Junctional Rhythm 

Junctional Escape Rhythm


A cardiac rhythm usually originating at the junction of the atrioventricular (AV) node and the AV bundle. It may be a normal escape rhythm (rate between 40 and 60 beats/ min) or an active focus (rate 60 beats/ min or greater). Mosby (2009-02-11)


Characteristics

Rate 39 BPM or less


Rhythm Regular

P-Waves May occur before during or after the QRS. If visible, the P wave is inverted in leads 2, 3 and a VF

PR Interval If a P wave occurs before the QRS the PR Interval will be 0.12 sec (3small boxes) or less


QRS Duration 0.11 seconds (2 1⁄2 small boxes) or less


Treatment

Monitor Diagnostic 12 lead


Oxygen 15 LPM NR mask


IV 18g AC


Administer Meds 

Atropine 0.5-1 SIVP over 1-2 min Repeat every 3-5 min w/ 3.0mg max 

Dopamine 5-10mcg/kg/min (Diluted Infusion only)

Epinephrine 2-10mcg/min (Diluted Infusion only)


Consider Transcutaneous Pacing


MEDS

Atropine 0.5-1 SIVP over 1-2 min Repeat every 3-5 min w/ 3.0mg max 

Dopamine 5-10mcg/kg/min (Diluted Infusion only)

Epinephrine 2-10mcg/min (Diluted Infusion only)


Noticeable by

No P wave OR the P wave is inverted. Less than 39 BPM

© Matt Dillard 2012