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!

[VaEMT190]

I would think a PVC, a Elevated ST segement, or a Tombstone T-Wave would be a indicated for something REALLY lethal. On our trucks we use 3 leads which do work fine, but some rythms can be distored and look like a depression in some of the waves. We are thinking about going towards 12 leads, but IDK

[GilaRRT]

An isolated unifocal PVC in many cases is quite benign. In fact, PVC's are quite common in healthy people. The etiology of the PVC should be the real concern. A healthy person has ten cups of coffee to keep him up through the night throws a few unifocal PVC's, not a big concern. A dig toxic patient starts throwing multifocal PVC's and runs of ventricular tachycardia may be a bit more of a concern.

[Roy Fokker, BSN, RN]

It's not just a prolonged QTc that's bad - but the one where the interval increases is worse (more susceptible to R-on-T). Had a case just last noc - very interesting presentation [coupled with the fact that the pt. had not even a detectable trace of Calcium OR Magnesium in his blood!! Like I said, it was an interesting presentation]

IMHO, one of the most misunderstood and undiagnosed/misdiagnosed condition is ST depression. Not all MIs occur with elevated STs.

My advice to OP:

I too recommend taking the ACLS class but before doing that, it helps a lot to take a class with basic dysrhythmias (not just a 12-lead EKG class). ACLS core concepts are fairly simple, but taking a dysrhythmia course helps form a good foundation of basics which in turn makes the entire process of understanding ACLS easier.

cheers,

[GilaRRT]

In addition, inverted T waved and depression can mirror injury in other areas of the heart. Reciprocal changes for example. In the case of posterior wall infarct, you may only see inversion unless you perform a posterior ECG.

I agree, that people can be fooled into looking only for ST elevation and large Q waves. However, depressed ST segments and T wave inversion are indicators of a non Q wave MI. This type of MI is still considered an acute coronary syndrome just like unstable angina. USA can also present like a non Q wave MI on the 12 lead. So in some ways, an acute coronary syndrome other than a Q wave MI can be more confusing to work up. This does not take into account other impostors or confusing findings such as LVH, LGL, WPW, BBB, among many others.