How to interupt: X-Rays & EKG

maolin · Jul 30, 2007

I found EKG's Made Easy most helpful in learning to interpret rhythms. I would also like to suggest sitting with your facility's monitor tech for a few hours and practice measuring out the strips, identifying PQRSTs and interpretting the rhythm - read as many strips as you can - practice makes perfect.

As far as interpreting radiology images - do you read the films on a backlight, or view them on a computer? We view our radiology films via a system call PACS - it was cool because I could adjust color settings, invert white/gray, adjust contrast to view lines better (when confirming placement for a DHT for example)

X-treme · Jul 30, 2007

I found EKG's Made Easy most helpful in learning to interpret rhythms. I would also like to suggest sitting with your facility's monitor tech for a few hours and practice measuring out the strips, identifying PQRSTs and interpretting the rhythm - read as many strips as you can - practice makes perfect.
As far as interpreting radiology images - do you read the films on a backlight, or view them on a computer? We view our radiology films via a system call PACS - it was cool because I could adjust color settings, invert white/gray, adjust contrast to view lines better (when confirming placement for a DHT for example)

I was hoping for a website with actual 12 lead EKG's and various abnormal rhythms on it which I could learn from.

All X-rays are on backlight - remember, I said rural hospital setting, we're old school

Any websites would be great.

BBFRN, BSN, PhD · Jul 30, 2007

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

Go to the link above, and click on rhythm master. It's a great site, and also has ACLS megacode practice. Enjoy!

jojotoo, RN · Jul 30, 2007

You have MDs that can't interpret EKGs or X-rays? I think that I'd be worried about that.

Editorial Team / Admin · Jul 30, 2007

check here for helpful information for the unit

excellent weblinks for what you need.

time4meRN · Jul 30, 2007

didk a 12 lead interpritation course with western schools. It was really good. It had an in depth book cd etc with it. It sounds like you have a good background with ekg, that is helpful with this course. I'm with you, I can look at x ray's , swan , et placement, some basic Dx. but I think it would be wounderful to look at a ct even and understand more about it.

GilaRRT · Jul 30, 2007

Very complex subjects. You need to take a formal course to learn the basics of these topics. If you have the chance, the CCEMTP course covers the basics of 12 lead interpretation and looking at radiographic studies among other topics in critical care medicine and transport.

For looking at 12 leads:

First, you need to have a good foundation of cardiac A&P. You also need to know the major coronary artery branches and what part of the heart they feed. Then, you need to know how the artery + the part of the heart = changes seen on the 12 lead. Finally, you need to understand imposters and the various conduction disturbances. (Bundle branch blocks, fascicular blocks, LVH, WPW, LGL, early repolarization, axis deviation, etc.)

Here is a basic reference to get you started.

Think of the statement "I see all leads" to help.

I= Inferior wall (Leads II,III,AVF)

See= Septal wall ( Leads V1, V2)

All= Anterior wall (Leads V3, V4)

Leads= Lateral wall (Leads V5, V6, I, AVL)

AVR= does not really look at any specific cardiac structure. In addition, many of your right ventricular infarcts and posterior wall infarcts will not show up on a standard 12 lead. This is where we look at right sided ECG's and posterior leads along with the mirror test.

Next, look at the arteries:

Right Coronary: feeds the inferior wall, right ventricle, AV node, posterior wall of the left ventricle, and SA nodes in most of your population: Expect hypotension and bradycardias, these people may require fluids and inferior wall MI's should have a right sided ECG and possibly a mirror test or posterior ECG.

Left Coronary Artery: This divides into two large branches. 1) descending branch: Anterior wall of the left ventricle. 2) Circumflex branch: lateral wall of the left ventricle. So, a LCA occlusion can cause: Anterior wall, Septal wall, or Lateral wall infarct depending on the location of the lesion. Just to complicate things more: some people have right dominant cardiac perfusion, then you can throw conventional wisdom out. You can expect, bundle branch blocks, tachycardia, and left ventricular dysfunction among other findings in patients LCA occlusion.

I will try to post images of the basic infarct 12 lead findings when I have access to a computer.

X-treme · Jul 31, 2007

Thank you.

GilaRRT · Aug 1, 2007

As promised a few basic 12 leads to help you get an idea of what you are looking at with MI's.

The first 12 lead is essentially normal except for a little artifact. Pay attention to how the ST segments appear so you can contrast this to the abnormal findings of an MI.

The next 12 lead is an example of an inferior wall MI. You can easily appreciate the elevation in leads II,III,& AVF. You can also appreciate depression in the septal/anterior leads. This is called a recipricol change. You can see recipricol changes in opposite leads of the infarct. In the setting of an inferior wall MI, these changes are highly suggestive of posterior wall infarct however.

The next 12 lead is an example of an anterior septal wall MI. Appreciate the elevation in V1-V4.