Which Strips Are MOST Dangerous?

[pagandeva2000]

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 time.

Which are the MOST dangerous ones? I know v-fib, v-tach, asystole, couplets, bigeminys...but are there others? What do the monitors look like? I plan to practice with my EKG CD ROMs over the weekend to try and simulate an experience.

Any help would be appreciated!

[pagandeva2000, LPN]

In addition any indication of WPW (delta waves) and the presence of atrial fibrillation can lead to deadly dysrhythmias.

I distinctly remember those delta waves! I really remember quite a bit from that class; they were wonderful instructors. I also remember the tousades, etc...

I am going to have to take out the time to decipher between the different types of heartblock. I can look and see that it is a type of heartblock, but need to get more specific.

[GilaRRT]

If you ever get a chance to take a complete class on 12 lead monitoring, just do it. Understanding the 12 lead will open a whole new world. It is incredible when you learn how to ID axis deviation, tell a RBBB from a LBBB and localize ischemia/injury among many other things by looking at a 12 lead.

[suzy253, RN]

I'll never forget Torsades de Pointes. My first code and I've been involved with two other codes since then with Torsades.

And like others have mentioned, check the patient first. One monitor had a patient in asytole....and he wasn't...very much alive, A&O.

[pagandeva2000, LPN]

If you ever get a chance to take a complete class on 12 lead monitoring, just do it. Understanding the 12 lead will open a whole new world. It is incredible when you learn how to ID axis deviation, tell a RBBB from a LBBB and localize ischemia/injury among many other things by looking at a 12 lead.

I took that class as well. I just need the experience, now by watching actual monitors. It is amazing, because reading the strips are one thing...knowing where the situation is actually located is fascinating. I have a color coded EKG book that I used which really stayed in my brain when it came to locations. Fascinating stuff!

[pagandeva2000, LPN]

Do you guys think that having a pocket sized EKG booklet would be helpful until I really get the jist of it would be advisable? What I am mainly concerned with is that seeing the EKGs in the book versus the machine look totally different. I used to copy 12 lead EKGs from the machines in my clinic, take off the name and bring them home to try and decipher them, and they didn't seem to be as cut and dry as what the textbook showed...or is it that the monitors themselves look more like the readings in the books?

[sharona97, BSN, RN]

Do you guys think that having a pocket sized EKG booklet would be helpful until I really get the jist of it would be advisable? What I am mainly concerned with is that seeing the EKGs in the book versus the machine look totally different. I used to copy 12 lead EKGs from the machines in my clinic, take off the name and bring them home to try and decipher them, and they didn't seem to be as cut and dry as what the textbook showed...or is it that the monitors themselves look more like the readings in the books?

I've seen many tmes the patient hooked up MCL ( I think that's right>>.>) Anyway it involves three leads. I too like the lead two. I carried with me the pocket size ACLS book and I also had a plastic coded cheat sheet for different lead abnormalities for identification.

Blocks are tricky, too me anyway, so I'll watch the patient not the monitor if my antenna's start going up.

I also made a cheat sheet for all the different abnormal atrial and ventricular rhythms and kept it with my stuff. The total 12 lead class mentioned is so informative, I did the same took EKG's without ID and used the 12 lead as a cheat sheet to help idenify where and what is happening. It's ongoing for me any way.

[GilaRRT]

Many times what you see in a book is an example of an isolated problem. For example, you will see a picture of STEMI in V1-V4 and say hey, that is an anterior/septal MI. The reality may be much more different when we throw a BBB and a low voltage ECG into the mix.

In addition, you have many other conditions that can mask or mimic an MI. Conditions such as LVH, LBBB, and Q waves from an old MI can muddy the water so to speak.

[RNperdiem, RN]

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).

[NurseDawgJess, BSN, RN]

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.

[GilaRRT]

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.

[NurseDawgJess, BSN, RN]

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.

[sharona97, BSN, RN]

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.