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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.
So before you name anything, you work the strip the same way every time. Six steps, in order:
Pattern-matching off a first glance is how experienced providers talk themselves into the wrong rhythm. Run the six steps, and the name falls out of the answers instead of a guess.
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.
Once you have a name, you're not done. The rhythm tells you what the electricity is doing. The patient tells you what to do about it.
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