EKG Rhythm Interpretation

[EmxoRenee]

I'm in my third semester of nursing school, and trying to learn EKG interpretation. I understand measuring the intervals and complexes and idenfying if P QRS and T and present. In lab, it all made so much sense!

Now, I'm at home with a practice worksheet where we are supposed to determine the rhythm by looking at strips. I do fine with the Sinus rhythms, but I'm getting majorly tripped up on all of the abnormal rhythms! I've tried looking at study guides we were given and notes I took in lab, but I'm in way over my head! My issue is that none of the practice strips look like the "typical" examples we looked at in lab for the abnormal rhythms! Does anyone have any tips for interpreting which abnormal rhythm I'm looking at? Also, any good tips for determing if ST elevation is present? Any resources you've found that help or any tricks you've learned along the way would be greatly appreciated, because right now I'm overwhelmed and it's making me a little nervous to eventually be out on the floor trying to interpret my patient's heart rhythm!

Thank you so much!

-Emily

[bgxyrnf, MSN, RN]

Excellent Online Resources:

Life in the FastLane ECG Library

ECG Library

Excellent Books:

The Only EKG Book You'll Ever Need

Introduction To 12-Lead ECG: The Art Of Interpretation

[bgxyrnf, MSN, RN]

Does anyone have any tips for interpreting which abnormal rhythm I'm looking at?

Before you look at the ECG, look at the clinical picture to get an idea of what you might be looking for.

Start with the basics... Rate (fast or slow) and Rhythm (regular v irregular)

Then look at intervals... PR, QRS, QT, ST

Then focus on QRS... wide or narrow

Then look closely at ST in each lead for elevation or depression

Then look at morphologies... (peaked T waves, notched QRS, etc)

Also, any good tips for determing if ST elevation is present?

Use a straight edge along the PQ segment and look closely at the ST voltage.

Post some strips, along with your interpretations, and you'll probably get some good feedback.

[meanmaryjean, DNP, RN]

Also- HUGE leap between identifying rhythm disturbances and thinking you need to be skilled in 12-lead interpretation. Stick to the basics- learn the arrhythmias.

[bgxyrnf, MSN, RN]

Also- HUGE leap between identifying rhythm disturbances and thinking you need to be skilled in 12-lead interpretation. Stick to the basics- learn the arrhythmias.

For sure.

If you can reliably spot A-fib, SVT, STEMI, and VT/VF, you're pretty well-equipped for the nursing role.

Differentiating SB from a 3rd degree block is pretty big, too.

[Dodongo, APRN, NP]

Dubin's Rapid Interpretation of EKGs is the best text to train your mind in systematically evaluating EKGs. You should approach every EKG/strip in the same manner every time. Are there P waves? QRS complexes? T waves? Are the P waves marching out regularly? The QRS? T waves? Do they have a positive or negative deflection? What is the PR interval? QRS? QT? Etc, etc. Once you've collected all your data, then you can start piecing it together and interpreting the rhythm. Certain rhythms are no brainers and these are usually the ones that will cause significant morbidity or mortality the quickest.

In summary, develop a systematic approach and then practice.

Once you've got the basics down, then you can start throwing in more advanced information - delta waves, U waves, biphasic waves, determining the axis, etc. But Dubin's will give you the basics.

[emergenceRN17, ASN, BSN, RN]

Dubin's Rapid Interpretation of EKGs is the best text to train your mind in systematically evaluating EKGs. You should approach every EKG/strip in the same manner every time. Are there P waves? QRS complexes? T waves? Are the P waves marching out regularly? The QRS? T waves? Do they have a positive or negative deflection? What is the PR interval? QRS? QT? Etc, etc. Once you've collected all your data, then you can start piecing it together and interpreting the rhythm. Certain rhythms are no brainers and these are usually the ones that will cause significant morbidity or mortality the quickest.

In summary, develop a systematic approach and then practice.

Once you've got the basics down, then you can start throwing in more advanced information - delta waves, U waves, biphasic waves, determining the axis, etc. But Dubin's will give you the basics.

I agree with Dodongo, Dubin is a great book!!!!

[bgxyrnf, MSN, RN]

Personally, I don't care for Dubin's book but to each their own.

[nursej22, MSN, RN]

From my first class on rhythms:

1. Look at the patient pulse or no pulse, symptomatic or asymptomatic

2) Look at the rate: too fast, too slow, none at all

3) Look at the rhythm: regular or irregular. If irregular irregularly irregular (most likely afib), regularly regular: if too slow, think block

4) Look at the QRS: normal, wide (ventricular or bbb) or narrow (?junctional)

5) Look at the patient

[bellini]

I agree with a previous comment that you need to adopt a systematic approach when you are learning rhythm interpretation. I think you are getting tripped up because you are using a pattern recognition strategy...that is appropriate for an expert who got to be an expert by first systematically analyzing hundreds or thousands of strips but not for a novice.

I recommend Gail Walraven's "Basic Arrhythmias", Seventh Edition. It teaches a systematic approach to interpretation, and has hundreds of practice strips with the answers so that you can check your work. It also addresses 12-lead interpretation at the end, but I agree with another comment that you should first make sure that you have mastered the basics before you tackle 12-lead.