This ECG is being offered as a teaching aid, to show how artifact can affect our ability to interpret an ECG, and to encourage our students to be meticulous in obtaining a good-quality tracing whenever possible. If there are insurmountable obstacles preventing a technically good tracing, the circumstances should be written on the ECG. Such obstacles could be: seizures, tremors, vigorous resuscitation efforts underway, or patient not cooperating.
This patient was diagnosed by the rescue crew as having atrial fibrillation, based on the fact that they thought the rhythm was irregular, and they could not see P waves. They also noted a wavy baseline, and considered it to be fibrillatory waves. In reality, the underlying rhythm is regular, with some PACs (regularly irregular).
This rhythm strip shows normal sinus rhythm, slightly on the fast side of normal at 95 bpm. The baseline undulates up and down with the movements of the patient's chest as she breathes. One way to correct this problem on a monitor strip is to move the limb electrodes away from the chest and onto the limbs.
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