ekg strips...need help!!!!

  1. hello....I need help with ekg strips if anyone can give me some pointers.....I have read & read but still am not "getting it" .....and we have a test coming up next week of 75 questions.....48 which are all ekg strips, cardiac meds etc etc...............I am a wreck because I am finding this ekg stuff very very confusing.........can anyone offer me any way to easily understand how to read a strip and especially which leads determine what area of the heart is having the problem???????This is so confusing to me!!!! Thanks alot for anyone who could offer some suggestions Much appreciated!:uhoh21:
  2. Visit KellieNurse06 profile page

    About KellieNurse06

    Joined: Sep '05; Posts: 528; Likes: 23

    21 Comments

  3. by   hellonurse36
    One of the best sites I have found for learning ECGs is -

    http://www.randylarson.com/acls/

    He explains things very well.

    Good luck,

    Terri Finney in Greenville, NC
  4. by   sirI
    hello, kellienurse06,

    click here for helpful information for the unit

    many links for what you need including the randy larson link.
  5. by   DRNurse1
    Are you learning 12 lead or EKG interpretation?
  6. by   KellieNurse06
    Yes it's 12 lead ekg......arrrggghhhh!!! I feel like a stupid idiot because I am not getting it....:uhoh21:
  7. by   maryloufu
    Well don't waste time feeling stupid- because A LOT of seasoned nurses don't get it!
  8. by   KellieNurse06
    Quote from KellieNurse06
    Yes it's 12 lead ekg......arrrggghhhh!!! I feel like a stupid idiot because I am not getting it....:uhoh21:
    Yes..I forgot..and interpretation.......:uhoh21:
    We are supposed to know what lead looks at what area of the heart and what is it that is going on..such as 2nd degree heart block, 3rd degree heart block, pvc's , a fib, v tach, ischemia, mi etc etc etc I know the Q wave means damage was done...lol..hey I learned one thing..no make that two...things..I know what asystole looks like.lol...........This is all sooooo confusing to me.....the school I am at used to do 3 tests and this year we are doing 4 tests ..and our 1st one for the semester is this cardiac one......everyone in my class is majorly stressed out over this...........it stinks!!!
  9. by   hellonurse36
    I have always loved blocks (well, only on paper...don't really care to see third degree up on my pt's monitor!!). I had a great ECG teacher who made it really simple.

    First degree heart block - PR interval is lengthened (> .20) and consistent. She likened it to a renter who pays his rent late, but consistently....it is due before the 20th but he pays it on the 24th every month...he is late but consistent.

    Second Degree heart block, type 1 ( aka Wenckeback) - PR interval is increasingly longer until a QRS is dropped, then it starts up at the original length again and starts over. Think of it as the renter pays later and later each month, then misses a month (no QRS), then starts back up paying rent but pays it late and continues to pay it progressively later until he again misses a month.

    Second degree heart block, type 2 (Mobitz 2) - PR is CONSISTENT but a QRS is randomly dropped. I remember it by the saying - Mobitz 2 out of the blue drops a Q.

    Third degree heart block - no synchrony between P waves and QRS complex. Call it the divorce rhythm because the P and QRS are ignoring each other. The Ps are consistent but do not create a QRS, QRSs are consistent but are not stimulated by a P. If you see a P in a QRS you pretty much have 3rd degree.

    Hope this helps.

    Terri
  10. by   KellieNurse06
    Thank you so much Terri! I appreciate your input!!!
  11. by   floridaRNtoo
    Quote from hellonurse36
    One of the best sites I have found for learning ECGs is -

    http://www.randylarson.com/acls/

    He explains things very well.

    Good luck,

    Terri Finney in Greenville, NC
    Ditto to the above. I recommend his website to all of our new nurses on my tele unit.
  12. by   KellieNurse06
    Well..I can't get onto the Randy Larson website...everytime I do it ends up coming up on my computer as the "send error report" and then it shuts my computer down.......has anyone else had this problem??? It happens as soon as I click on the "run active x on this page" or whatever it says ..it's really frustrating me!!! One of my friends who is a nurse dropped off a book for me & she said it really helped her out.....it's called " The only EKG book you'll ever need" I am looking through it to see if it will help me get this whole thing........arrrgggghhh! The horizontal plane, the leads.....I feel soooo lost.....Hope it will suddenly put the lightbulb on in my brain.....:uhoh21:
  13. by   hellonurse36
    I just logged on and it opened up. Are you trying

    randylarson.com/acls

    Or try this

    http://www.randylarson.com/acls/start.html

    Also, here is another good site.

    http://students.med.nyu.edu/erclub/ekghome.html

    or

    http://medinfo.ufl.edu/~ekg/TOC.htm

    Just remember that what you are seeing is a representation of electricity moving through the heart. The horizontal plane represents time and the vertical plane represents voltage. With the leads placed in a certain pattern (either a 3 lead, 5 lead or 12 lead pattern) we can see how the electricity is moving through the heart and thus how the heart is working or not working. For basic rhythm interpretation ie. is the pt in sinus brady, afib, having frequent PVCs etc we look at lead 2, for indications of ischemia, injury, MI (active, old, new etc) we look at a 12 lead as this allows us to see WHERE in the heart the problem is.

    If I were you I would focus on the rhythms first then try to figure out the 12 lead. I am surprised you are doing 12 lead as it is pretty complicated. Do you have to diagnose where an MI is occurring or just know some basics of why we use 12 leads? Basically a 12 lead allows you to look at the heart from different angles. Since we are looking at conduction of electricity through the heart we expect to see certain patterns. Injured or dead heart muscle does not conduct the electricity the same way and will result in ECG changes. The lead(s) these changes show up on tell us where the injury is.

    In the clinical setting we use the 12 lead along with pt's report of chest pain and results of labwork (cardiac enzymes) to help diagnose an MI vs angina when pt presents with chest pain. When a pt presents with chest pain we draw cardiac enzymes (CKMB, troponin) q 6 hr x 3 sets and do an ECG. When there is active heart muscle damage, enzymes are released from the heart tissue and show up in the blood (thus these enzymes are often called cardiac markers). If the enzymes come back positive (especially troponin as it is specific to the heart vs CKMB which is released by skeletal muscle as well), the person is dx with an MI. Problem is, these enzymes take time to show up in the blood (hence the need to have 3 negative sets to rule out an MI). Since we don't want the person sitting around having an MI while we wait for the enzymes to elevate, we can do an ECG and look for any changes. Q waves would indicate an OLD MI while T wave inversion, ST elevation or depression indicate active injury. For all of these WHAT LEAD it shows up in on the 12 lead tells you what part of the heart is being damaged and thus which coronary artery is the probable culprit.

    Off the top of my head I cannot remember them all, but here is an idea. If you see changes (Q waves, ST elevation etc) in leads II, III and aVF you know it is an inferior issue. Changes in V1-V4 means anterior problem. A Q means an old MI of unknown date in this area, ST elevation means an active MI in this area and the pt goes to the cath lab where they can see what is causing the problem and fix it (balloon, stent, consult with Cardiothoracic surgery for a bypass!!).

    Hope this helps,

    Terri
  14. by   KellieNurse06
    Quote from hellonurse36
    I just logged on and it opened up. Are you trying

    randylarson.com/acls

    Or try this

    http://www.randylarson.com/acls/start.html

    Also, here is another good site.

    http://students.med.nyu.edu/erclub/ekghome.html

    or

    http://medinfo.ufl.edu/~ekg/TOC.htm

    Just remember that what you are seeing is a representation of electricity moving through the heart. The horizontal plane represents time and the vertical plane represents voltage. With the leads placed in a certain pattern (either a 3 lead, 5 lead or 12 lead pattern) we can see how the electricity is moving through the heart and thus how the heart is working or not working. For basic rhythm interpretation ie. is the pt in sinus brady, afib, having frequent PVCs etc we look at lead 2, for indications of ischemia, injury, MI (active, old, new etc) we look at a 12 lead as this allows us to see WHERE in the heart the problem is.

    If I were you I would focus on the rhythms first then try to figure out the 12 lead. I am surprised you are doing 12 lead as it is pretty complicated. Do you have to diagnose where an MI is occurring or just know some basics of why we use 12 leads? Basically a 12 lead allows you to look at the heart from different angles. Since we are looking at conduction of electricity through the heart we expect to see certain patterns. Injured or dead heart muscle does not conduct the electricity the same way and will result in ECG changes. The lead(s) these changes show up on tell us where the injury is.

    In the clinical setting we use the 12 lead along with pt's report of chest pain and results of labwork (cardiac enzymes) to help diagnose an MI vs angina when pt presents with chest pain. When a pt presents with chest pain we draw cardiac enzymes (CKMB, troponin) q 6 hr x 3 sets and do an ECG. When there is active heart muscle damage, enzymes are released from the heart tissue and show up in the blood (thus these enzymes are often called cardiac markers). If the enzymes come back positive (especially troponin as it is specific to the heart vs CKMB which is released by skeletal muscle as well), the person is dx with an MI. Problem is, these enzymes take time to show up in the blood (hence the need to have 3 negative sets to rule out an MI). Since we don't want the person sitting around having an MI while we wait for the enzymes to elevate, we can do an ECG and look for any changes. Q waves would indicate an OLD MI while T wave inversion, ST elevation or depression indicate active injury. For all of these WHAT LEAD it shows up in on the 12 lead tells you what part of the heart is being damaged and thus which coronary artery is the probable culprit.

    Off the top of my head I cannot remember them all, but here is an idea. If you see changes (Q waves, ST elevation etc) in leads II, III and aVF you know it is an inferior issue. Changes in V1-V4 means anterior problem. A Q means an old MI of unknown date in this area, ST elevation means an active MI in this area and the pt goes to the cath lab where they can see what is causing the problem and fix it (balloon, stent, consult with Cardiothoracic surgery for a bypass!!).

    Hope this helps,

    Terri
    Thanks Terri! Yes we are doing 12 lead ekg..I am also surprised because we just started back to class 3 weeks ago.....so the past 3 weeks have all been cardiac..and it is very difficult you are 100% right.......that's why I don't understand why we are doing something so in depth..........and even the nurses at the place we do our clinicals which is a cardiac icu say even nurses who have beeen nurses for many many years have a hard time differentiating the readings that are in depth......I have been reading & reading but I wish it would just click...... and yes we have to know where the damage or ischemia is going on in which part of the heart by what the ekg reading is....I have down where the leads go and a couple of ekg readings like asystole & atrial flutter......pretty much the easier stuff.....I just feel buried!!! I am going on the ekg sites you posted....one was really good! Thanks again for your help! Kellie

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