EKGs on Step

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Transformers

Transformers

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First Aid seems legit but do you have to know any of those obscure Arrythmias (PSVTs, PVCs, Junctional, escape beats, Accelerated IDV, pacemakers etc...)?
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Transformers said:
First Aid seems legit but do you have to know any of those obscure Arrythmias (PSVTs, PVCs, Junctional etc...)?
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None of those arrhythmias are obscure in the least. You will see those kinds of arrhythmias regularly. Just know how to read an EKG. As a former cardiology tech, the inability of some residents to know how to read an EKG and recognize arrhythmias, electrolyte disorders and other extremely important clinical signs is appalling. Certainly not all, but don't be one of them. It will keep you from looking like an idiot and will improve the care of your patients. Don't even get me started on nurses...
 
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The only EKG on Step 1 and 2 I have ever seen are AFib, AFlutter, VFib, Torsades de Pointes, effects of hypo/hyperkalemia, Heart blocks 1,2,3rd degrees.

The ones you mentioned are not "obscure" in that they are very common in real life. But I have never seen them show up on the Boards.

To put your mind at rest, you will not be seeing Brugada Syndrome or have to differentiate VTach from SVT with aberrancy via the Brugada Criteria... That's more for IM boards.
 
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I had a full fledge 12 lead ECG today. Super easy though, just had to determine basically if there was LVH. That was the only ECG I had on the entire test. Felt like I had barely any cardio. :confused:
 
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jozeppy26 said:
I had a full fledge 12 lead ECG today. Super easy though, just had to determine basically if there was LVH. That was the only ECG I had on the entire test. Felt like I had barely any cardio. :confused:
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Forgive my stupidity, but what do you look for? Just QRS widening?
 
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223556 said:
Forgive my stupidity, but what do you look for? Just QRS widening?
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WPW has a shortened PR interval, a delta wave (a sort of hump in the PR interval that directly connects to the QRS complex), and a widened QRS complex.
Edit: Oops! Thought you were referring to something else. Left for posterity.
 
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jozeppy26 said:
I had a full fledge 12 lead ECG today. Super easy though, just had to determine basically if there was LVH. That was the only ECG I had on the entire test. Felt like I had barely any cardio. :confused:
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Lol what? That's definitely not an average EKG that most people would know
 
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LVH is a super easy/common EKG. You just count the amplitudes...

OP, do what I did: learn the EKGs in FA before you step1, then read Dubin right after taking step1 but before you start M3. You definitely need to know other EKGs for M3 but not for step1.
 
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Heart sounds suck. Am I the only one who can't understand heart sounds at all unless I palpate the carotid?!
 
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calvnandhobbs68 said:
I mean if I saw a gigantic I and V5-V6 (the other ones are usually huge too though) with LVH as an answer and no other problems...it wouldn't be too hard to figure out probably.
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That's essentially how you should view EKGs. Go to the wikipedia article, look at the picture where the leads are placed and then you can essentially extrapolate. Learning the hexaxial system too can also be really helpful. http://en.wikipedia.org/wiki/Hexaxial_reference_system
 
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LVH is another super common one. You look for high voltage in precordial leads. There are different criteria out there, but the one from Dubins that I learned is S in V1 + R in V5 > 35mm. Another characteristic feature is the non-symmetrical inverted T wave you see often in the left precordial leads.

I know yall are focusing on Step I, but please for the love of god at the very least just memorize Dubins cold before residency.
 
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Packman2003 said:
I know yall are focusing on Step I, but please for the love of god at the very least just memorize Dubins cold before residency.
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I learned the EKGs in FA for Step 1. My first day of M3 my attending told me to learn Dubins by the next week :eek: It's such a great book but after the first 150 pages it gets to be really slow going and dense. Luckily labor day gave me an extra week before I see that attending again!
 
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what about specifics for arrythmia treatment, UW didnt really have questions like heres an EKG, what drug would be the best to use?
 
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Transformers said:
what about specifics for arrythmia treatment, UW didnt really have questions like heres an EKG, what drug would be the best to use?
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I'd recommend looking at page 208 of Lippincott Pharm.

But if you don't have access to the book, here's what it really comes down to:

PSVT - adenosine
WPW - never use adenosine, or anything that can block AV node and aggravate reentry. Use 1A or 1C
VFib/flutter - amiodarone, lidocaine (1B best for ischemic tissue due to fast dissociation)
AFib/flutter - propanolol/verapamil
 
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