How confident are you with reading tele

Ruby Vee, BSN · Feb 18, 2018

Hey guys. I was wondering how confident are you in reading telemetry rhythm strips for those that work in critical/stepdown/tele floors in the hospital. Personally I work on a tele floor and feel pretty confident except when it comes to the heart blocks. Also, do you feel comfortable with managing tele patients? Getting tele patients and starting them on a amiodarone drip if they get into rapid afib as an example...
Anyways, thoughts?

Save up your telemetry strips with heart blocks and try to figure out exactly what is going on with the blocks. Then when there's a cardiologist around who seems to have an extra moment or two, pull one of them out and ask if your analysis is correct and why or why not. There may also be a nurse around who is expert. There may be ECG classes offered in your city which are worth taking -- and most workplaces offer some education money to take them. How confident are you on pacemakers? That seems to be an area that flummoxes many nurses. NPs are often very interested in teaching, too. The key is to choose one who actually knows what she's talking about.

As a ICU/CCU nurse of a few decades, I feel pretty comfortable with those kinds of patients. I was in CCU years back when amiodorone was still investigational.

Kitiger, RN · Feb 18, 2018

Save up your telemetry strips with heart blocks and try to figure out exactly what is going on with the blocks. Then when there's a cardiologist around who seems to have an extra moment or two, pull one of them out and ask if your analysis is correct and why or why not. There may also be a nurse around who is expert. There may be ECG classes offered in your city which are worth taking -- and most workplaces offer some education money to take them. How confident are you on pacemakers? That seems to be an area that flummoxes many nurses. NPs are often very interested in teaching, too. The key is to choose one who actually knows what she's talking about.
As a ICU/CCU nurse of a few decades, I feel pretty comfortable with those kinds of patients. I was in CCU years back when amiodorone was still investigational.

Excellent advice, Ruby Vee. I saved some of those telemetry strips, with the correct diagnosis written on each of them. (These were HIPAA compliant, of course, although "HIPAA" didn't yet exist.) We used them to quiz each other.

I was flummoxed the first time a doc seriously diagnosed a "FLB". I looked it up, but could find no reference.

He later told me that he meant, "Funny Looking Beat." (He didn't know, either; some beats are like that.)

Been there,done that, ASN, RN · Feb 18, 2018

Telemetry interpretation is a hard earned, ongoing learned skill. Took me 3 years , before I felt I knew my stuff. You must have had to pass a competency course from your facility. Consult with nursing education... tell them what you still need to learn. You need to know the determination of a block in seconds.

As far as antiarrhythmic agents, if you are not comfortable with them yet, you have pharmacy, senior nurses and the ordering physician to use for your questions.

Best of luck, it's a jungle out there.

Grobyc82 · Feb 18, 2018

Very good advice. There is a course that im considering taking if my schedule opens up some free time. Whenever cardiologists are available ill ask them their two cents on a questionable rhythm strip. Heart blocks are interesting but I always seem to have doubts in myself with mobitz, and 3rd degree.

Been there,done that, ASN, RN · Feb 18, 2018

Very good advice. There is a course that im considering taking if my schedule opens up some free time. Whenever cardiologists are available ill ask them their two cents on a questionable rhythm strip. Heart blocks are interesting but I always seem to have doubts in myself with mobitz, and 3rd degree.

The blocks are not that hard to learn. You should not have to remediate your teaching alone. I would NEVER ask a cardiologist to teach me on the fly. They expect us to know our stuff. They are way too busy to teach nurses.

nursej22, MSN, RN · Feb 18, 2018

In terms of initiating therapy, unless the patient is unstable, our cardiologists insisted on getting a 12 lead first. There are too many variables in monitor strips, imo. And sometimes you just can't tell.

Blocks are interesting, and looking at the whole patient can help with this. What is their age, what meds are they on, what are their labs, are they symptomatic? And yes, practice, and save the interesting strips. The real ones look way different that the text books.

Triddin · Feb 18, 2018

Free ECG Simulator! - SkillSTAT Is a good resource to practice quickly reocognizing ecg strips

psu_213, BSN, RN · Feb 18, 2018

Sometimes 2nd degree blocks can be difficult to see on 6 second strips--see if you can print off something longer. I worked on a unit that had a jar for "interesting" tele strips/rhythms. FWIW, I never saw them used again (for education, etc.), so they must have been used to start a fire or something.

Personally, I think it is totally appropriate to ask a cardiologist about a difficulty rhythm--you will find out which ones are approachable and like to teach. Having said that, I would not go to a cardiology with a strip and ask "Is this normal sinus rhythm or asystole" (this is a bit of an exaggeration, but you probably want to avoid going to a cardiologist with a "basic" rhythm). Also, you can go to your unit/hospital educator. Even if it is a "silly" question about a rhythm, the educator is not very likely to go around and blab about what you don't know (some catty staff nurses might).

smf0903 · Feb 18, 2018

I am always learning and will love the day when I can confidently look at a not-so-run-of-the-mill strip and know what it is. If in doubt I bounce it off other RNs (ones that know their stuff), the hospitalist if s/he has a moment, and there are certain cardiologists who come to our facility who love to teach so there's that

I recently bought a subscription to medcram. I had watched all of their free videos and I love them so went ahead and sprung for the subscription. Holy cow, I have learned oodles from watching the ecg videos. I'm sure there are plenty of free online learning sites but this one I knew I'd definitely learn from so I spent the money (by the way, they do have a free heart block video if you'd like to check it out).

Good luck to you! I approach tele/ecg as one of those things you have to practice, practice, and practice some more to get good at it :)

Mr_Edwino · Feb 18, 2018

Arrhythmia Practice Drill T#9211

EKG practice strips

Grobyc82 · Feb 18, 2018

Cool, thanks!