interested in cardiac

is the exam in school or for the job?

Dale Dubin has a book on strips that is helpful and easier to understand. Usually testing is on afib(irregular)/ flutter (regular), v tach( tombstones)/v fib, 1st 2nd 3rd degree blocks, sinus tach see p wave 100-150 rate ,atrial tach >150 don't see p wave, regular sinus 60-100,,sinus brady

the blocks get confusing but 1st degree is just long p wave

2nd degree type 1 wenkebach short p then longer then drop (irregular)

2nd type 2 classical constant p wave same length same then drops(irregular)

3rd degree has extra p wave (Regular) the p march at the same distance and will get buried in the t wave sometimes,regular and extra p's means 3rd degree

Make sure you don't mix up a pac with a fib

6 months is a long time( my place gives 12 shifts) you might go crazy having to be precepted that long especially being an LPN for 18 months. Stepdown is what I love but started in tele and would never go to icu out of school. There isn't much room for error and you are only human and who knows how many other nurses in that icu can be a great resource when you're on your own. What if they are not expert nurses. it would be scary. Wait for icu til you feel comfortable with your ability to assess and pick up on problems quickly and also ask RN that work there which icu is the best most supportive environment. In med/surg there is so much that we see go wrong many rapid responses and you at least are not expected to be the expert. You call for help. In icu it's all on you and you might not have the experience to know when things are going bad for the pt, you have less pt's which means less chaos which is nice but doesn't necessarily prepare you to be fast and able to manage time well.

I played with this, it's kind of fun.

http://www.skillstat.com/ECG_Sim_demo.html

I used this book. Schaum's Outline of ECG Interpretation (Schaum's Outline Series) It got the job done and it's inexpensive. http://www.amazon.com/Schaums-Outline-ECG-Interpretation/dp/0071736484/ref=sr_1_35?ie=UTF8&qid=1316607789&sr=8-35

I was an LPN with two years of LTC experience and I got 12 weeks on tele. I was going crazy by week 4...my preceptors had a great time, they sat in the charting room gossiping, had a lot of FB time, and one got her X-mas shopping done early.

I second the skill-stat, great practice :)

There are two EKG books I recommend: ECG's Made Incredibly Easy and ECG Workout by Jane Huff, RN. ECG Workout was a required book when I took critical care in nursing school. Both are EXCELLENT. The ECG Workout book has A LOT of rhythm strips for practice - even more so than the ECG's Made Incredibly Easy book.

I honestly hated doing EKG's in the beginning because I felt like I didn't get it, but now looking and interpreting rhythms is like second nature to me. You just have to practice, practice, practice! Know how to interpret an EKG, know that 1 small block = 0.04sec and 5 small blocks = 0.20sec. Know the normal time for QRS and PR intervals. There should be 1 P wave (appearing before) to 1 QRS.

The hardest to learn (and keep straight!) for me are the AV blocks. Here is how I learned it:

* If your R is far from your P, then you have a 1st degree

PR interval is >0.20sec.

* Long, longer, drop....then you have a Wenckebach (2nd degree Type 1/Wenckebach)

Your PR interval will progressively get longer and then you have a missed QRS.

* If your P's don't go through, then you have a Mobitz II (2nd degree Type II/Mobitz II)

Here the PR interval remains CONSTANT with every beat, but then you'll have P waves without a QRS.

* If you're P's and Q's don't agree, then you have a 3rd degree

Complete AV-dissociation. Basically, the P waves are doing one thing and the QRSes are doing another thing!

Oh and in your EKG test, make sure you measure the distance from R wave to R wave. I almost wrote down "NSR" for a rhythm until I went back and measured the R-to-R distance and the answer was definitely sinus arrhythmia!

And what about a cardiothoracic ICU or coronary care unit (CCU)? I know those aren't options with this internship but if that sparks your interest, I think starting out in progressive care/telemetry is ideal. You will get a strong background and you will be able to move up. Also, I have heard of nurses working on a progressive care unit and then moving to ICU.