Interpreting an EKG rhythm strip: An 8 step method

1 Evaluate the P wave. The P wave represents the depolarization of the atria. (Depolarization occurs as the impulse passes through the muscle tissue.) Observe the P wave's size, shape, and location in the waveform. If the P wave consistently precedes the QRS complex, the SA (sino-atrial) node is initiating the electrical impulse. 2 Evaluate the atrial rhythm. The P wave should occur at regular intervals, with only small variations associated with respiration. Using calipers, you can easily measure the interval between P waves, or the P-P interval. Compare the P-P intervals. 3 Determine the atrial rate. For a quick count, add the number of P waves in two 3-second segments and multiply by 10. To be more accurate, count the small squares between the apexes of two P waves. Each small square equals 0.04 second; 1,500 squares equal 1 minute. Divide 1,500 by the number of squares you counted to get the atrial rate. 4 Calculate the duration of the PR interval. Count the small squares between the beginning of the P wave and the beginning of the QRS complex. Multiply that number by 0.04 second. The normal interval is between 0.12 and 0.20 second, or between three and five small squares wide. If the interval is wider, there is a delay in conduction of the impulse to the ventricles. 5 Evaluate the ventricular rhythm. Use calipers to measure the R-R intervals. Place the calipers on the same point of the QRS complex. If the R-R intervals remain consistent, the ventricular rhythm is regular. 6 Determine the ventricular rate. Use the same formula for calculating the atrial rate (Step 3), but count the small squares between the two R waves. Also check that the QRS complex is: shaped appropriately for the lead you're monitoring. 7 Calculate the duration of the QRS complex. Count the squares between the beginning and the end of the QRS complex and multiply by 0.04 second. A normal QRS complex is less than 0.12 second. Some references specify 0.06 to 0.10 second as the normal duration for the QRS complex. 8 Calculate the duration of the QT interval. Count the number of squares from the beginning of the QRS complex to the end of the T wave. Multiply this number by 0.04 second. The normal range is 0.36 to 0.44 second, or 9 to 11 small squares wide.