Any tips on reading EKG's?

LilRedRN1973 · Oct 12, 2003

Our entire A&P class failed our cardiology exam. Our professor had questions on there where we had to basically diagnose using only a 12 lead EKG. For instance, we were shown an EKG and had to tell if it was an MI and if so, where was it occurring. He also had us do axis deviation and a myriad of other cardiac diagnosing. There was a nurse in our class who actually worked in a cardiology unit and was auditing his class...she scored a 68 on the exam. The class average was a 62. It was by far our most difficult exam the entire year. I'm dreading when we pick cardiology up in the nursing program....ugh!!!! But I agree with the other poster...Dubin's book did help some. I"m still confused but it's organized confusion! = )

gwenith, BSN, RN · Oct 12, 2003

There are other good websites out there and I wrote a thread on cheaters tips for rhythm interpretation that has some hints in it.

RNKPCE · Oct 12, 2003

I agree Dubin's books was also recommended to me when I started 17 yrs ago. But don't start trying to read 12 leads.

Start with learning the basics, a rhythm strip, what each part of the ekg complex is, what are the arrhythmmia? Later learn to tell ischemia and infarctions and determine was artery it is originating from. Lastly worry about axis, actually I have never learned this stuff.

I work on tele and you get a great experience with rhythms there. Unfortunately not many rhythms are textbook perfect to diagnose. If we have an unusual rhythm we go back to basics what is the rate, is it regualar or irregular, is there a p wave for every qrs, is there a relationship between the p wave and qrs. And most importantly how is the patient doing or feeling.

You will get better analyzing more and more strips, practice makes perfect!

XIGRIS · Nov 16, 2003

Hi,

I like it when RNnTraining said " organized confusion " and it is. Have you ever seen a telemetry floor thats not chaotic and busy? LOL.

I don't work in a Telemetry unit however, in the hospital that I work, I have opened the unit and trained almost all the core nursing staff of the unit.

Most cardiologists want a competent RN to know basic things. And again, let me emphaisze practice makes perfect. And if one works the night shift, you must be able to easily recognize a chest pain that needs immediate intervention ( PTCA and CABG ) or not.

These are the basic things a TELE nurse should know:

1. when pt has chest pain, 12 lead EKG is very important. Obtaining it right the moment pt complains of chest pain is good. Comparing it with the old 12 lead is nec. So what do we look at:

a. Any T-wave inversion on any leads that were not present in the previous EKG has to be reported. If a pt is sympotmatic eg. chest pain, and t wave inversion and is unreleievd by Nitro and MS, that angina needs to be cath quick. Time is muscle remember this.

b. the easiest to spot ST elevation. any ST elevation that are not there or has gotten worst from the previous 12 lead. has to be reoported.

c. LBBB or RBBB on patients having RCA involment. Omminous sing. Go to cath lab quick.

frogger · Nov 24, 2003

Hi everyone!! I am also in my last year of nursing school and studying ECG's. Other than the great books recommended, does anyone know of any websites available?

Thanks!

Heidi

Neon8 · Jan 9, 2004

Here's a few more sites"

http://www.embbs.com/ekg/fileroom.html

http://www.nurse-beat.com/stripshow/strip_index.htm

http://rnbob.tripod.com/arrhythmiarecognition.htm

http://sprojects.mmi.mcgill.ca/cardiophysio/default.htm

MrsWampthang, BSN, RN · Jan 9, 2004

It's not a good sign when the monitor starts showing a chaotic squiggly line and you find your patient face down in his oatmeal!

:chuckle

Other than that the most important rule to remember with telemetry patients is "treat the patient, not the monitor!" Don't ever think you can keep tabs on your patient by looking only at the monitor at regular intervals.

Good luck!

Pam

frogger · Jan 12, 2004

Neon 8 ~

Thank you for all of the web sites!! I am going to pass them on to my instructor to give out for future references!! :)

PHTLS · Sep 27, 2004

It's not a good sign when the monitor starts showing a chaotic squiggly line and you find your patient face down in his oatmeal!
:chuckle
Other than that the most important rule to remember with telemetry patients is "treat the patient, not the monitor!" Don't ever think you can keep tabs on your patient by looking only at the monitor at regular intervals.
Good luck!
Pam

:rolleyes: That's not funny. I've had patients like that

stbernardclub · Sep 27, 2004

Hi...when I started working in Critical Care, I picked up a book called EKG's made easy ( you probably seen the series, they even have nclex made easy). Well, what the book does is teach by association . Might want to check it out at your local Borders and see if you think it may help. And as a side note, nothing compares to a good nclex study book(with cd) for your exam...

First, I would like to say God bless you all. I am in my last semester of nursing school and we are learning how to read EKG's...I just learned it any my head is spinning!:roll
Any way, I know once I start memorizing some stuff it'll make more sense but I was wondering if you guys had any memorization tips you learned along the way to recognize a certain arrythmia or ANYTHING that has to do with EKG's.
This repolarization and depolarization has me a little confused...does repol mean the heart isn ot contracting at the time and depol means it is contracting?
Please help me if you can! Thank you so much guys!
Nicole

sargent · Sep 29, 2004

The book i recommend to all my students is

Basic Dysrhythmias :interpretation & management by Robert Huszar.

Published by Mosby.

It takes you from the basics up wards and is probably all the ECG (oops sorry, EKG ) book you will ever need!

It has lots of pictures too, which helps you with the visualisation of what is happening in the heart to explain the recording that you get.

good luck

illusiondweller · Oct 27, 2004

I think to answer your question with a "memorization tip" on repolarization and depolarization would be: the letter "d" comes first and the letter "r" is after. Hence, "depolarization" is first, before the heart beat and "repolarization" is after the heart beat.

illusiondweller