Which Strips Are MOST Dangerous? - page 3

I may be considered to be a per diem monitor nurse for telemetry; a woman from staff ed wishes to recommend me. I took a wonderful EKG class last year, have books to refer to, but have not read the... Read More

  1. by   sharona97
    Just an FYI,

    Callipers became my best friend when trying to figure out the harder ones to read!
  2. by   pagandeva2000
    Quote from RNperdiem
    Will you be working alone, or will there be others there to provide a second opinion? It would be helpful to work with someone who can tell the difference between SVT and someone getting chest percussion(the percussion jiggles the leads and makes interesting patterns).
    Not sure if I will be alone at the monitors, but there should be other nurses milling around the ward. I don't know these nurses personally, but I know that many of the ones that work in med-surg eat their young. I work in the hospital, but in a clinic. My facility does not pay overtime to employees that work in other units, but they will pay you if you sign for an agency, which I have. Most times, agency nurses are abused because they get paid more and they expect them to come in running.

    The Staff Ed employee who recommended me really likes me, so, she is trying to get me as much experience as possible. My plans are to contact the nursing administrator in med-surg, share with her the continuing education training that I acquired, and ask if I can volunteer a bit of time to sit with someone to see how they work up there, the expectations, and also to see 'the lay of the land'...meaning who are the other nurses working there, if they are helpful, who to trust, etc.
  3. by   caliotter3
    You're smart to ask to get a look see before you try. Getting a chance to pick up on who is helpful and who to watch out for will ease some of the strain when you start. Try to identify a possible mentor on the floor, someone who is patient and doesn't mind answering your questions. Good luck and enjoy your new assignment!
  4. by   HJS27
    There are some cool free EKG simulators online...just google "ekg simulator", and try some sites until you find one you like. This is one of those things that you just need to practice until you are comfortable. The same rhythms look a little different in each patient. I like Barb Aehlert's, ECGs Made Easy (you can find it on Amazon.com for about $15...great reference book), for practice strips. Also, ask around...lots of folks keep copies of cool rhythm strips they have seen, and most are happy to share.
  5. by   RN Randy
    Heh... I think the most dangerous strip out there is sinus rhythm.

    Don't let it fool ya! It may look innocent enough, but as soon as you turn your back... [dingdingdingdingdingding]

  6. by   5toedragon
    You'll Spend Most Of You Time Sitting And Waiting, Changing Batteries And Checking Leads For Placement. So Check Your Patients Condition From The Bedside, Know What Gtts Are Running And Why.know Their Cardiac Hx To Allay Or Forwarn Of Problems. Remember: Left Sided Heart Problems Predispose To , Tackycardia And Hypertension And Right Sided , To Brady , Blocks And Hypotention .
    Know Your Nurses , Who'o On Top Of It, Goofing Off, Worry Wart Self Appointed Expert. Know Your Docs Too . Talk To Them When The Are On The Floor Get Their Input Let Them Know Who You Are, It'll Make It Easier If You Have To Call Them.
    It All Takes Time, It's Not As Complicated As It Looks. Give A Clear Concise Report Without Gossip And Expect One.
    Ask Questions And Stay Current On New Procedures, Gtts, And Expect The Best And Be Prepared For The Worst. Good Luck
  7. by   EMS RN 7
    Quote from pagandeva2000
    I may be considered to be a per diem monitor nurse for telemetry; a woman from staff ed wishes to recommend me. I took a wonderful EKG class last year, have books to refer to, but have not read the EKGs often enough at this time.

    Which are the MOST dangerous ones? I know v-fib, v-tach, asystole, couplets, bigeminys...but are there others? What do the monitors look like? I plan to practice with my EKG CD ROMs over the weekend to try and simulate an experience.

    Any help would be appreciated!
    As a 4-year paramedic and soon-to-be RN, remember that the wider and faster the rhythm, the worse it is. When QRS complexes begin to widen, that is a bad sign. Extremely slow bradycardias, especially 2nd Degree type II (Mobitz II) and 3rd degree blocks are very serious and can quickly lead to VF or VT (seen it twice in front of my own eyes). Mulitple PVCs that are different morphologies (from different places in the heart) in close succession are also an indicator of an impending problem. Any active ECG changes (PACs, PVCs, runs of V Tach, junctional--no P waves or inverted P waves) that you are watching occur are usually indicative of a current or impending problem that will need immediate attention.

    Review your rhythm strips using books such as ECGs Made Easy and any other guides, and take an ACLS class ASAP!!! Know your monitors, both tele and defibrillator/ monitors on the crash carts (ZOLL, Lifepak, they all do the same thing but have buttons in different places, differing escalation of energy levels for defib/ cardioversion), know how to use the TCP (external pacing), and know your protocols on the floor so you can react quickly and not panic. Rhythms really aren't that hard if you study them. Reading ECGs is like riding a bike, you may be a little rusty after awhile but you'll never forget how to do it if you learn properly.

    Hope this helps!
  8. by   EMS RN 7
    Quote from NurseDawgJess
    I have heard that phrase as well but I'm unclear about what exactly that rhythm is or looks like. Any insight on that would be appreciated.
    Tombstone is indicative of STEMI (ST-elevation MI) and indicates an active infarction, depending on what leads ST-elevation appears in on a 12-lead ECG. Start at the J-point (beginning of T-wave) and note if the ST segment moves sharply up, and across, like a tombstone. It is a hallmark sign of an MI and must not be ignored.
  9. by   Warpster
    Other than the obviously lethal ones like V-fib, torsades, and asystole, the one to watch out for is pacemaker misfiring on the downslope of the T wave. I have never seen pacemaker induced V-fib have a positive outcome, no matter how fast we got into that room.

    If you have a misfiring pacemaker, it's a potentially lethal situation. Call the doc and get that thing interrogated ASAP or be prepared to DC it until a doc can get in there. People can last a lot longer in CHB or on an external pacer than they can if they go into pacer induced V-fib or torsades.
  10. by   sharona97
    Excellent point. I completely do not get the PM. I understand the theory, but the mechanics I'm a deer in the headlights.

    Have you noticed any changes in procedure or escape mechanismn with PM's that also have a defib? Does the Defib over ride the PM in critical rhythms such as you described?

    I went to a Guident Conference and had hands on with computerized PM's. I couold not grasp how to tune it up. I was paired of with an MD from Columbia...yikes, I couldn't answer his questions which were many, and concentrate on the exercise at hand.

    My hats off to you for any knowledge in this difficult area of cardiac nursing.
  11. by   VaEMT190
    I would think a PVC, a Elevated ST segement, or a Tombstone T-Wave would be a indicated for something REALLY lethal. On our trucks we use 3 leads which do work fine, but some rythms can be distored and look like a depression in some of the waves. We are thinking about going towards 12 leads, but IDK
  12. by   GilaRRT
    An isolated unifocal PVC in many cases is quite benign. In fact, PVC's are quite common in healthy people. The etiology of the PVC should be the real concern. A healthy person has ten cups of coffee to keep him up through the night throws a few unifocal PVC's, not a big concern. A dig toxic patient starts throwing multifocal PVC's and runs of ventricular tachycardia may be a bit more of a concern.
  13. by   Roy Fokker
    It's not just a prolonged QTc that's bad - but the one where the interval increases is worse (more susceptible to R-on-T). Had a case just last noc - very interesting presentation [coupled with the fact that the pt. had not even a detectable trace of Calcium OR Magnesium in his blood!! Like I said, it was an interesting presentation]

    IMHO, one of the most misunderstood and undiagnosed/misdiagnosed condition is ST depression. Not all MIs occur with elevated STs.

    My advice to OP:
    I too recommend taking the ACLS class but before doing that, it helps a lot to take a class with basic dysrhythmias (not just a 12-lead EKG class). ACLS core concepts are fairly simple, but taking a dysrhythmia course helps form a good foundation of basics which in turn makes the entire process of understanding ACLS easier.