# ECG Experts Advice Needed

1. I am pretty expert at ECG's, having worked in a cardiac ICU. But, I have never "officially" taught ECG's in a classroom setting. Need some guidance on teaching BEGINNING ECG's to my ADN students. Thank you for any pointers you can give me. :kiss
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2. ### About VickyRN

Joined: Mar '01; Posts: 12,046; Likes: 6,494
Nurse Educator; from US
Specialty: 16 year(s) of experience in Gerontological, cardiac, med-surg, peds

7 Comments

3. Number one: Proper way of measuring each of the waves, can't stress this enough. This will help, whether they are using a ruler or just an index card.
Let them get used to all of the variations with the normals first, before you begin on any of the dysrhythmias. Try getting multiple different strips of NSR from various patients so that they can see the difference. Quite different than what you see in the text book................Hope that this helps.
4. Thank you so much!
5. I agree with what Suzanne mentioned, esp about teaching the normals first (and pointing out what normal is in different leads...etc)

I would stress finding a system...Teach the basics first:

Electrical system of the heart
EKG paper
Waveforms (P, QRS, T...positive and negative deflections)
Interval Measurement: Normal values and what it means physiologically

To help you can make a graph summary page that lists normals, how to measure it and what it represents.

Next you can discuss rate determination and how to calculate it. Is it normal or abnormal?

Back to a system:
Atrium: Is there a p wave? Is it regular, irregular, or regularly irregular? What is the rate of the P waves? Do the P-Waves look alike or do they vary in configuration?-> P Wave Rhythm, P Wave Rate, P Wave Configuration

AV Conduction: What is the PR interval? Is the PR consistent or does it vary from one cycle to the next? How many P waves are there for each QRS?-> PR Interval, P to QRS Ratio

Ventricles: QRS rhythm (what is the rate)? Are the QRS' regular, irregular, or regularly irregular-ie: grouped beats. What is the duration of the QRS (discuss the implications...) What is the QT interval...QTc intervals...
-> QRS Rhythm, QRS Rate, QRS Duration, QT Interval

Intrepretation: Is the pacemaker Sinus/Junctional/Ventricular? Is the AV Conduction normal? Are they any abnormalities: pauses, premature beats, abnormal rhythms, supraventricular/ventricular....any flat lines? :chuckle

Always remember to include patient assessent...if the monitor shows a flat line and the patient is talking to you- he's not dead. If the monitor shows a bunch of squiggly lines and the patient has parkinsons or is brushing their teeth, it is probably not VF (or symptomatic VF anyway)...What is the BP, are they tolerating changes in rhythm?

It is my feeling that in a basic class, stressing patient assessment and teaching a basic system to intrepretation is key...it dosen't come together for most until you can practice alot and have to use it, IMHO!
6. Thank you so much for the suggestions! They are greatly appreciated
7. Vicky I "threw together" a thread over in the ccu forum on "cheaters tips for rhythm interpretation" it kinda grew so it was not what I would consider structured by any stretch of the imagination but it does have some common tips that will help your students.

KISS cannot emphasise this enough

Also teach horses - when you hear hoofbeats expect to see horses not zebras (unless you are living in Africa lol)

In other words teach the common every day staff like atrial fibrillation before you get into the more essoteric stuff such as Wolf Parkinson White. That does not mean you ignore the more uncommon stuff but it is best to concentrate on the common stuff first.

Zambezi did it well - because I am one of those who LOVE teaching using core concepts I teach utilising a physiological model for rhythm generation I find this gives structure and meaning and therefor makes it more understandable. By that I mean I talk only of circuitry I find getting too far down into action potentials sets up a barrier to learning - use a top down appoach in giving them the gross concepts and THEN the finer concept of action potentials later - sounds counter intuitive but it does work.

Luck!!!!
8. Thank you so much for the tips. I will check out the thread in the CCU forum also.
9. though you probably know this...I stress to the interns I teach to do it the same way with every strip...no matter what...I tell them to get a system that they like or an order for interpreting the strips and do it that way forever....Like- rhythm, rate, look for all of the components of the beat, measure the intervals including QT, and if it needs to be treated or reported...Something like that, just so they know to do it the same way every time, that way they will not miss something....Hope this helps...

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