Need Help Designing EKG crash course

[MasterintuBater]

So I'm finishing up my OB month and the OB senior asks me to give them a 15-20 minute talk on basic EKG interpretation. I have seen them attempt to read EKGs and they are, admittedly, not good at it. (I guess glossing over miles and miles of toco strips blunts their attention to detail and scientific reasoning)

So, I'd like to ellicit any suggestions of what to cover in a 15 minute "Survival Guide" to EKGs

topics I plan to cover: Acute MI, basic arrythmias including heart block, Pericarditis, congenital anomalies (WPW, long QT), and normal variants (i.e. J-point) I just want them to be able to recognize "abnormal" well enough to know when to consult cards and when to feel comfortable that they are looking at a normal EKG.

Any other suggestions of topics I should cover in that vast 15-20 minutes. Pertitnent EKG's for obstetrical patients.

Also, anyone know of any online (and free) databases of EKG's?

Thanks for your help.

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[MedicFL]

The University of Miami has a very good 12 Lead Course, their book is very good and simple to follow. Brady also has a simple but effective book out.. I am sure you can get some American Heart ACLS course Material that should help out..I would also cover artifact and Bundle Branch blocks...

 

[141837]

Humbly, if you can present these points, and drill them home, ECG skills will soar. These are theories, and not points to memorize. The only way to effectively *understand* ECG interpretation is to understand the "what I'm looking at"... and not just regurgitate "if ____, then ____".

- Firstly, please don't teach specific rhythms, believe it or not. The below points are more important in my eyes. If you just teach specific strips, you doom them to memorization... not good!
- Next, allot WAY more time! 15 minutes?... yeah, right. It'll take that long for the first set of questions. Sincerely...
- Make sure that the ECG is for your patient: read ECG name and then chart and wristband (!)
- Understand the placement of the colored electrode wires.
- Know that each ECG lead observed on a machine is just displaying electrical activity between the two electrode poles making up that lead. It is NOT like a battery SENDING electricity between the wires! It only monitors activity BETWEEN them!
- If electrical activity is going TOWARDS the + electrode of a lead, the deflection displayed is UP
if electrical activity is going AWAY from the + electrode, deflection is DOWN
- Understand EXCITATION (neuro) - CONTRACTION (mechanical) COUPLING is necessary for a PULSE (nervous signal crossing the NMJ, depolarization, and subsequent squeezing of the myocardium)... and that the ECG is NOT DISPLAYING THE PULSE, only electrical IMPULSES!
- Know, that leads I, II, III, aVr, aVl, and aVf are coronal, looking at the surface of the heart, and that the - electrodes for the aV leads are computer-derived at about dead center in Einthoven's triangle
- Know that aVr should be negative "a majority of the time". Why is this and why the Diff Dx list; being pimped with the wires on wrong [a CLASSIC pimp!], dextrocardia/situs inversus/Kartagener's, massive trauma, WAY tall and skinny...?
- Know that leads V1-6 are looking at the heart in cross-section, transversely, and that the - electrode is ~ the AV node (computer-derived)
- Myocardial demise:
NL = isolectric ST
Ischemia (reversible) = depressed ST and/or inverted T
Injury (reversible) = elevated ST
Infarct (irreversible) = Q waves +/- elevated ST
- ST elevation is ALWAYS myocardial injury (!!!), but ST segment depression can be ischemia OR reciprocal changes!
- Diabetics may not feel ischemic heart Dz!
- Ischemic heart Dz may NOT show up on ECG

Well, that's how I teach it in about eight hours. Have fun with your time, as much as you're able!

Peace.

 

[ditch doctor]

15 minutes? Um... use that time to recommend some good EKG books they can read...

 

[nachoDoc]

15 minutes? Um... use that time to recommend some good EKG books they can read...

Agree, you could also create a handout with links to EKG resources online. A crash course would be ill advised, for example: Flat or inverted T Wave in leads III, V1 and V2 and Q waves in leads III and aVF are normal findings during pregnancy that might otherwise have you thinking ischemic or non-specific changes and a full 12-lead review. Referral is your best bet.

 

[BKN]

So I'm finishing up my OB month and the OB senior asks me to give them a 15-20 minute talk on basic EKG interpretation. I have seen them attempt to read EKGs and they are, admittedly, not good at it. (I guess glossing over miles and miles of toco strips blunts their attention to detail and scientific reasoning)

So, I'd like to ellicit any suggestions of what to cover in a 15 minute "Survival Guide" to EKGs

topics I plan to cover: Acute MI, basic arrythmias including heart block, Pericarditis, congenital anomalies (WPW, long QT), and normal variants (i.e. J-point) I just want them to be able to recognize "abnormal" well enough to know when to consult cards and when to feel comfortable that they are looking at a normal EKG.

Any other suggestions of topics I should cover in that vast 15-20 minutes. Pertitnent EKG's for obstetrical patients.

Also, anyone know of any online (and free) databases of EKG's?

Thanks for your help.

I have to agree with the others. It'll never happen. Ask them if they can teach you how to decide when to do a laparoscopy in 15 minutes.

Best advice, teach them to:

1. Read the computer reading, and if it looks bad get help.

2. Realize that the computer readings are frequently wrong.

 

[WilcoWorld]

EKG's in 15 minutes?

Can't be done.

I agree with the above sentiment, but would take it one step further to say that if all they are willing to devote to EKG's is 15 minutes then that time should be spent reviewing the pager numbers of the cardiologists.