Basic EKG interpretation class

[Level1pedstech]

One of my many duties especially on the adult side of the ER is to preform EKG's. Over the last three years I have done a few hundred but have no formal training in interpretation. My job is to preform the test and have the results read by an MD,PA or RN. I have been meaning to get a book and start studying on my own but I now have the chance to take a 16 hour interpretation class provided by my employer.

I am always up for a new education opportunity but want some feedback on the subject. What I would like out of the class is to know what I am looking at when I run a test, this will not change my job duties its just for my knowledge. It would count as CME hours and would be a great head start for future education. The down side is I'm scheduled to work and it would end up costing me 400.00 in lost pay. Is 16 hours to much or to little for what I want out of the class, how much EKG training do you get in medic school and would I be better off just getting a good book and waiting until I move on with my education. Thank you in advance for any help.

 

[triemal04]

What!? You're doing something that you don't fully understand and can't interpret!? You mean you've only been trained in the "skills" portion of an ekg and not all of it!? What kind of insane nonsense is that? Sorry, couldn't help it...just funny.

Take the class. And buy a book on EKG interpretation if you are really serious about learning; having something to study along with the lecture will help. Neither will make you an expert or (hopefully) even get you to the same level you'd be at after paramedic school, but it also shouldn't be a waste of time, especially if you plan on medic school in the future. Just make sure that you fully understand all the material presented; if you don't you're opening yourself up to more problems.

Just be sure and remember that it DOESN'T change what you job is, and it DOESN'T make you an expert on reading ekg's. Do that and it shouldn't be a problem for you and, assuming the people you work with a willing, can lead to learning even more.

 

[Level1pedstech]

I'm not sure how to "interpret" your reply. I was trained in the "skills" portion of the test during my orientation into the ER. Do you know whats involved with the EKG machines in the ER? Proper lead placement and a good clear test with little or no artifact and the computer does the rest. I'm not sure what more there is to know to preform the test. I think if there were any doubts in our ability the big shots upstairs would have put an end to the practice of techs doing EKGs a long time ago.

Did I not clearly state in my message that I was doing this for my own education not to be able to give results. In ten years of service I have never stepped over the line or attempted to practice out of my scope. I am not licensed to do Jack in Oregon but the facility trusts me to provide patient care above and beyond the level I am licensed to provide care in the field in Washington. As far as being an expert even I know 16 hours of any training is far from what I would call an amount that would place someone in the expert category. I don't mean to come off as crass but I take this all very seriously.

 

[Shishkabob]

Careful, ped, it's just something some of the more gun-ho medics say when an under-patchman talks about doing an ALS skill.


I recommend reading Dale Dubins "Rapid Interpretation of EKGs"

 

[VentMedic]

As far as being an expert even I know 16 hours of any training is far from what I would call an amount that would place someone in the expert category. I don't mean to come off as crass but I take this all very seriously.

Take the training the hospital is offering. Take any training the hospital offers regardless of how it relates to your present duties. Classes for various central lines, insulin, technology or whatever may be of some use to you in the future. You may also be able to build on the inital 16 hours at the hospital to some of their CCU courses.

16 hours of 12 lead EKG may be alot more then some in EMS get especially since you have already gone through the skills portion which counts for something. Some places such as L.A. county only give their medics a quick placement instruction and then rely on machine interpretation. That didn't go well with their first STEMI results from the hospitals as there were too many false positives because neither the machine or the medic could tell artifact from ST elevation. They then had to train for how to recognize artifact.

Yes, doing EKGs in the hospital is very different because not only do the ED physicians read and critique the tracings, the cardiologists which also includes the medical director of cardiology must oversee quality. Some places have had to staff the hospitals with EKG technicians 24/7 because quality was slipping. If we can not get a quality tracing, we have to document exactly why. If we can not place the electrodes correctly, we have to document why. The physician can then take this into consideration and not make a diagnostic error which could lead to more costly and/or invasive tests.

 

[Level1pedstech]

Roger that. No disrespect intended. I guess Im having a little trouble with the ALS part. Is it not the interpretation and the treatment that makes it an ALS skill. Do you consider placing a patient on full monitor an ALS skill. It may well be in the field but I bet I do it a dozen times a shift in the ER.

 

[VentMedic]

Roger that. No disrespect intended. I guess Im having a little trouble with the ALS part. Is it not the interpretation and the treatment that makes it an ALS skill. Do you consider placing a patient on full monitor an ALS skill. It may well be in the field but I bet I do it a dozen times a shift in the ER.

This is why the terms "ALS" and "BLS" are rarely referred to in a hospital. The focus is on patient care and less on just counting skills. This is also why hospitals give on trying to interpret the many different levels of the EMT and just have their own job titles. EMTs get too hung up on counting skills. I have even heard of EMTs passing up great hospital jobs that were going to train them to do EKGs and phlebotomy because "it wasn't in their scope" regardless of how the hospital told them they would not be working under their EMT cert.

Hospitals will train you for whatever they can as long as they stay within the guidelines for what a nonlicensed staff member can do. For other classes, they usually welcome all once those that must have the classes have gotten their space.

 

[triemal04]

Roger that. No disrespect intended. I guess Im having a little trouble with the ALS part. Is it not the interpretation and the treatment that makes it an ALS skill. Do you consider placing a patient on full monitor an ALS skill. It may well be in the field but I bet I do it a dozen times a shift in the ER.

Calm down, it's a joke. Browse through various topics here about who can do what at various levels and it should become much clearer; the common refrain you here from people is what I posted; screaming in horror because someone is doing a "skill" without all the knowledge that goes with it and lamenting the fact that EMS is the only place that that happens. Like I said, it was funny in this case.

Regardless, take the class, read the book, whichever you buy, and learn more. But, since I don't know you as a person, still have to mention what I did in the third paragraph; may not be applicable to you (kudos if it's not), but that isn't always true. Either way, build off and learn more about what you learn in the class as you start to come across those things while working and you're on the right track.

 

[sdadam]

I thought that EMT-Intermediates had training in EKGs, and defib. that's not part of the EMT I scope?

Anyway, I think $400 is a bit much to lose over an EKG class. get the Dale Dubin book, it rocks, and wait till there is a class that you can get to without working. Or you could look in to paying for one at a local community college or something, it will most likely be less than $400 bucks.

And performing an EKG is a BLS skill. It is easily the standard of care in every ER to have a tech running the EKG, and a Dr. interpreting it, much like a radiology tech working the X-ray but not reading it.

I don't get the problem, my EMT does my 12 lead 90% of the time.

Adam

 

[triemal04]

I believe (hope really) that he's talking about 12-leads; in fact I'm pretty damn positive about that. And even with the funky levels in Washington I don't know that that is covered in the middle ones...but I could be wrong about that.

My basic partners also often run a 12-lead for me; I expect it, and require it of them, so don't worry there. But it's also really, really common on this, and other forums for people to have reactions like the above when an EMT is doing something without the requisite knowledge; most common topic would be IV's, though intubation and 12-leads have also had their moments. Regardless, this situation isn't applicable to any of those arguments, it just seemed like a funny thing to say.

 

[VentMedic]

My basic partners also often run a 12-lead for me; I expect it, and require it of them, so don't worry there. But it's also really, really common on this, and other forums for people to have reactions like the above when an EMT is doing something without the requisite knowledge; most common topic would be IV's, though intubation and 12-leads have also had their moments. Regardless, this situation isn't applicable to any of those arguments, it just seemed like a funny thing to say.

Those reactions come when advanced procedures are done by EMTs or other levels before Paramedic that do not have the ability to do much more than just the skill.

 

[vquintessence]

A member here, TomB, has a blog that is amazing regarding 12 leads.

http://ems12lead.blogspot.com/

Seriously check it out once you've taken your works course and read at least a basic ECG book. The blog is really informative and an easy refresher.