EKG tips and tricks in the ER?

[alliecatrn10]

I've worked on a med/tele unit for 2 years and am comfortable with basic EKG rhythms. I'll be moving to the ER (cant wait!) and know I have a ton to learn about them and practical treatments associated with different rhythms. I certainly wouldn't want to miss something "big" on an EKG. Any tips or tricks for interpretations? Especially 12 leads. For example, how do you tell an old injury from a new?

What weird or unusual things have you seen on EKGs?

I know that's a couple different questions...answer however you want! I just want to hear what yall have to say. Love learning from other nurses!

[alliecatrn10]

Beautifully explained. Thank you!

[canned_bread]

One tip in the ED....show it to a doc. Our EKG has the computer interpretation on the top of it. Even if it is entirely normal, we still have to show it to a doc right after it is completed. If it is normal, the doc just has to sign it off--they don't have to actually take the patient and, if they do take the patient, they are under no obligation to see them right away--if it is not a STEMI or other ominous finding of course. Not that basic EKG interpretation is not a valuable skill for the ED nurse, but cover your behind and show that EKG to a doc.

Just so you know, those "computer interpretations" are very very often wrong. They are most certainly not to be relied on. Frequently I get "AF" when it's really flutter and vice versa. Incorrect lead placement, even by less than an inch, can show incorrect things too. never trust the computer intepretation, actually KNOW what you see.

[emtb2rn, BSN, RN, EMT-B]

Here's a youtube classic:

[psu_213, BSN, RN]

Just so you know, those "computer interpretations" are very very often wrong. They are most certainly not to be relied on. Frequently I get "AF" when it's really flutter and vice versa. Incorrect lead placement, even by less than an inch, can show incorrect things too. never trust the computer intepretation, actually KNOW what you see.

I totally agree.

[~agape~]

Here's a youtube classic:

I watched that video and it was great! Thank you so much!

[akulahawkRN, ADN, RN, EMT-P]

Just so you know, those "computer interpretations" are very very often wrong. They are most certainly not to be relied on. Frequently I get "AF" when it's really flutter and vice versa. Incorrect lead placement, even by less than an inch, can show incorrect things too. never trust the computer intepretation, actually KNOW what you see.

The computers are programmed with the same criteria we're supposed to use for interpretation. The problem is the computer may be keying in on the wrong things when it's attempting to make it's interpretations so it sees the wrong thing and attempts to apply the "rules" to that... and makes the wrong interpretation.

That's why earlier I said the computer is sometimes right...

IMHO, the computer between our ears is often far more powerful and accurate in making certain diagnoses than a machine is. Trust your training and experience in reading EKG's. Chances are you'll be right more often than the computer is. If you become really good at it, you might even be "right" as often as the physicians are.

[zmansc, ASN, RN]

Slightly off topic... The monitors in our ED are really crappy at detecting this stuff. They frequently seem to think they see v-tach, yet continue to report a rate of 56, or whatever slow rate the patient is actually at. If your going to tell me v-tach, tell me the tachy rate too! Reminds me of the saying "treat the patient not the machine". I think that is the case for both the monitor and the EKG machines interpretation, frequently wrong, sometimes in amusing and/or annoying ways!

[JasHorns]

I would also point out in my experience if you see really peaked T waves be prepared to give all the drugs for hyperkalemia. Also make sure they are on pads just in case. I had a pt with a small bowel obs and she had peaked t waves. Her K+ was 7 or so. I walk back into the room VTach. Also afib rvr and svt can look similar if it's fast enough. Just be prepared for adenosine or cardizem or if unstable cardioverting. ER rocks. You will love it if you like running around. Be prepared to be hated by basically every other floor though lol. Just comes with the territory. Good luck.