EMS RN 7

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.

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!

What it means for us--lower pay, and less time with patients. Judging from what my 2 friends from the UK have told me about the socialized system in place there, the majority of Americans will simply not put up with the hassles true universal health care brings.

I'm currently headed into 172 this fall and found your post accurate but anecdotal. From what I can tell, many of the posters here are probably from my night class. We had a great teacher but our overall experience with the program has not been great thus far (I'm optimistic though for the future). The PE is a deadfully poor way to evaluate skills. Despite several years of responding to 911 calls I still got a pit in my stomach trying to master skills for a PE that was an entirely made up-scenario. Far more stress than I ever had with real critically injured patients in real life. That being said, practice does make perfect so keep yourself in the lab as much as possible like I did. So far we've had no real lecture and the program is largely self-directed, a big problem for some students will little or no experience to relate to. THe program is under evaluation currently, however, and I will not be surprised to see changes in the coming semesters, though not in time to help me most likely. Your observation about the pass rate is definitely anecdotal. While I expect a high pass rate form ym mostly adult section as well, the current pass percetage is 80% for the school, down from 86 and 87% respectively. I actually asked in the nursing office at the end of the prior semester and those are the official stats from them. Bear in mind that the NCLEX is a standardized test but I find those number s bit low compared to everyone else's 96-99% pass rates. Will you be a good nurse coming from this program? Possibly, but you will have to work extra hard. And remember, the way CLC writes their exams, if there's one answer that just makes no sense, that's the one they're probably looking for!