Third-degree heart block: All P waves are nonconducted, and there is either a junctional or ventricular escape rhythm. Mobitz type II second-degree heart block usually indicates structural disease in the atrioventricular (AV) node or His-Purkinje system and is an indication for pacemaker implantation. In Mobitz type II block, the PR interval is fixed and occasional P waves are nonconducted. Mobitz type I second-degree heart block is sometimes due to increased vagal tone and is usually a relatively benign finding. Second-degree heart block: In Mobitz type I (Wenckebach) block, the PR interval increases until a P wave is nonconducted ( Fig. ▪įirst-degree heart block: The PR interval is a fixed duration of more than 0.20 seconds. 7.ĭescribe the three types of heart block. Junctional escape rhythms usually occur at a rate of 40 to 60 beats/min and will usually be narrow complex (unless the patient has a baseline bundle branch block), whereas ventricular escape rhythms will usually occur at a rate of 30 to 40 beats/min and will be wide complex. How can one distinguish a junctional escape rhythm from a ventricular escape rhythm in a patient with complete heart block? Rates of 61 to 100 beats/min are referred to as accelerated junctional rhythm, and rates of >100 beats/min or higher are referred to as junctional tachycardia. What is the normal rate of a junctional rhythm? P-wave height in the inferior leads (II, III, and aVF) ≥ 2.5 to 3 mm (2.5 to 3 small boxes) ( Fig. What electrocardiogram (ECG) finding suggests right atrial enlargement (RAE)? ▪ Terminal portion of the P wave in lead V1 ≥ 0.04 sec (1 small box) wide and ≥ 1 mm (1 small box) deep 4. P wave total width of > 0.12 sec (3 small boxes) in the inferior leads, usually with a double-peaked P wave ▪ What criteria are used to diagnose left atrial enlargement (LAE)? ▪ What are the most commonly used criteria to diagnose right ventricular hypertrophy (RVH)? ▪ R wave in lead I + S wave in lead III > 25 mm 2. R wave in V5-V6 + S wave in V1-V2 > 35 mm ▪ Remember, the time (T) piece is usually optional and therefore can be omitted.What are the most commonly used criteria to diagnose left ventricular hypertrophy (LVH)? ▪ You may find it helpful to use one of the following templates when creating your PICO question. How much time does it take to demonstrate the clinical outcome(s)?ĭesign a question that incorporates the most salient piece of information from each of the above categories. What is(are) the ideal clinical outcome(s)? (Examples: Different treatment placebo continuation of current standard of care lack of a risk factor) Is there an alternative intervention or treatment to compare?

What is the main intervention, diagnostic test, or treatment you wish to consider? INTERVENTION, PROGNOSTIC FACTOR, OR EXPOSURE What is the patient population? What is the primary problem? Students can complete the following worksheet, incorporating detailed information into each response.ĭecide what your research interest or topic is and then develop a research question to answer it. The PICO(T) Chart provides an easy framework for integrating clinical information into the development of a research question. Students sometimes have difficulty incorporating classroom skills into the clinical setting. Below is a chart to guide you in formulating a question by breaking it down to its most important parts. When searching for evidence-based practice studies in the Nursing and Medical databases, you must first develop a well-built clinical question.

Serial ecgs