# ekg strips...need help!!!! - page 2

hello....I need help with ekg strips if anyone can give me some pointers.....I have read & read but still am not "getting it" .....and we have a test coming up next week of 75 questions.....48 which... Read More

1. Here is another pretty good site...
http://www.skillstat.com/ECG_Sim_demo.html

It has a dynamic rhythm section with a brief explanation of each rhythm's characteristics.

This one is also good. It goes into detail regarding the rhythms, conduction, EKG review, etc.
http://www.medi-smart.com/tutorials.htm
2. The other thing which helped me "get it" was knowing the path that conduction "normally" takes through the heart. If you know that, and you know where each lead is placed, you can figure out whether each lead should be positive (electricity coming towards the lead) or negative (electricity moving away from the lead).

Once I learned the Einthoven triangle off by heart, I could write it down in a test, and figure out the leads that way.

The other thing is, ECGs are all about systematic review. Go through the parameters one by one, the same way each time, and learn the rhythm disturbances, and then it's easy - if it has certain features, it can only fit certain rhythm definitions.

eg.
- What is the rate?
- Is it regular?
- Are there P waves? Is there one before each QRS? (If so, you know there is atrial--> ventricular conduction)
- What is the PR interval? Is it the same throughout the rhythm?
- Are the QRS all the same? What is the QRS width?
- Are there T waves? What is the QT interval?

Once you work it all out, you know without doubt what the rhythm is. Draw up a table with all the parameters, and write the corresponding rhythms. Then practice-practice-practice!! The more you do, the easier it gets.

I don't think I "fully" got it until I was doing it every day once I was working, but it's definitely doable. Good luck.
3. I wish I had found this info earlier. After being a nurse for 3 years, primarily oncology, then neuro. I switched to a cardiac unit. I was so frustrated there. Because I had experience, I got virtually no orientation, I did get some, but it was 6 days, then I was on my own. I had been a nurse for 3 yrs, so they assumed I didn't need any help learning how to be a cardiac nurse. There is a big difference between cardiac, neuro, and oncology. In 3 years, I had never sent a patient for a stress test, heart cath, or took care of a patient post cath. I mean, you just don't do that stuff on an oncology floor. My self esteem really took a beating. I love that I've found this forum, because I can ask so many questions here, and many of the questions I have, have already been answered.
My point for posting here, is I was going through the info, on the websites for 12 lead interpretation. I'm comfortable with tele monitors, but don't begin to have a clue on any indepth EKG interpretation. I work cardiac stepdown, and float to ccu, and they never gave us any training on 12 leads. Does that sound logical to all of you?
I mean, I just thought a facility would do that.

Have a great day!
4. Hi everyone...just wanted to say thanks for all your knowledge & input! I passed my test with an 83!!!!! I thought I bombed it for sure....lol! The lowest grade in my class was a 58..and the highest was an 88...it was not as hard as I thought it was going to be but it was still very very tough without a question....some of the answers I had to wing it ..and I got the right one...luckily....hey something must of stuck, right?? Anywho..thanks so much again! I am so relieved!!! Next one is on Oct 23rd.....it's on Fluid & Electrolytes, Acid Base (resp/metabolic acididosis/alkalosis)...and ICP, and spinal cord injury.... I guess this test was the hardest one of all 4 we have this semester.....I am studying my behind off! thanks again!
5. Heart blocks are easy to remember. I learned this trick many years ago from a long time ER MD. First degree- any pr interval longer than .20. Thats all. Second degree type one- progressively longer pr interval until ONE whole qrs complex is dropped. Second degree type 2- 2 or more p waves to every QRS. Third degree- no correlation between anything.
6. I recommend the website RNCEUS.com. It does multiple ceu classes, though you dont have to pay for the information. You can look at the different rhythms and it explains them in simple terms.
7. Quote from KellieNurse06
hello....I need help with ekg strips if anyone can give me some pointers.....I have read & read but still am not "getting it" .....and we have a test coming up next week of 75 questions.....48 which are all ekg strips, cardiac meds etc etc...............I am a wreck because I am finding this ekg stuff very very confusing.........can anyone offer me any way to easily understand how to read a strip and especially which leads determine what area of the heart is having the problem???????This is so confusing to me!!!! Thanks alot for anyone who could offer some suggestions Much appreciated!:uhoh21:
Take a class at your hospital. I took a basic ekg class that was right to the point and it told exactly what to look for, how to measure the time in the pr interval, the st segment, etc etc & what it means when prolonged or absent. Your relly need a class because a book just doesnt do it like having an instructor. :spin:
8. I teach this class. I like the "renter" analogy.
9. Remember this little phrase every time you look at a 12 lead. "I see all leads."

I: Inferior wall- look at II, III, AVF

See: Septal wall- look at V1 & V2

All: Anterior wall- V3 & V4

Leads: Lateral Wall- What is left over? V5, V6, I, & AVL

Remember: you can write AVR off.

A down and dirty cheat for bundle branch blocks. Look at V1, find the J point, and draw a line back through the QRS. If the triangle you create goes up, it's a RBBB. Down, it;s a LBBB. This is called the turn signal criteria and is quite accurate.