[KellieNurse06]

Well..I can't get onto the Randy Larson website...everytime I do it ends up coming up on my computer as the "send error report" and then it shuts my computer down.......has anyone else had this problem??? It happens as soon as I click on the "run active x on this page" or whatever it says ..it's really frustrating me!!! One of my friends who is a nurse dropped off a book for me & she said it really helped her out.....it's called " The only EKG book you'll ever need" I am looking through it to see if it will help me get this whole thing........arrrgggghhh! The horizontal plane, the leads.....I feel soooo lost.....Hope it will suddenly put the lightbulb on in my brain.....

[hellonurse36]

I just logged on and it opened up. Are you trying

randylarson.com/acls

Or try this

http://www.randylarson.com/acls/start.html

Also, here is another good site.

http://students.med.nyu.edu/erclub/ekghome.html

or

http://medinfo.ufl.edu/~ekg/TOC.htm

Just remember that what you are seeing is a representation of electricity moving through the heart. The horizontal plane represents time and the vertical plane represents voltage. With the leads placed in a certain pattern (either a 3 lead, 5 lead or 12 lead pattern) we can see how the electricity is moving through the heart and thus how the heart is working or not working. For basic rhythm interpretation ie. is the pt in sinus brady, afib, having frequent PVCs etc we look at lead 2, for indications of ischemia, injury, MI (active, old, new etc) we look at a 12 lead as this allows us to see WHERE in the heart the problem is.

If I were you I would focus on the rhythms first then try to figure out the 12 lead. I am surprised you are doing 12 lead as it is pretty complicated. Do you have to diagnose where an MI is occurring or just know some basics of why we use 12 leads? Basically a 12 lead allows you to look at the heart from different angles. Since we are looking at conduction of electricity through the heart we expect to see certain patterns. Injured or dead heart muscle does not conduct the electricity the same way and will result in ECG changes. The lead(s) these changes show up on tell us where the injury is.

In the clinical setting we use the 12 lead along with pt's report of chest pain and results of labwork (cardiac enzymes) to help diagnose an MI vs angina when pt presents with chest pain. When a pt presents with chest pain we draw cardiac enzymes (CKMB, troponin) q 6 hr x 3 sets and do an ECG. When there is active heart muscle damage, enzymes are released from the heart tissue and show up in the blood (thus these enzymes are often called cardiac markers). If the enzymes come back positive (especially troponin as it is specific to the heart vs CKMB which is released by skeletal muscle as well), the person is dx with an MI. Problem is, these enzymes take time to show up in the blood (hence the need to have 3 negative sets to rule out an MI). Since we don't want the person sitting around having an MI while we wait for the enzymes to elevate, we can do an ECG and look for any changes. Q waves would indicate an OLD MI while T wave inversion, ST elevation or depression indicate active injury. For all of these WHAT LEAD it shows up in on the 12 lead tells you what part of the heart is being damaged and thus which coronary artery is the probable culprit.

Off the top of my head I cannot remember them all, but here is an idea. If you see changes (Q waves, ST elevation etc) in leads II, III and aVF you know it is an inferior issue. Changes in V1-V4 means anterior problem. A Q means an old MI of unknown date in this area, ST elevation means an active MI in this area and the pt goes to the cath lab where they can see what is causing the problem and fix it (balloon, stent, consult with Cardiothoracic surgery for a bypass!!).

Hope this helps,

Terri

[KellieNurse06]

Originally Posted by hellonurse36

I just logged on and it opened up. Are you trying

randylarson.com/acls

Or try this

http://www.randylarson.com/acls/start.html

Also, here is another good site.

http://students.med.nyu.edu/erclub/ekghome.html

or

http://medinfo.ufl.edu/~ekg/TOC.htm

Just remember that what you are seeing is a representation of electricity moving through the heart. The horizontal plane represents time and the vertical plane represents voltage. With the leads placed in a certain pattern (either a 3 lead, 5 lead or 12 lead pattern) we can see how the electricity is moving through the heart and thus how the heart is working or not working. For basic rhythm interpretation ie. is the pt in sinus brady, afib, having frequent PVCs etc we look at lead 2, for indications of ischemia, injury, MI (active, old, new etc) we look at a 12 lead as this allows us to see WHERE in the heart the problem is.

If I were you I would focus on the rhythms first then try to figure out the 12 lead. I am surprised you are doing 12 lead as it is pretty complicated. Do you have to diagnose where an MI is occurring or just know some basics of why we use 12 leads? Basically a 12 lead allows you to look at the heart from different angles. Since we are looking at conduction of electricity through the heart we expect to see certain patterns. Injured or dead heart muscle does not conduct the electricity the same way and will result in ECG changes. The lead(s) these changes show up on tell us where the injury is.

In the clinical setting we use the 12 lead along with pt's report of chest pain and results of labwork (cardiac enzymes) to help diagnose an MI vs angina when pt presents with chest pain. When a pt presents with chest pain we draw cardiac enzymes (CKMB, troponin) q 6 hr x 3 sets and do an ECG. When there is active heart muscle damage, enzymes are released from the heart tissue and show up in the blood (thus these enzymes are often called cardiac markers). If the enzymes come back positive (especially troponin as it is specific to the heart vs CKMB which is released by skeletal muscle as well), the person is dx with an MI. Problem is, these enzymes take time to show up in the blood (hence the need to have 3 negative sets to rule out an MI). Since we don't want the person sitting around having an MI while we wait for the enzymes to elevate, we can do an ECG and look for any changes. Q waves would indicate an OLD MI while T wave inversion, ST elevation or depression indicate active injury. For all of these WHAT LEAD it shows up in on the 12 lead tells you what part of the heart is being damaged and thus which coronary artery is the probable culprit.

Off the top of my head I cannot remember them all, but here is an idea. If you see changes (Q waves, ST elevation etc) in leads II, III and aVF you know it is an inferior issue. Changes in V1-V4 means anterior problem. A Q means an old MI of unknown date in this area, ST elevation means an active MI in this area and the pt goes to the cath lab where they can see what is causing the problem and fix it (balloon, stent, consult with Cardiothoracic surgery for a bypass!!).

Hope this helps,

Terri

Thanks Terri! Yes we are doing 12 lead ekg..I am also surprised because we just started back to class 3 weeks ago.....so the past 3 weeks have all been cardiac..and it is very difficult you are 100% right.......that's why I don't understand why we are doing something so in depth..........and even the nurses at the place we do our clinicals which is a cardiac icu say even nurses who have beeen nurses for many many years have a hard time differentiating the readings that are in depth......I have been reading & reading but I wish it would just click...... and yes we have to know where the damage or ischemia is going on in which part of the heart by what the ekg reading is....I have down where the leads go and a couple of ekg readings like asystole & atrial flutter......pretty much the easier stuff.....I just feel buried!!! I am going on the ekg sites you posted....one was really good! Thanks again for your help! Kellie

[shadowflightnurse]

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

[augigi]

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.

[hopecandles]

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!

[KellieNurse06]

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!

[HyperTension]

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.

[sscathlab]

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.

[KrysyRN]

Originally Posted by 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!

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.