12 Lead ECG in CEN

  1. I am thinking about taking the CEN soon and it seems that the only trouble I am having is the questions regarding the 12 lead ECG. Anyone have any advice on how to better prepare for this, or is this not that big of an issue in the test....I have been on the job for over a year, but have several years EMS experience behind me...Any help would be appreciated.
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    About gs1976

    Joined: Mar '08; Posts: 11
    graduate nurse - ER

    14 Comments

  3. by   Pixie.RN
    My advice is to learn how elevation in certain leads correlates to the part of the heart muscle that is damaged (i.e., inferior wall = II, III, and aVF), and then understanding which coronary arteries are likely to be occluded in such a situation. With that being said, I haven't taken my CEN yet, but I've done some practice CEN questions, and that's the kind of thing I've seen regarding 12 leads -- just some real basic stuff. If you read 12 leads in EMS, that'll help; if you didn't, then not so much. Good luck on your CEN!
  4. by   billythekid
    Hey QS,

    If you read 12-Leads in EMS, you can pretty much stop right there. Only very basic knowledge is required... I took the CEN and did fine with not even reviewing the 12 -Leads, so I guess alot depends on your comfort level with them. As Lunah mentioned, you need to know the basic patterns of infarct.. II, III, aVF = inferior, etc..

    which coronary artery is affected,

    where would the reciprocal change be,

    and initial course of treatment... is nitroglycerin appropriate, or a fluid challenge and dob?

    I wouldn't stress beyond that for the CEN. Best of luck!
  5. by   cardiacmadeline
    OK, dumb question. What is the CEN?
  6. by   Katnip
    Quote from cardiacmadeline
    OK, dumb question. What is the CEN?
    It's the certification for emergency nurses.
  7. by   rnffemtguy
    Quote from cardiacmadeline
    OK, dumb question. What is the CEN?
    It is a certification in Emergency Nursing granted by the Emergency Nurses Association:

    http://www.ena.org/bcen/
  8. by   Displaced
    Wikipedia has some nice basic information. Scroll down to the clinical lead groups section. http://en.wikipedia.org/wiki/Electrocardiogram

    You could also look in your hospital library for a book on it.
  9. by   mwboswell
    Most everybody has done a good job responding.
    I've done quite a bit of reading/reviewing on this while writing and publishing our CEN review course/manual.

    The majority of 12-lead "core" ED nurse knowledge is to readily identify those major infarct/injury patterns and be able to anticipate particular interventions/treatments.

    The main ones to know: Inferior, Septal, Anterior, Lateral ("I See All Leads"), and Posterior.
    You should know which vessels affected: LAD, RCA, Circumflex.

    And; be VERY familiar with your "routine" ACLS Lead II rhythms (Vfib, Vtach, Asystole, PEA, 1st/2nd/3rd Deg HB, Sbrady, Stach, SVT, PSVT etc)

    Hope this helps....
    -MB
    http://www.bemetweb.blogspot.com/
  10. by   GilaRRT
    Do not neglect the RVI association with Inferior wall MI. The V4R question is making it's way into nearly every exam that tests emergency or critical care knowledge.
  11. by   mwboswell
    Quote from GilaRN
    Do not neglect the RVI association with Inferior wall MI. The V4R question is making it's way into nearly every exam that tests emergency or critical care knowledge.
    Please explain the "V4R question" - ?

    However I can assure people that there are no "new" questions on the CEN exam since Mid 2007.
    The next revision is probably 3-4 years from now -that's when new questions will be put in place.
  12. by   GilaRRT
    Assessing V4R in the setting of inferior wall MI to rule out RVI.

    Edit: This is not a new concept; however, it can easily be missed as the RV does not fall into the generic ISAL assessment.
  13. by   Pixie.RN
    I assume he's talking about flipping some of the precordial leads?
  14. by   mwboswell
    Quote from GilaRN
    Assessing V4R in the setting of inferior wall MI to rule out RVI.

    Edit: This is not a new concept; however, it can easily be missed as the RV does not fall into the generic ISAL assessment.
    In the classes we teach, the assessment for RVI does fall into the "generic" ISAL under discussion of IWMI.
    One would be remiss if they didn't discuss it as part of that.

    We don't teach just doing V4R however, we do teach that "if" you have an inferior infarct pattern, to get a complete R side EKG, (not just V4R) and look for the changes in V4R, V5R and V6R.

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