# Basics and EKG knowledge



## rhan101277 (Nov 2, 2008)

I know basics needs to focus on basic life support.  But I like to know the meaning of basic EKG strips and such so I can have a somewhat of a understanding of what is going on with a patient.  I was working with a medic when I asked about elevated T waves I noticed on a strip of a pt. we just had.  I was told that they didn't look into the strips that much and that 12 leads are best used for that.  How are you supposed to treat a pt. if you are not sure what the strip is telling you, even if the pt. symptoms aren't cardiac in nature.  Maybe his/her CC was something different that was masking a cardiac issue.  Anyway I just wanted to post it and see what others thought


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## fma08 (Nov 2, 2008)

Depending on who you ask, and the textbook answer is basic strips (i.e. lead II) can only tell rate and rhythm. A 12-lead is needed to diagnose MI's, electrolyte imbalances, bundle branch blocks... etc. But there are some good introductory books out there. R/r has recommended some books which I can't remember the names of off the top of my head. Try a search and see what you come up with.


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## Ridryder911 (Nov 2, 2008)

Although, one can actually see some  malformed ECG tracings, it does really take a 12 lead to determine true abnormalities. 

Some of my recommended books are: 

_Dubin's Rapid Interpretation ECG 

ECG Interpretation -Bob Page

ECG Interpretation-Incredibly Easy!_


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## rhan101277 (Nov 3, 2008)

Thanks for clearing this up for me.  I feel better about it now.  That a-fib tracing I posted earlier was from a 3 lead.  What are some of the tracings you can see, besides tachycardia, bradycardia, a-fib and asystole on the three lead?


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## fma08 (Nov 3, 2008)

There's many, many, many different rhythms out there that you can see on a 3 lead. Remember, that's what the 3 lead is for, rate and rhythm. But, all the rhythms (outside of "normal") will generally fit into one of three categories which you listed there, tachy, brady, or Asystole/PEA. To quote one of my instructors during ACLS, "Is it fast, is it slow, or is it a no go?" As everyone will tell you over and over again, make sure you understand what you are seeing, not just the heart is beating irregularly at X times a minute. What are the atria doing? What are the ventricles doing? What is going on with the SA/AV nodes? etc. etc. Know what you are seeing and why it is happening. And again, it's just a tool. Treat the patient, not the monitor. Pick up one of the books R/r recommended there and dig in. ^_^


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## BossyCow (Nov 3, 2008)

I would add to the fast/slow regular or irregular.


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## KEVD18 (Nov 3, 2008)

rapid interp is probably the best book for your case. its breaks it right down to the most basic level. it wouldnt suprise me if a three year old could read a III lead after a trip or two through that book. im not inferiing anything about your intelligence there, just stating my assesment of the book.

one piece of advice. tread carefully with your new found knowledge. what i mean is dont try to interpret strips and base patient care off of that interpretation and dont call the medics out on what they say. phrase everything you say to the medics about a strip as a genuinely inquisitive question and not as an underhanded "im smarter than you" question. even still, some hard headed paragods will still see your questioning as trying to call them out, so tread lightly.


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## NRCCEMTP26 (Nov 3, 2008)

Ridryder911 said:


> Although, one can actually see some  malformed ECG tracings, it does really take a 12 lead to determine true abnormalities.
> 
> Some of my recommended books are:
> 
> ...



DIDDO! spent a little and gain a bunch of knowlage, thoes books are in my library, and the little that is taught in class will be enhanced to your further knowlage. Keep advancing yourself, it will do wonders


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## LucidResq (Nov 3, 2008)

Hm... there are basic EKG interpretation courses aimed at EMT-Bs available in my area. There's also another course that an EMT-B can take after the basic interpretation course for 12 leads. In fact, these courses are actually prerequisites for several local paramedic programs.

Not sure if these programs exist elsewhere.


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## NRCCEMTP26 (Nov 3, 2008)

if you also have a couple extra bucks. Go to the local hospital and see how much it would be to get certified in moniter tech. again the more you know the better off you are


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## fma08 (Nov 3, 2008)

LucidResq said:


> Hm... there are basic EKG interpretation courses aimed at EMT-Bs available in my area. There's also another course that an EMT-B can take after the basic interpretation course for 12 leads. In fact, these courses are actually prerequisites for several local paramedic programs.
> 
> Not sure if these programs exist elsewhere.



Our basic course didn't even touch on EKG's or 12-leads, that came in medic school. We did get a pretty good A&P lecture on the basics of the heart conduction though which it sounded like from other posts some basic programs were lacking. Yet another example of problems in EMS education.


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## rhan101277 (Nov 4, 2008)

fma08 said:


> Our basic course didn't even touch on EKG's or 12-leads, that came in medic school. We did get a pretty good A&P lecture on the basics of the heart conduction though which it sounded like from other posts some basic programs were lacking. Yet another example of problems in EMS education.



We have been over basic rythms and conduction in class already.  The class I have is extremely comprehensive and difficult.  I am doing good in there though, just 1 more ambulance ride.  I gotta get better at taking BP, this one lady had big arms and I just couldn't get it, guess I need to press harder on stethoscope.  I definitely gonna buy a stethoscope with squishy ear pieces, the hard plastic ones let to much noise in.


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## mbcwgrl (Nov 4, 2008)

Best advise... Remember to treat your patient not your monitor! As an EMT that has my basic EKG cert and am currently working for a company that makes it mandatory that you audit an ACLS class every year, I think its a great idea to have the basic knowledge. 4 leads are a great start to quickly visulize any abnormalities. 12 lead allows for more views and to determine what could be going on. It is really nice to be able to print out a 6 second strip, glance at it and know what could be going on, hand it to my paramedic and be able to tell them all I see currently is A-fib. It makes life a little easier on both me and my medic!


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## Ridryder911 (Nov 4, 2008)

I am NEVER against anyone receiving education and training, but to require Basics to take an ECG course is not warranted. I much rather for them to take an anatomy & physiology course, something they can use as well as forming a better foundation. 

One can take a surgical course, yet this would not make them a better EMT. Focus upon the basics and be sure one has a full understanding of this before moving upward. Again, part of the problems of EMT's is taking a short cut and as always, it will come back & bite you. 

R/r 911


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## fma08 (Nov 4, 2008)

Ridryder911 said:


> I am NEVER against anyone receiving education and training, but to require Basics to take an ECG course is not warranted. I much rather for them to take an anatomy & physiology course, something they can use as well as forming a better foundation.
> 
> One can take a surgical course, yet this would not make them a better EMT. Focus upon the basics and be sure one has a full understanding of this before moving upward. Again, part of the problems of EMT's is taking a short cut and as always, it will come back & bite you.
> 
> R/r 911



I'd just add to that, have the basics take a "real" A&P course. The A&P I got in Basic... was whatever they happen to mention in the book. The "A&P" course in medic school we got was a complete joke. Now that I'm back in college and taking an actual A&P lecture and lab course, so much more is falling into place from medic school, and it is even the introductory A&P.


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