November 17, 2004
A...B...C...D...EKG
I recently completed the first half of my EKG class and, while I know diddly, I don't know squat.
I can identify several rhythms fairly well. I know PVCs and A-Flutter (I should know that one!), asystole, sinus bradycardia and sinus tachycardia, and I can also pick out Wenckebach (Weinkebach or Wenkebach - depends on who you ask) from 500 paces.
I'm having a terrible time remembering where to measure my QRS and Q-Ts. I can never seem to remember what a junctional rhythm looks like. And I know that picking out the right block from a cast of thousands is going to be the death of me. How can I remember which is first degree and which is third?
Einthoven can bite my rather ample behind.
"Hi, I'm Da Goddess, and EKGs are my downfall. I need help. I need you to talk to me like you would a three-year old and pound this information into my brain. Thank you."
I have a dozen sites with illustrations, simple words, and quizzes...and none of them are making this easier.
Excuse me while I bang my head against the wall repeatedly.
Posted by DaGoddess at November 17, 2004 11:19 PMDale Dubin's book, "Rapid Interpretation of EKG's" is a rather good place to start. Very, very simple. Or you could do what the nurses on my floor have been doing this month- just find an intern and watch him squirm as he tries to remember what he read in Dubin... :^)
Posted by: Michael at November 18, 2004 03:33 AMNot too long ago I got hit with some solvent fumes that put me into a stronger than usual arrythmia (sometimes it does suck to be me). Went to the Dr. to get it checked out, he had the tech do an EKG. Her first reaction was to check all the leads and run it again. I had a very normal looking graph, with the minor exception of the parts where there was nothing. Dead flat line for the space of a beat or two. That sent me off for my 24-hour monitoring, which revealed that I continue to not be dead yet.
If they give you too much trouble over reading a trace, just remember that there *will* be one that stumps them too, sooner or later.
Posted by: KCSteve at November 18, 2004 08:30 AMOkay, remind me not to have a heart attack whenever I visit you.
Posted by: David Kilpatrick at November 18, 2004 09:10 AMI like the part where I get to shave the cranky patient - it's that "I dunno why they asked me to shave your left nipple... I s'pose they want a really good contact patch. I just work here, I'm just following orders. Oops, did the razor cut you?"
Posted by: inkgrrl at November 18, 2004 10:06 AMWell, at least you'll need an EEG instead of an EKG if you keep banging your head into the wall.
Posted by: TW at November 18, 2004 11:13 AMDavid, I can handle a heart attack. I know what to do with that.....but don't ask me to interpret more than just the basic damn data from that crazy machine! That's what doctors are supposed to do.
Posted by: Da Goddess at November 18, 2004 01:26 PMIf I told you my secrets for reading EKG's I'd have to shoot you ;-)
Posted by: Azygos at November 18, 2004 05:44 PMDa Goddess,
Don’t try to learn it all at once. Go back to baby steps.
Are there P waves
Are the P waves regular
Is there a QRS for each P wave
Is the QRS wide or narrow
If you take a systematic approach you will get it eventually. It takes reading lots and lots of EKG’s. The most important part is being able to tell what the seven lethal rhythms are. If it’s not lethal you have time to figure out what it is.
Good Luck
Azygos
I wish I could help, but respiratory equipment is my strong suit.
Posted by: M+ at November 18, 2004 06:04 PMI am just a lowly street medic and I don't know if these simple memorization techniques will help but here are a few things that always seem to work for me on the blocks.
1st degree: PR interval > .20
2nd degree Type I: PR gets wider and wider until it drops a beat (remember "Wenkebach-wider, wider, wider, drop)
2nd degree Type II: more P's than QRS's but each QRS has a P wave "dancing" with it.
3rd degree: more P's than QRS's. P waves are NOT "dancing" with the QRS.
Hope that helps. :)
Posted by: medicmom at November 19, 2004 12:45 AMHunky patient: I think I'm having a heart attack.
DaGoddess: You need mouth-to-mouth. Lay down.
Hunky patient: But...
DaGoddess: Don't argue; I'm a nurse.
Hunky patient: What's that thing?
DaGoddess: Medical equipment. Standard procedure.
Hunky patient: Looks like a Frederick's of Hollywood leather corset and a pair of handcuffs to me.
DaGoddess: Who's the nurse here? Lay down and keep still.
Hunky patient: And THAT looks like a cattle prod.
DaGoddess: I'm a professional. I do this every day. Trust me.