Normally the SA node fires first. That's why it's called the pacemaker. The signal spreads across the atria, pauses at the AV node, then races down the ventricles. Every dysrhythmia is that sequence breaking somewhere.
Before you name anything, you work the strip the same way every time. Six steps, in order:
Don't jump to the name. The usual way an experienced provider misses one is to decide what it is in the first second, then read the rest of the strip looking for proof they were right. Go through all six steps first, and the name is whatever your six answers add up to.
The National Registry adds one more question inside step 4. Most people skip it. What's the relationship between the P waves and the QRS complexes? There are only three possible answers: consistent, progressively prolonging, or no relationship at all. Those three answers are the entire AV-block differential. Ask the question in that form and you get to the block faster than trying to recall four block names off a picture.
The name still doesn't tell you how to treat it. Check a pulse, get a blood pressure, and look at how the patient is acting. The same rhythm on the monitor can be a stable patient you watch and a crashing patient you cardiovert, and most of the rest of this lesson is about telling those two apart.
Quick check
At step 4, the paramedic asks how the P waves relate to the QRS complexes. Which three answers are possible?
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