EKG reading and leads

Lev, MSN, RN, NP · Jun 16, 2016

Each lead represents a different part of the heart so sometimes only certain leads will show ischemia and infarction because only part of the heart is experiencing lack of oxygen.

Red398 · Jun 16, 2016

Oh, well, I guess I expected it to be a more complicated answer then that! Thank you :)

Boomer MS, RN · Jun 16, 2016

Hello everyone! First topic here :) as said in the title, I have an EKG question. I am getting ready to take boards soon and I have accepted a job on a step down unit in a hospital, so I'm trying to refresh myself on cardiac.
I am an LPN but I don't have any experience with EKG's, other than how to apply the leads. And of course, we had a quick lecture on how to read EKG's in RN school but I'm still a bit confused. Please correct me if I'm wrong, but from my own research, an MI has to be in certain leads before it can be diagnosed?
I understand the basics of a STEMI and NSTEMI but I'm confused about the actual leads part. How can an MI be seen only in certain leads? I may be way off here but if someone could clarify or lead me to a good resource, I would appreciate it. Thank you!!!

Think of the 12- lead EKG as looking at the heart from 12 different angles/spots, if you will. And as Lev

NurseGirl525, ASN, RN · Jun 16, 2016

It's kind of crazy how that gets glossed over in nursing school, isn't it? I learned how to read strips and what they mean, but not the EKG test itself.

I'm finding there are so many things I wish they would go into detail about in nursing school so I didn't feel like such an idiot sometimes.

Central BSN, RN · Jun 16, 2016

Hmm schools vary so much.... My school had three entire lectures on EKG's. What the leads are reading, how to interpret, proper interventions related to certain dysrhythmias etc.

We also had a mock code in are sim labs where the patient would go through 3 different rhythms and we had to lead the code teams. We had two chances to pass the scenario. Fail it you fail the critical care course.

Red398 · Jun 16, 2016

Yes, that definitely makes more sense then what I was originally thinking. As I said, I think I was making it harder than it should be. I will be required to become ACLS certified so hopefully that will help. Thank you!!

Red398 · Jun 17, 2016

It's kind of crazy how that gets glossed over in nursing school, isn't it? I learned how to read strips and what they mean, but not the EKG test itself.
I'm finding there are so many things I wish they would go into detail about in nursing school so I didn't feel like such an idiot sometimes.

Exactly, that's how my school was as well. We just learned the basics about reading the strips and treatments for some dysrhythmias. I've discovered the art of self teaching :up:

Red398 · Jun 17, 2016

Hmm schools vary so much.... My school had three entire lectures on EKG's. What the leads are reading, how to interpret, proper interventions related to certain dysrhythmias etc.
We also had a mock code in are sim labs where the patient would go through 3 different rhythms and we had to lead the code teams. We had two chances to pass the scenario. Fail it you fail the critical care course.

We also did a code simulation, which was harder than I thought! But fortunately we didn't get a grade for it. More for the experience, I suppose.

AgentBeast, MSN, RN · Jun 17, 2016

Basic RN education and ACLS teach basic rhythm interpretation not 12+ lead EKG interpretation. Expert level EKG interpretation takes years of post graduate education.

Scrubs_n_sirens, MSN, RN · Jun 17, 2016

Leads for routine cardiac monitoring.

I go by colors typically as our wires typically have 5 tails. White on the right, smoke over fire, clouds over grass, brown in the middle.

On a twelve lead, V1 and V2 are on opposite sides of the sternum. V1 on the right side of the sternum (patients right) and V2 directly across. V3-6 are in almost a line under the breast starting midclavicular and ending midaxillary. Then you have your four limb leads, which are labeled with which limb they go on, typically. Just remember it's the patient's right/left, not yours.

ST elevation can only be seen in some leads because the leads actually look at many different "views". The image is captured when electricity is sensed between two of the lead patches. The lead you see the elevation in correlates to a part of the heart. [ATTACH]22463[/ATTACH]

I attached this to give you a better visual on what directions each lead looks at so you can understand which parts of the heart could be affected with elevations.

Scrubs_n_sirens, MSN, RN · Jun 17, 2016

[ATTACH]22464[/ATTACH]