Educational reference · Not a medical device
Rhythm strips,
explained the way nurses learn them.
Identifying traits, intervals, and verification steps for the rhythms tele and ED nurses see most. These pages exist as study material and bedside refresher. They do not diagnose, and they don’t replace your facility’s approved interpretation.
The 5-step method
Every strip, read the same way.
Most nursing schools teach a version of this. Different orders, same intent. Use it as the spine; each reference page below adds the specifics for that rhythm.
- 1
Rate
Count R-R intervals — 300 / (number of large boxes) for regular rhythms; six-second method (count complexes × 10) for irregular.
- 2
Rhythm
Regular or irregular? Walk a caliper across at least six R-R intervals. Regularly irregular vs. irregularly irregular changes the differential.
- 3
P waves
Present? Upright in lead II? Before every QRS? Same morphology? P-wave changes carry most of the rhythm story.
- 4
PR + QRS
PR 0.12–0.20s, QRS < 0.12s. Long PR → AV block. Wide QRS → ventricular origin or aberrancy.
- 5
QT / QTc
Use QTc (Bazett or Fridericia) because raw QT depends on rate. Critical at > 500ms — flag pharmacy.
Reference library
12 rhythms, each with the full breakdown.
Rhythm
Normal Sinus Rhythm — Nurse Reference
Educational reference: how to identify normal sinus rhythm on a strip. Not a medical device.
Open reference →Rhythm
Atrial Fibrillation — Nurse Reference
Educational reference: how to identify atrial fibrillation on a rhythm strip. Verify clinically.
Open reference →Rhythm
Sinus Tachycardia — Nurse Reference
Educational reference: how to identify sinus tachycardia on a rhythm strip. Verify clinically.
Open reference →Rhythm
Sinus Bradycardia — Nurse Reference
Educational reference: how to identify sinus bradycardia on a rhythm strip. Verify clinically.
Open reference →Rhythm
Heart Blocks — Nurse Reference
Educational reference: 1st, 2nd, and 3rd degree AV blocks on a rhythm strip. Verify clinically.
Open reference →Rhythm
Atrial Flutter — Nurse Reference
Educational reference: how to identify atrial flutter on a rhythm strip, and how to tell it from AFib. Verify clinically.
Open reference →Rhythm
SVT — Supraventricular Tachycardia
Educational reference: how to identify SVT on a rhythm strip and tell it from sinus tach. Verify clinically.
Open reference →Rhythm
Ventricular Tachycardia (VT) for Nurses
Educational reference: how to recognize ventricular tachycardia on a rhythm strip. Verify clinically and follow ACLS.
Open reference →Rhythm
Ventricular Fibrillation (VFib)
Educational reference: recognizing ventricular fibrillation on a strip. A shockable arrest rhythm — follow ACLS.
Open reference →Rhythm
PVCs — Premature Ventricular Contractions
Educational reference: identifying PVCs on a strip, bigeminy vs couplets, and when they matter. Verify clinically.
Open reference →Rhythm
Asystole — Nurse Reference
Educational reference: recognizing asystole, confirming it's not fine VFib or a lead issue, and the ACLS response.
Open reference →Rhythm
Junctional Rhythm — Nurse Reference
Educational reference: identifying junctional rhythms and their P-wave pattern on a strip. Verify clinically.
Open reference →
Frequently asked
About this reference library.
Is this a medical device or a diagnostic tool?
No. RN PocketPal is positioned as educational decision-support. The rhythm strip reference pages are study material and bedside refreshers. The Rhythm Practice drills in the app work the same way — known-answer strips, with the answer already settled before you see it. Diagnosis is the clinician's responsibility.
How do I verify what I see on a strip?
Calipers across at least six R-R intervals for regularity. Lead II for P-wave morphology. Patient's clinical context — sinus tachycardia and bradycardia look like NSR with rate variation, but the differential isn't the same. When in doubt, refuse to interpret and escalate.
Does the app read a strip I photograph?
No. RN PocketPal does not analyse, measure, score, or name a rhythm from a photo, a camera, or a monitor. The Compare view puts your own strip photo beside a reference strip so you can eyeball the difference yourself — that is the whole of it. Drills run on known-answer strips. The earlier photo-based reader was retired in August 2026 because it could not meet the accuracy bar we set for it, and confidently wrong is worse than not shipping.
Are these reference pages a substitute for ACLS training?
No. These pages help you keep recognition skills warm between trainings. ACLS, BLS, and PALS courses cover the protocols + scenarios you actually need to run a code — this reference is the in-between layer that helps you spot the rhythm faster when you're paged at 0300.
Try Rhythm Practice
Read it here. Drill it until it’s automatic.
RN PocketPal is live on Google Play. The identification drills, action questions, and mega-code scenarios are a Pocketpal Pro feature; the in-app rhythm atlas and the reference library you’re browsing are free for everyone.