help with EKG basics

Specialties CCU

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I'm not a cardiac/tele nurse or anything related, I'm starting in L&D but my hospital has a requirement that all nurses (except psych and outpatient basically) have to pass an EKG interpretation test. I'm really struggling because there is JUST SO MUCH to an EKG and even in nursing school I didn't learn most of this stuff, like junctional rhythms and whatnot. And I worked postpartum for a few years at a different hospital that didn't have this requirement, so I'm a few years removed from whatever EKG basics I did learn at one point.

I'm just looking for some study help, any resources that might help me to get the basics of reading and interpreting a strip because the modules the hospital provided have not done the trick. Any help appreciated, thanks in advance!

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Isn't the hospital nursing education department providing any study guides? What are, or have, your fellow L & D nurses done?

I doubt you are going to be interpreting a 12 lead EKG. I assume you will be given some telemetry strips. I assume they will only want a basic interpretation.

Honestly counting the boxes, counting the rate is easy. Knowing if it's too fast, over 100, or to slow, less than 60. V fib, V flutter, V tach, flat line. If you have a handle on those you'll be in good shape. That covers the basics of a MEGA code for ACLS.

I can't imagine they will want you to know blocks or junctional rhythms, etc.

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Yes, they provided us modules, but I didn't find them helpful and am looking for a different study guide or resource.

Yes, they do want us to know junctional rhythms, blocks, and pacemaker rhythms.

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Ay carumba, that's crazy. I am not even going to bother trying to figure out why they want an L & D nurse to know blocks, pacemakers, etc.

I knew (past tense) all that stuff years ago, but that was when I worked telemetry and CCU.

Have you looked at You Tube? They have good educational videos on telemetry strips.

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ECG analysis is not as difficult as some seem to make it. You can't learn it by looking at strips and trying to memorize what atrial tachycardia/flutter, supraventricular tachycardia, etc. looks like and apply this to other rhythm strips look light. Rather, you need to learn the basic criteria for the individual rhythm, and then apply the criteria to the rhythm strip you are analyzing.

When I analyze an ECG rhythm strip I use the following mnemonic: RRPPQQ.

Rate: What is the rate? Less than 60 or greater then 100?

Regularity: Is the rhythm regular? If irregular, Is there a pattern to the irregularity?

P wave: Are P waves present? Is each P wave followed by a QRS complex?

PR interval: 0.12 – 0.2 seconds.

QRS complex: 0.06 – 0.1 seconds, although you will find some variation to these values.

QT segment.

You might find the following sites helpful. Although the latter two include 12 lead ECG information, the basic information concerning rhythm identification, wave analysis, etc. is appropriate.

Life in the Fastlane ECG Library

ECG Learning Center Characteristics of the Normal ECG

Analysis and Interpretation of the Electrocardiogram

I also want to mention that learning ECG analysis is like learning heart and lung sounds; the more you do it, the better you will become.

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I just commented this on another thread but Dubin's Rapid Interpretation of EKG's is SUCH a good tool for learning EKG analysis. I really can't recommend it enough.

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I also want to mention that learning ECG analysis is like learning heart and lung sounds; the more you do it, the better you will become.

Thanks, this is all super helpful. And yeah I agree, if I were on a tele floor or CVICU or something I would totally understand the need to learn this stuff and practice it all the time, but it just seems so pointless when on L&D I'm going to be doing EKGs every once in a while at best, and I know there won't be nearly enough practice to get reliable or comfortable with it.

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I would love for you to ask why L & D nurses need this. I will send you a check for $100.00 if you ask the powers that be and let me know what they say. :)

It makes as much sense as having med/surg, ICU, ER, etc., nurses know and be tested on what those uterine contractions and fetal heart rate tracings mean. I forget their official name.

Sure, as I said maybe all nurses should know too fast, too slow, V tach, V fib, V flitter, but that is all!

We had a pregnant woman with a known "bad heart" in our CCU. I was new, didn't speak much Spanish at the time, I finally asked an interpreter what the patient was saying. She wasn't in pain, no obvious signs of being in screaming, pushing, labor, but of course she was saying she felt like the baby was coming.

Yep, the baby was delivered in CCU. I'm pretty sure she didn't have fetal monitors on her? Or could she have had them on but can a premature delvery contractions not show significant tracings? I think. L & D nurses were coming over from time to time to check?

Probably a HIPAA violation to even mention this story! Stupid HIPAA. It was about 38 years ago. The baby was premature but breathing on its own, transported to a higher level of care facility.

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I would love for you to ask why L & D nurses need this. I will send you a check for $100.00 if you ask the powers that be and let me know what they say. :)

haha, I basically did ask this at the time they presented it, and they were just kinda like you'll have some really sick/heart failure moms for sure. It's a major destination/teaching hospital with a close partnership with one of the best children's hospitals in the country next door that often immediately receives our sick/premature kiddos.

I don't doubt that I'll have chronically ill moms as patients including cardiac cases. But they're going to be the exception and I'm not going to be doing EKGs even close to every day. I mean, I feel like sure, I should be able to basically identify a normal-looking PQRST and assess for regularity. But if there's literally any variation I'm not going to be hunched over that strip trying to remember the difference between all the heart blocks and junctional rhythms, I'll just be saying uhhh this does NOT look right and calling for help asap. Am I wrong?

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Update: nurses on my floor told me whenever we have a cardiac pt their EKG is being monitored at a remote location (I assume a tele floor or something) and those nurses are responsible for notifying us if there's anything funky. So this really is mostly pointless!

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Yeah.....what a waste of time. It is crazy. What are they going to do to you if you flunk the test?

The best of a bad situation would be for a maybe a 20 question test on arrhythmias to be passed out at work, to be worked on over the next 2 - 4 shifts. You and your co-workers, with the powers that be approval, could work on the answers together as a group. Working together, bouncing questions off each other, is a good way to learn, (and of course forget 80% of what you learned two weeks later)!

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