BS, NREMTP, NCEE, Training

Officer, Loudoun County Fire Rescue, Leesburg, VA

Michael Smertka, EMT-P, EMS, Assistant Instructor,

Cleveland Clinic EMS Academy Cleveland, OH

Kimberly Tew, BSN, RN, University of Iowa College of

Nursing, Iowa City, IA

Paul S. Visich, PhD, MPH, Director of the Human

Performance Laboratory, Central Michigan University

Mt. Pleasant, MI

Carl Voskamp, MBA, LicP, EMS Program Coordinator,

The Victoria College Victoria, TX

Michael L. Wallace, MPA, E T-P, CCEMTP, EMS

Captain/Educator, Central Jackson County Fire

Protection District, Blue Springs, MO

Charlotte A. Wisnewski, PhD, RN, BC, CDE, CNE,

Associate Professor, University of Texas Medical

Branch School of Nursing, Galveston, TX

xi

Navigating Through the Text

The text is broken up into three sections: Section 1:

Self-Instructional Unit, Section II: Practice Strips, and

Section III: Appendices. The first eight chapters of this text,

found in Section 1 are structured as a self-instructional

unit in a “programmed learning” format. As such, it is an

entirely self-contained learning package; the only

SECTION I: Self-Instructional Unit

Chapters 1–8 each include the following sections:

• Programmed Content The narrative will teach you any rules and explanatory materials you’ll need to know to

interpret arrhythmias. Each content section (called a frame) is numbered. As you are asked to respond, write your

answer in the blank space provided. The answers are given in the right-hand margin directly across from the question. If you have trouble with an answer, go back over the referenced frames to find the explanation.

• Flash Cards Some of the chapters will ask you to take time out from the program to memorize material such as

specific rules for each arrhythmia. For your convenience, material that must be committed to memory has been

printed on the flash cards that are provided with this book. This is an effective method of memorizing material in

a short period of time.

• Key Points All major points contained in a chapter are presented in a bulleted list at the end of that chapter. This

is provided for your review as you complete the chapter, and as a reference should you need to look up a point in

the future.

• Self-Test Each chapter closes with a self-test of the important information contained in that chapter. The format

of the self-tests is very similar to the format of the text, except that each question is keyed back to the frames in the

chapter that provide the answer to that specific question. Since the self-test is intended to tell you whether or not

you learned the material in the chapter, you will want to let a little time pass between completing the chapter and

beginning the self-test. If you take the test immediately after finishing the chapter, you might simply be recognizing

familiar terms, rather than truly understanding the information. So, once you finish the chapter, take a break from

the subject for an hour or two. Then come back to take the test. If you do well on the test, go on to the next chapter.

If your results indicate that you did not really learn the material, go back and remedy that before you move on. Otherwise, you won’t have a solid foundation for learning future subjects well.

• Practice Strips Starting in Chapter 2, practice rhythm strips are provided at the end to illustrate key points in the

chapter, and to allow the student to practice what was learned in that chapter.

SECTION II: Practice Strips

Chapters 9 and 10 both have collections of EKG strips to practice analyzing; however, each has its own purpose.

• Ch 9: Practice Strips This collection of strips is designed for practice only.

• Ch 10: Self-Test This collection is a fully weighted self-test in case you’d like to see how you’re doing.

additional materials you will need are a pencil and a set

of EKG calipers, which are available at most medical supply houses and medical bookstores. Everything else is provided here in a format designed to make this learning an

enjoyable and worthwhile process. The internal structure

of the individual chapters is as follows:

ALGrawany

xii Navigating Through the Text

SECTION III: Appendices

Over the years, a number of topics have been requested by readers, some of which were beyond the scope of the original

introductory course. Those topics have been added as appendices to differentiate them from the original scope of the book. The

format in the appendices is not self-instructional; it is covered in a more traditional text style.

A Cardiac Anatomy and Physiology

B Pathophysiology and Clinical Implications of Arrhythmias

C 12-Lead Electrocardiography

D Basic 12-Lead Interpretation

E Pacemakers

xiii

Learning Objectives

The objectives below outline in depth what you can be

expected to learn and do after completing each chapter.

Section I: Self-Instructional Unit

Chapter 1 ELECTROPHYSIOLOGY

1 Describe the electrophysiologic basis of cardiac

arrhythmias.

1.1 Give the uses and limitations of cardiac arrhythmia

monitoring.

1.1.1 Distinguish between the electrical and the

mechanical functions of the heart.

1.1.2 Relate cardiac arrhythmia monitoring to

pulse/perfusion assessment.

1.2 Explain how cardiac impulses are formed.

1.2.1 Briefly describe the sodium pump.

1.2.2 Define polarization and describe the

polarized state.

1.2.3 Define depolarization and explain how it occurs.

1.2.4 Define repolarization and explain how it occurs.

1.3 Describe the heart’s electrical conduction system.

1.3.1 Identify the five major areas of electrical

conduction.

1.3.2 Outline the physical layout of the conduction

system.