Need tips on how to read an ECG

Nursing Students Student Assist

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I am in need how assistance on how to better read an ECG. I understand the basics, but get thrown off by different rhythms. Tips, advice, book, website..whatever you can recommend would be much appreciated :)

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Specializes in Hospice, Palliative Care.

Good day:

These are from notes I've taken from other posts:

Interpreting ECG strips

There's a nice interactive page for ECG basics here.

The rest of the site is mostly aimed at EM docs, but the ECG Quiz is also helpful.

Here are some great resources teaching sites.

ECG Learning Center - An introduction to clinical electrocardiography

ECGpedia

Learn EKG basics - ECG review

Also ECG ? A Pictorial Primer

might also help.

Thank you.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Thanks pmabraham for finding those links from AN. Not being a nurse or in nursing school..... it would be difficult knowing which are quality/suitable sites for students.....thank you for finding ones that would help the OP in the allnurses community!

OP ......I know these links and recommend them myself.....:)

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Specializes in Hospice, Palliative Care.

Good day Esme12:

Thank you for your kind words.

I'm still waiting for my acceptance (hopefully it is acceptance) letter for nursing school.

In the mean time, I've been trying to learn from you, and others in terms of taking notes (I use Evernote) that I will believe will be useful should I get accepted.

It is good to read / hear, that the at least this set of particular notes were on target.

Thank you.

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Specializes in ER, progressive care.

I love the 6 Second ECG Simulator.

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Specializes in ER trauma, ICU - trauma, neuro surgical.

Youtube has great videos on EKG interpretation.

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Specializes in Emergency Department.

I would have to agree that YouTube is a really good series of videos for interpreting EKGs. Personally, I would not start with learning the really complicated stuff, rather I would focus on learning the ten or so basic rhythms that people can have. Once you have those down, you can go on to other things such as dealing with infarctions, hypertrophies, and the like. Reading the basic EKG stuff is relatively easy, it is when you get into that other stuff that things can get extremely hard and sometimes even the experts have problems.

While I also have not taken a good look at the links above, I would certainly hazard a guess that most, if not all, would be suitable for student use. Just start with the basics and go from there! Probably the only thing that I would add is for you to keep in mind that sometimes you might find patients that are in a 1° heart block in a Sinus Brady rhythm, and they're completely asymptomatic. If you see that, consider the possibility that your patient may have been, or is, an athlete. That is a physiological adaptation to exercise, and may not be a pathological problem. It wouldn't be something that I'd see in the non-athlete. Athletes are usually pretty aware of their bodies, so they'll know what their resting heart rate usually is. It doesn't hurt to ask!

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I couldn't agree more Akulahawk... Patients often know what their baseline is, or have been in the hospital before and heard someone mention "some kind of block." I work on a telemetry floor with a lot of return customers, so to speak, and the most important thing is to look for changes. Start with the basics, but also be aware that a new block is occasionally indicative of something more serious (or sometimes it's just a new med, or often totally benign!!), but bottomline- don't be afraid to ask! I liked reviewing youtube videos, and Dubin's EKG interpretation book is great.

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There's an online course here on how to do this.

How to identify a save EKG rhythms from a fatal one.

Hope it helps!

Melissa

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Thought experiment here, just for fun:

You are at your favorite baseball diamond. You are holding a piece of plexiglas in front of you, and you have a wax crayon in your dominant hand. You will be drawing lines on it based on what you see on the other side of it. Or you can draw on your TV screen, but I can't be responsible for the long-term effects on your relationship with your significant other. Ready?

You are sitting in the stands between home plate and first base. The pitcher throws the ball to the catcher. You follow its progress and draw the line on the plexiglas as you see it go. The line goes from...? Correct, a long line, going from your right to your left, dropping down a bit with gravity.

Through the miracle of time travel, you are now on the other side of the diamond, between third base and home. The pitcher throws the same pitch. Where do you draw your line? Correct-- the ball appears to go a long way from left to right, again dropping down a bit with gravity. Same pathway, different vantage point, different crayon tracing on the plexiglas.

OK, now you are sitting right behind the pitcher. Same pitch, coming straight at you. When you trace its path on your plexiglas, what does the line look like? NO right-to-left, because it's coming straight towards you, so you draw a very short line from the center of the plexiglas, where you see the pitch leaving the pitcher's hand, dropping a little bit to account for the gravity as it settles into the pitcher's mitt.

Last, you could even pretend you were in the grass between the pitcher's mound and the plate, and seeing the ball coming by. Your line would rise as the ball approached you, and then fall as it went past you.

In EKG-land, the electrical impulse traveling through the heart's anatomical conduction system is that ball. The different lines you have drawn on your plexiglas are the picture of that impulse as seen from many different vantage points. Why bother? Because it's important to see the path clearly as it moves about the heart. Some leads "see" the P wave better than others. Other leads, because of their vantage point, show the QRS upright or downgoing. Depending on where the lead is, it might show derangements in conduction better, like a bundle branch that's damaged (bundle branch block). So the derangements in some leads specifically tell you about how the conduction goes through specific areas of the myocardium, with the understanding that abnormal conduction (an abnormal line) means something wrong in the muscle.

You might not see the P wave in one lead and wonder where it is. There's (probably) still conduction from the SA node to the AV node, but you're looking from behind the plate, not from first base, so you don't see its movement so well.

I hope that helps some. I love baseball. Go Red Sox! (We made more than $3.3M for the Jimmy Fund last week on the telethon!)

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