Is it really necessary to learn to read an ekg? anyone really use it? - page 3

Do any of you actually know how to read and use the telemetry monitor when it comes to watching the heart beat pattern (p wave, etc). Would it be worth my time to spend the summer learning to really... Read More

  1. Visit  Ivana RN-BC profile page
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    Quote from Do-over
    We are required to analyze the telemetry for our patients.

    Can I expertly interpret a 12-lead? Not even close, but we have to know enough to know when to consult the doc.
    Same here. Our hospital is requiring all nurses to pass an annual EKG test because we have to read the strips. We have tele monitors at every nurses desk, which is nice because you can see all of your patients strips without calling the tele tech. We have tele techs, but we want the nurses not to rely on them to tell them what the strip is.
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  3. Visit  Altra profile page
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    All inpatient units at my hospital are flex/mixed tele & non-tele ... so yes, every nurse needs to be able to interpret rhythms and act on them accordingly.
  4. Visit  CaitlynRNBSN profile page
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    Yes. In our hospital we have techs that are trained to watch telemetry because clearly i can't be watching it 24/7. We have monitors at the nurses station and in the rooms we can hook them up to. Even when the techs call you that your patient is in a certain rythm, it is your responsibility to take a look at those strips and intervene. I'm not the greatest at them, i'll be honest. with difficult ones i will get help from others...but i take it as a learning experience. Sometimes we as nurses will catch things before technicians.

    Or, your patient is c/o SOB and palpitations. Doc orders an EKG. The EKG gets done, and the technician hands you the EKG. The on call doctor (who is busy or not in the building) calls and says "What is the rhythm?".you need to be able to read that. Surley no nurse is going to be a professional. We had a guy who NOBODY knew what the heck his rhythm was. I printed off the strips and got the PA to look at them. We were all going back and fourth from Atrial tach to Aflutter to sinus tach, to some random rythm i never even heard of. Cardiologist looked at it and it took him a while too. It was just a weird rythm we don't see much with some Atrial Tach. But sitll....you don't have to be the BEST at it but it helps to have some understanding.
  5. Visit  amoLucia profile page
    0
    Quote from One1
    Yup, your patient is not going to wait for you to whip out your phone and google Vfib as he is about to tank and needs some pads attached.
    AMEN!

    I laughed with this response.

    Just FYI - I was EKG cert in a prior job before I was working at a psych hosp. Had to go to mandatory morning management meetings where I happened to be sitting next to the Medical Director. He was reviewing a pile of EKGs. I glanced over to the last EKG he had interpreted when I noted such an extreme 1st degree heart block that I just blurted out something about the prolonged PR. He revised his interpretation and set it aside (for further followup, I guess).

    So to OP - yes, you do use that skill even when you least expect to. There have been times when I've been doing a HR and the AP/RP don't match or I can detect a rhythmic discrepancy and I wonder if I'm not catching PVCs. In LTC, not many places have a LIFPAK (do they still make them?) so the ability to catch something as it occurs is rare.
    Last edit by amoLucia on May 4, '13
  6. Visit  akulahawkRN profile page
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    Quote from amoLucia
    AMEN!

    I laughed with this response.

    Just FYI - I was EKG cert in a prior job before I was working at a psych hosp. Had to go to mandatory morning management meetings where I happened to be sitting next to the Medical Director. He was reviewing a pile of EKGs. I glanced over to the last EKG he had interpreted when I noted such an extreme 1st degree heart block that I just blurted out something about the prolonged PR. He revised his interpretation and set it aside (for further followup, I guess).

    So to OP - yes, you do use that skill even when you least expect to. There have been times when I've been doing a HR and the AP/RP don't match or I can detect a rhythmic discrepancy and I wonder if I'm not catching PVCs. In LTC, not many places have a LIFPAK (do they still make them?) so the ability to catch something as it occurs is rare.
    To answer your question about whether or not they make LIFEPACKS, yes they do. I believe the current model of those is the LP – 15, which has so many different options that it can pretty much make your head spin if you're thinking about getting a monitor/defibrillator that can do pretty much everything and almost cook your breakfast too. They still also make AED's. Most of those are not able to display cardiac rhythms. If they have something of a memory chip they will also record the rhythm that they see. You will not see that in real-time.

    I would suspect that quite a few nursing facilities that are not acute care hospitals have some sort of an AED available, but I would be very surprised if they had a monitor with 12 – lead capability, let alone 3 – lead capability!

    Over the years, I have noticed that occasionally some patients do seem to drop a pulse after a heart beat. I may be doing it "wrong" but when I do a apical/radial pulse, I simply count the number of beats I hear and note how many beats were dropped. Then I know how many premature contractions did occur, but I probably won't be able to tell if they were PAC, PJC, or PVC in nature.
  7. Visit  amoLucia profile page
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    To akulahawk - thank you for the response. Sheesh, I remember Lifpak 4. Tells you something ...

    In LTCs, we have AEDs, but as you say, not all have the option to record a real-time rhythm. But boy, would I just love to run a simple rhythm strip now & then just to see what I'm thinking might be there!! Some places had those telephonic EKG monitors, but I think I was the only person in the world who ever tried to use them. Of course, I would have to locate it, find batteries, etc. And by then, the immediacy of any arrhythmia would probably be lost.

    I do like to review chart 12 lead EKGs. Can't read them - only remember something about reciprocal lead changes in leads II, III & AVF.
  8. Visit  Meriwhen profile page
    3
    I know how to read an EKG and I use that skill often...and I'm in psych

    Seriously, between medications playing with P-R and Q-T intervals, as well as electrolyte imbalances from medications or the disorders themselves, it's important for me to know if an EKG is normal/acceptable or if I need to get the MD's attention stat. We do EKGs upon admission and on an as-needed basis.
    FuturePsychNP, Hygiene Queen, and Altra like this.
  9. Visit  Not_A_Hat_Person profile page
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    I learned to read EKGs in school. In my 4-year nursing career, I've read exactly 1 EKG, during my tour of Nursing Home Hell.
  10. Visit  Creamsoda profile page
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    Hahaha, sorry but your question just struck me as funny, in that ABSOLUTELY YES IT IS MAJORLY IMPORTANT. I mean if you work on a tele unit, you need to know what your looking at and basic rhythm analysis is imperative. 12 lead EKG, no not everyone needs to learn the indepth stuff but its nice to know how to analyze them. I willl never be as good as a cardiologist in reading them (think about it, they analyze thousands and thousands of them, and well they are cardiologists), but I can tell you what the rhythm is, if there is ischemia and if its a STEMI vs NSTEMI and in what part of the heart. If you have a patient who suddenly has chest pain, even if your on med surg, and you get the STAT EKG, its kind of nice to know if you have an emergent situation on your hands. The ST elevation depression and basic rhythm analysis will tell you that. Maybe they suddenly went into a heart block or a SVT and thats why theyre having chest pain. Its just necessary to know this stuff so you will know what the indicated treatments are and can prepare for them when you tell the doc whats going on and your patient will be better cared for with less delays. Also what others mentioned, QT monitoring ect.
  11. Visit  Creamsoda profile page
    2
    Quote from SummitRN
    I fail to understand why more emphasis is not put on EKG in nursing schools. It seems that is mostly taught on the job or through CE classes. I've seen community health RNs who didn't even know how to hook up their 12 lead and hospital nurses who were notorious for hitting print and then taking the strip to another nurse to read.

    Its sad but true. Im pretty sure I only knew what sinus rhythm was. I hardly understood what afib was, just that it was irregular. Finally once I graduated and started working, when I oriented to the step down unit, they put us through a few week course and things started making more sense. Then I went into critical care and took the more indepth course, and I thought to myself, Wow I was a scary new grad- 8 years ago. You dont know what you dont know. Things started making more sense, and I thought to myself, why on earth are they not teaching this stuff in school, but continue to focus on florence nightengale and the stages of greiving, and the use of therapeutic touch.
    on eagles wings and SummitRN like this.
  12. Visit  tcvnurse profile page
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    YES. If you work on a tele floor, it is absolutely important to know your rhythms. I work in cardiothoracic stepdown and we are expected to pull and read strips on all patients.You pull them first thing in the morning so you can know if the rhythm changes throughout the day.

    If a patient appears to have a change in rhythm, we are responsible for obtaining a 12 lead. Knowing basic 12 lead interpretation is the difference between calling a doc saying, "Hey Mr Jones has ST elevation in the inferior leads, do you want any bloodwork" and understanding what is happening with the patient that moment and having the monitor tech just leave the EKG printout in the doorchart and the doc will look at it sometime later.
  13. Visit  fermium profile page
    2
    The funny thing is that the amount of formal ECG training I received in medical school wasn't actually that much more than what I received in nursing school. The main difference is that I read a lot more ECGs as a medical student (and even more now as an ED resident) than when I was practicing nursing. It really is one of those skills that you rapidly forget if you don't use it. Case in point: I showed a trace to my friend who is a PGY4 radiology resident and he had no idea what the trace was.

    As a RN, while you do not necessarily need to know the trace is a multifocal atrial tachycardia with posterior hemiblock, you would be extremely useful if you are able to pick up simple abnormalities, such as basic arrhythmias, ST segment/TW changes, and QT changes.
    FuturePsychNP and Altra like this.
  14. Visit  Racer15 profile page
    2
    Heck yes it is. I work in the ER, I don't dx my patients, but I sure as heck need to be able to recognize significant arrhythmias so that I can notify the MD that this patient needs to be seen NOW. There are no disadvantages to learning EKG rhythms.
    GrnTea and Meriwhen like this.


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