In a cardiac arrest emergency, identifying the rhythm strip on the monitor is the first step in determining whether to deliver a shock or perform immediate chest compressions.
Shockable Rhythms
- Ventricular Fibrillation (V-Fib): Chaotic, rapid, irregular wave pattern representing twitching ventricles. No P waves, no QRS complexes. Action: immediate defibrillation.
- Pulseless Ventricular Tachycardia (pVT): Rapid, wide QRS complexes without a pulse. Action: Treat as V-Fib; deliver unsynchronized shock (Defibrillation).
Non-Shockable Rhythms
- Asystole: Total absence of electrical activity (flat line). Action: High-quality CPR, Epinephrine 1 mg IV/IO every 3-5 minutes. Do not shock.
- Pulseless Electrical Activity (PEA): Electrical activity is present on the monitor, but the patient does not have a detectable pulse. Action: Treat as asystole; perform CPR and identify underlying reversible causes (H's and T's).
