Part of the ICU Emergencies Hub — browse every related guide in one place.
Most telemetry units use a 5-lead system. Standard placement:
| Electrode | Placement | Color (US) |
|---|---|---|
| RA (Right Arm) | Right infraclavicular area | White |
| LA (Left Arm) | Left infraclavicular area | Black |
| RL (Right Leg) | Right lower abdomen/hip | Green |
| LL (Left Leg) | Left lower abdomen/hip | Red |
| V (Chest) | V1: 4th ICS right sternal border | Brown/White |
| Rhythm | Key Features | Immediate Action |
|---|---|---|
| Sinus Tachycardia | Rate >100, regular, normal P waves | Find cause (pain, fever, hypovolemia, anxiety); treat underlying |
| Sinus Bradycardia | Rate <60, regular, normal P waves | Assess symptoms; if symptomatic: atropine 1 mg IV; notify MD |
| PAC (Premature Atrial) | Early beat, abnormal P wave, narrow QRS | Usually benign; note frequency; assess caffeine, stress, electrolytes |
| Atrial Fibrillation | No distinct P waves, irregularly irregular, variable rate | Rate control vs rhythm control per order; anticoagulation assessment |
| Atrial Flutter | Sawtooth flutter waves (~300 bpm), regular ventricular rate | Rate control; assess hemodynamics; cardioversion if unstable |
| SVT | Rate 150–250, narrow QRS, abrupt onset/offset | Vagal maneuvers; adenosine 6 mg rapid IV push if ordered |
| PVC | Wide, bizarre QRS, no preceding P wave, compensatory pause | Single: usually benign; multifocal/runs: notify MD; check K+/Mg2+ |
| Ventricular Tachycardia | Wide QRS (>0.12s), rate >100–250, regular | Check pulse! Pulseless = CPR + defibrillation; pulse present = ACLS |
| Ventricular Fibrillation | Chaotic, no discernible complexes | CPR IMMEDIATELY + defibrillate (200J biphasic); call code blue |
| Torsades de Pointes | VT with twisting axis; long QT on baseline | Mag sulfate 2g IV; stop QT-prolonging drugs; correct electrolytes |
| 2nd Degree AV Block Type I (Wenckebach) | Progressive PR lengthening until QRS dropped | Usually benign; monitor; notify MD if symptomatic |
| 2nd Degree AV Block Type II | Constant PR, randomly dropped QRS | Notify MD promptly; may need pacemaker |
| 3rd Degree (Complete) AV Block | No relationship between P waves and QRS | URGENT: transcutaneous pacing; atropine usually ineffective; call MD stat |
| Asystole | Flat line (confirm in 2 leads) | CPR immediately; epinephrine 1 mg IV q3–5 min; no defibrillation |
| Drug | Used For | Key Nursing Considerations |
|---|---|---|
| Metoprolol (beta-blocker) | Rate control: A-fib, SVT, VT prevention | Hold if HR <50 or SBP <90; monitor for bronchospasm |
| Diltiazem (CCB) | Rate control: A-fib/flutter, SVT | Do NOT use in WPW with A-fib or decompensated HF; monitor BP/HR |
| Adenosine | SVT termination | Rapid IV push + NS flush; warn patient of transient chest pressure/doom feeling; very short half-life |
| Amiodarone | VT, VF, A-fib rhythm control | Many drug interactions; monitor LFTs, TFTs, pulmonary function; phlebitis risk (use central line if possible) |
| Lidocaine | VT (acute) | Watch for CNS toxicity (seizures, confusion) at high doses |
| Magnesium sulfate | Torsades de Pointes, hypomagnesemia-related arrhythmias | Monitor deep tendon reflexes; have calcium gluconate at bedside as antidote |
| Atropine | Symptomatic bradycardia | 1 mg IV; max 3 mg total; may worsen 2nd degree Type II — use with caution |
| Digoxin | Rate control in A-fib, HF with reduced EF | Narrow therapeutic index; check apical pulse 1 min before giving; hold if <60; toxicity: N/V, visual changes (yellow-green halo), bradycardia |
Get the ICU Notebook
Free investing strategies built for nurses. One email per week, no fluff.
Yes, send it freeNo spam. Unsubscribe any time.