Which Strips Are MOST Dangerous? - page 3

by pagandeva2000

36,619 Views | 39 Comments

I may be considered to be a per diem monitor nurse for telemetry; a woman from staff ed wishes to recommend me. I took a wonderful EKG class last year, have books to refer to, but have not read the EKGs often enough at this... Read More


  1. 0
    Quote from sharona97
    The phrase that has stuck with me is the tombstone rhythm!
    I have heard that phrase as well but I'm unclear about what exactly that rhythm is or looks like. Any insight on that would be appreciated.
  2. 2
    Quote from NurseDawgJess
    I have heard that phrase as well but I'm unclear about what exactly that rhythm is or looks like. Any insight on that would be appreciated.
    The tombstone or widow maker is sometimes used to describe the findings of an anterior/lateral/septal MI. ST elevation in these leads can look like a tombstone when you inject a little imagination into your analysis. The picture below is of an anterior/septal wall MI. Note the ST elevation in the V leads. I suspect the widomaker comes from the thought that a proximal occlusion of the LCA can cause a massive anierior MI will take out the left ventricle and thus leave behind a widow.



    Sometimes you will hear people use the term fireman hat. This is used to describe what you may find in the setting of an inferior wall MI. This is appreciated in the leads II, III, AVF. The image below is of an inferior wall MI. With a little imagination, you can appreciate the fireman hat like ST elevation in the leads II,III,and AFV.



    Sharona, I suspect you are talking about monitoring leat MCL 1. It is roughly a carbon copy of lead 1 so to speak. Many people like to use this over the standard lead II because V1 looks at the ventricles and bundle branch blocks are easier to identify in some cases. Some people call this the gold mine lead.
    sharona97 and NurseDawgJess like this.
  3. 0
    Thank you for your help. Coming from homecare and a med surg floor, I haven't had much experience with monitors and EKG's. I think they are fascinating to learn about. Looking forward to taking my 12 lead class soon.
  4. 0
    Quote from GilaRN
    The tombstone or widow maker is sometimes used to describe the findings of an anterior/lateral/septal MI. ST elevation in these leads can look like a tombstone when you inject a little imagination into your analysis. The picture below is of an anterior/septal wall MI. Note the ST elevation in the V leads. I suspect the widomaker comes from the thought that a proximal occlusion of the LCA can cause a massive anierior MI will take out the left ventricle and thus leave behind a widow.



    Sometimes you will hear people use the term fireman hat. This is used to describe what you may find in the setting of an inferior wall MI. This is appreciated in the leads II, III, AVF. The image below is of an inferior wall MI. With a little imagination, you can appreciate the fireman hat like ST elevation in the leads II,III,and AFV.



    Sharona, I suspect you are talking about monitoring leat MCL 1. It is roughly a carbon copy of lead 1 so to speak. Many people like to use this over the standard lead II because V1 looks at the ventricles and bundle branch blocks are easier to identify in some cases. Some people call this the gold mine lead.
    Thank you!!!! What an excellent post and 12 lead intererupts. Yes you are exactly correct in what I was trying to say about MCL 1. I'm not well versed in teaching verbally, but I love the demonstration and rationale thing........ I learned a thing or two and I love it!!!! Thanks again.
  5. 1
    ST elevation.
    NurseDawgJess likes this.
  6. 1
    NursedawgJess:

    ST elevation can give an appaearance f a tombstone head!
    NurseDawgJess likes this.
  7. 0
    Just an FYI,

    Callipers became my best friend when trying to figure out the harder ones to read!
  8. 1
    Quote from RNperdiem
    Will you be working alone, or will there be others there to provide a second opinion? It would be helpful to work with someone who can tell the difference between SVT and someone getting chest percussion(the percussion jiggles the leads and makes interesting patterns).
    Not sure if I will be alone at the monitors, but there should be other nurses milling around the ward. I don't know these nurses personally, but I know that many of the ones that work in med-surg eat their young. I work in the hospital, but in a clinic. My facility does not pay overtime to employees that work in other units, but they will pay you if you sign for an agency, which I have. Most times, agency nurses are abused because they get paid more and they expect them to come in running.

    The Staff Ed employee who recommended me really likes me, so, she is trying to get me as much experience as possible. My plans are to contact the nursing administrator in med-surg, share with her the continuing education training that I acquired, and ask if I can volunteer a bit of time to sit with someone to see how they work up there, the expectations, and also to see 'the lay of the land'...meaning who are the other nurses working there, if they are helpful, who to trust, etc.
    sharona97 likes this.
  9. 0
    You're smart to ask to get a look see before you try. Getting a chance to pick up on who is helpful and who to watch out for will ease some of the strain when you start. Try to identify a possible mentor on the floor, someone who is patient and doesn't mind answering your questions. Good luck and enjoy your new assignment!
  10. 1
    There are some cool free EKG simulators online...just google "ekg simulator", and try some sites until you find one you like. This is one of those things that you just need to practice until you are comfortable. The same rhythms look a little different in each patient. I like Barb Aehlert's, ECGs Made Easy (you can find it on Amazon.com for about $15...great reference book), for practice strips. Also, ask around...lots of folks keep copies of cool rhythm strips they have seen, and most are happy to share.
    sharona97 likes this.


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