1
About the
Authors
Adam Peddicord
Co-Founder, Pass with PASS, LLC
Adam has been a Paramedic since 1998 and started his fire
service career in 1993. He is currently the EMS Coordinator and
a Captain/Paramedic at Newport (KY) Fire/EMS Department
where he also serves as the Medical Commander of the
Newport Police Department SWAT Team.
He holds multiples Associate’s Degrees along with a Bachelor’s
and Master’s Degree in Nursing and is a board-certified Family
Nurse Practitioner. As a Nurse Practitioner, Adam has
experience in orthopedics and addiction medicine. Adam has
over 20 years of experience in EMS education through the
University of Cincinnati and Gateway Community and Technical
College.
Brandon Schoborg
Co-Founder, Pass with PASS, LLC
Brandon is currently the EMS Education Manager of a hospital
and college based EMT/Paramedic Program in Kentucky.
Previously, he was the EMS Education Manager for the
Columbus (OH) Division of Fire, Director of EMS Education at
Cleveland Clinic Akron General, Assistant Paramedic Program
Coordinator at a community college in Kentucky and the
Assistant EMS Coordinator, Engineer/Paramedic, and SWAT
Paramedic with the Newport Fire/EMS Department in Kentucky
for 8 years. He began his teaching career at the University of
Cincinnati Clermont College.
He completed his paramedic education at the University of
Cincinnati in 2010. Brandon has an Associate’s Degree in EMS-
Paramedic, Bachelor’s Degree in Health Science, and a MBA in
Healthcare Management.
Copyright 2022 - Pass with PASS, LLC 2 2
Disclaimer
All procedures listed in the study guide should only be performed by
appropriately licensed/certified, authorized, and trained personnel as your local
government, state, or country allow.
Medication dosages may differ across the country, any medication dosages in
the study guide are relatively standardized, however, we encourage you to check
your local protocol and/or program’s preferred dosages.
Copyright © 2022 by Pass with PASS, LLC. All rights reserved. No part of the
material protected by this copyright may be reproduced or utilized in any form,
electronic or mechanical, including photocopying, recording, or by any information
storage and retrieval system, without written permission from the copyright
owner.
Reference herein to any specific commercial product, process, or service by
trade name, trademark, manufacturer, or otherwise does not constitute or imply
its endorsement or recommendation by Pass with PASS, LLC.
Although we make every effort to ensure that the material contained within the
study guide is current and accurate, we cannot guarantee accuracy. However,
please know, that accurate and current study guides is extremely important to us
and we continuously review our guides for quality assurance.
Copyright 2022 - Pass with PASS, LLC 3
Table of Contents
1. EKG Rhythm Quick Reference 5
2. Bradycardia Rhythms 7
3. Tachycardia Rhythms 9
4. Cardiac Arrest Rhythms 11
Copyright 2022 - Pass with PASS, LLC 4
1
EKG Rhythm
Quick Reference
Copyright 2022 - Pass with PASS, LLC 5
Chapter 1: EKG Rhythm Quick Reference
EKG Rhythm Interpretation
Quick Reference
Copyright 2022 - Pass with PASS, LLC 6
2
Bradycardic
Rhythms
Copyright 2022 - Pass with PASS, LLC 7
Chapter 2: Bradycardic Rhythms
Symptomatic Bradycardia
Atropine
Single Dose: 1mg
Max: 3mg
Transcutaneous Pacing
25mA+, 70 – 80bpm
Increasing milliamps (mA) until electrical capture and mechanical capture
are received.
Electrical Capture: pacer spike immediately followed by wide QRS complex
Mechanical Capture: pulse that correlates with the transcutaneous pacing “beats per
minute”
Dopamine Infusion: 5 – 20mcg/kg/minute
OR
Epinephrine Infusion: 2 – 10mcg/minute
Copyright 2022 - Pass with PASS, LLC 8
Chapter 2: Bradycardic Rhythms
High Degree Heart Block
Symptomatic & Bradycardic
Second Degree Type II and Third Degree
Transcutaneous Pacing
25mA+, 70 – 80bpm
Increasing milliamps (mA) until electrical capture and mechanical capture
are received.
Electrical Capture: pacer spike immediately followed by wide QRS complex
Mechanical Capture: pulse that correlates with the transcutaneous pacing “beats per
minute”
Dopamine Infusion: 5 – 20mcg/kg/minute
OR
Epinephrine Infusion: 2 – 10mcg/minute
Second Degree Type II Heart Block Third Degree (“Complete”) Heart Block
Copyright 2022 - Pass with PASS, LLC 9
3
Tachycardic
Rhythms
Copyright 2022 - Pass with PASS, LLC 10
Chapter 3: Tachycardic Rhythms
Atrial Fibrillation (A-Fib)
Treatments below reflect a heart rate of greater than 150 beats per minute
Stable
No complaints, lightheaded, dizzy, palpitations – “feels like my heart is racing”
Contact Medical Direction
Consider use of Calcium Channel Blocker
Cardizem (Diltiazem)
.25mg/kg over 2 minutes
May repeat in 15 minutes at .35mg/kg
Unstable
Chest pain, difficulty breathing, decreased level of consciousness, hemodynamically
unstable (low BP, signs of inadequate perfusion)
Synchronized Cardioversion
120 – 200J biphasic
200J monophasic
Can consider sedation if IV already in place – Valium/Versed
Copyright 2022 - Pass with PASS, LLC 11
Chapter 3: Tachycardic Rhythms
Supraventricular Tachycardia (SVT)
Treatments below reflect a heart rate of greater than 150 beats per minute
Stable
No complaints, lightheaded, dizzy, palpitations – “feels like my heart is racing”
Vagal Maneuvers (have the patient “bear down”)
Adenosine
Has a 10 second half life, rapid IVP followed by 10 – 20mL normal saline flush
First Dose: 6mg
Second Dose: 12mg
Total: 18mg*
May consider a second 12mg dose – max of 30mg
Unstable
Chest pain, difficulty breathing, decreased level of consciousness, hemodynamically
unstable (low BP, signs of inadequate perfusion)
Synchronized Cardioversion
50 – 100J
200J
300J
360J
Additional “shocks” at 360J
Can consider sedation if IV already in place – Valium/Versed
Copyright 2022 - Pass with PASS, LLC 12
Chapter 3: Tachycardic Rhythms
Ventricular Tachycardia w/ Pulse
Treatments below reflect a heart rate of greater than 150 beats per minute
Stable
No complaints, lightheaded, dizzy, palpitations – “feels like my heart is racing”
Amiodarone, 150mg over minimum of 10 minutes
May also consider:
Procainamide: 25 – 50mg/minute
Sotalol: 100mg (1.5mg/kg) over 5 minutes
Unstable
Chest pain, difficulty breathing, decreased level of consciousness, hemodynamically
unstable (low BP, signs of inadequate perfusion)
Synchronized Cardioversion
50 – 100J
200J
300J
360J
Additional “shocks” at 360J
Can consider sedation if IV already in place – Valium/Versed
Copyright 2022 - Pass with PASS, LLC 13
4
Cardiac Arrest
Rhythms
Copyright 2022 - Pass with PASS, LLC 14
Chapter 4: Cardiac Arrest Rhythms
Pulseless Ventricular Tachycardia &
Ventricular Fibrillation
Immediately begin CPR
30:2 with rescue breathing – adult
Continuous compressions with intubation or supraglottic airway
When AED/monitor becomes available, defibrillate.
200J, 300J, 360J (LifePak)
200J (Zoll)
Epinephrine 1mg, 1:10 concentration
Every 3 – 5 minutes for the duration of the code
Advanced Airway
Anytime in the “early stages” of the arrest, as time and personnel allow
Amiodarone
If VF/pVT persists, administer 300mg of Amiodarone during second round of CPR (after Epi)
Consider H’s & T’s
See page 17 for additional explanation
Copyright 2022 - Pass with PASS, LLC 15
Chapter 4: Cardiac Arrest Rhythms
Asystole & PEA
Immediately begin CPR
30:2 with rescue breathing – adult
Continuous compressions with intubation or supraglottic airway
Epinephrine 1mg, 1:10 concentration
Every 3 – 5 minutes for the duration of the code
Advanced Airway
Anytime in the “early stages” of the arrest, as time and personnel allow
Consider H’s & T’s
See page 17 for additional explanation
These rhythms are NOT defibrillated
Copyright 2022 - Pass with PASS, LLC 16
Chapter 4: Cardiac Arrest Rhythms
H’s & T’s
Finding/treating the potential causes of cardiac arrest
“H’s”
Condition Treatment
Hypovolemia Fluid Resuscitation
Hypoxia Oxygenation/Ventilation
Hydrogen Ion Acidosis Sodium Bicarbonate
Hypo/Hyperkalemia Hyper = Calcium
Hypoglycemia Dextrose, IVP
Hypo/Hyperthermia Warm/Cool
“T’s”
Condition Treatment
Toxins Narcan (Opiates)
Tamponade Pericardiocentesis
Tension Pneumothorax Needle Decompression
Thrombosis Fibrinolytics/Clot Removal
Trauma Control bleeding, etc.
Copyright 2022 - Pass with PASS, LLC 17
Need Help with EKG
Interpretation?
If you’re struggling with EKG interpretation, check out our EKG/ACLS Study Guide.
This is a much more comprehensive study guide focused on 4 & 12 lead EKG
interpretation as well as the ACLS algorithms. You can find this at
www.passwithpass.com under “Paramedic Study Guides.”
Thank you for your support and best of luck!
www.passwithpass.com
Copyright 2022 - Pass with PASS, LLC 18
