ECG Guru - Instructor Resources

A gathering place for instructors of ECG and cardiac topics.

       

Subscribe to me on YouTube

Featured App

Welcome To The ECG GURU

The ECG GURU is devoted to providing resources for ECG teachers and their students. Follow the links above or the search terms to the left to find what you are looking for.  

Download ECGs, Illustrations, and other Resources For Your Classes!
Everything on the ECG GURU is free and free of copyright for your use in your classes.  

PLEASE BE COURTEOUS and leave any watermark or author attribution on the content you reproduce.

VISIT the ECG Guru on FaceBook and YouTube.

 

Instructors' Collection of the ECG of the WEEK, September 6, 2014 __ Wide Complex Tachycardia

Sat, 09/06/2014 - 17:03 -- Dawn

Wide-QRS rhythms can be difficult to diagnose from the ECG alone.  This difficulty is compounded when the rate is fast, as it can be hard to determine if P waves are present before the QRSs, or dissociated, or absent.

This ECG and rhythm strip were donated to the ECG Guru by Ryan Cihowiak.  We don't have clinical information on the patient, unfortunately.  It is a great example, however, of how difficult WCT can be to diagnose.

In the 12-Lead ECG, we see wide QRS complexes that are regular at a rate of 131 / minute. There are no obvious P waves before the QRS complexes, and no obvious distortion of the T waves, which would suggest a "hidden" P wave.  Unfortunately, there is significant artifact, which makes searching for P waves difficult.  The pattern overall suggests left bundle branch block, with the negative QRS in Lead V1 and positive QRS complexes in Leads I and V6.  However, one requirement for the diagnosis of LBBB is a supraventricular rhythm, and P waves are the best indicator of that.  An irregularly-irregular rhythm, indicating atrial fib, would also have made LBBB more likely.  In typical LBBB, the frontal plane axis is usually left-normal or left.  In this ECG, Lead III is taller than Lead I, putting the axis within normal range, but slightly rightward.

The rhythm strip uncovers something else.  Possible P waves are seen in some of the ST segments (arrows).  Are these dissociated?  Do they represent a first-degree AV block?  Are they actually artifact?  If this is a supraventricular rhythm, there is LBBB.   Then, notice beats #7,8,9.  If this rhythm is supraventricular (with LBBB), those must be a salvo of V Tach.  But, one of the possible P waves occurs in front of beat #7.

Another possibility is Right Ventricular Outflow Tract Tachycardia.  RVOT is a type of V Tach that typically has a LBBB pattern, with a slightly rightward axis.  If this is the case, beats #7,8,9 are probably "capture" beats or "fusion" beats.  Capture and fusion beats "prove" that the underlying tachycardia is ventricular, since, by definition, capture and fusion represent a return to supraventricular control of the rhythm.

What do you think about this ECG?  Remember, when WCT exists, it should be TREATED AS VENTRICULAR TACHYCARDIA until proven otherwise.  Emergency treatment of VT (and WCT) is chosen based on the patient's clinical condition.  The unstable patient should be immediately electrically cardioverted, as this is effective in VT and in SVT, provides immediate relief of the tachycardia, and has few side effects, if any. 

The ECG GURU website thanks Ed Burns of Life In the Fast Lane (http://www.lifeinthefastlane.com ) for providing a SUPERB reference source for all things ECG and more!

ECG TEACHING VIDEOS - An Important Tool For Teachers and Students Alike

Thu, 09/11/2014 - 23:40 -- Dawn

If you are a teacher, watching a masterful teacher present your topic can help you develop your style, and increase your own knowledge of your subject.  We don't all have the opportunity to attend live classes by the real ECG Gurus of the world, but many of them are now making FREE video lectures available to all of us. Even if you are not an instructor, for many of us, hearing and seeing the presentation is a more effective way to learn than just reading.    

ECG videos are plentiful on the Web.  That being said, we want to be careful who we learn from.  Anyone can publish anything now.  Fortunately, there are some really good teachers out there making videos.  The ECG Guru website would like to recommend two in particular:

Dr. Ken Grauer, MD, is a consulting expert for this website.  Most of you are aware of his website and his excellent print and e-pub publications.  But, he has recently begun making ECG instructional videos, and they are excellent!  Each video is presented in a methodical, organized way, with clear illustrations.  There is something for everyone, from the beginner to the advanced ECG user, including instructors.  To see Dr. Grauer's bio, go to this LINK.  Follow this link to watch his ECG videos.

Dr. Amal Mattu, MD, FACEP, is also well-known to regular readers of the ECG Guru website.  He is an Emergency physician and faculty member at the University of Maryland.  He presents an ECG Video of the Week every week, and they are outstanding!  You will love his conversational style, and his markup illustrations as he progresses through each week's case.  His focus is very clinical and practical, and he manages to be very entertaining as well.  If you are an instructor, you will learn a lot about teaching style from Dr. Mattu.  For his bio, go to this LINK.  Follow this link to his ECG Videos. 

 

ECG Basics: Ventricular Fibrillation Converted With Defibrillation

Sat, 09/06/2014 - 22:48 -- Dawn

A good example of ventricular fibrillation converted by electric defibrillation to what appears to be a sinus rhythm.  There is significant artifact in the post-conversion strip, but the last beat on the strip appears to have a P-QRS-T sequence.

Of course, V Fib presents without pulses, and must be defibrillated as soon as possible.  Best results are achieved by defibrillating a perfused heart, so if there is any delay from onset of V Fib, CPR should be performed to perfuse the heart prior to defibrillation.

Ask The Expert

Fri, 09/05/2014 - 17:23 -- Dawn
Darlene Hutton, RN, BScN, MSN

As a fairly new educator in the telemetry/medical unit or Emergency Department, what steps would you suggest taking in helping new nurses to the unit understand ECG Interpretation?

 

Today's Expert is Darlene Hutton, RN, BScN, MSN

Darlene Hutton has worked in CCU, ICU, PACU, and Emergency as a bedside nurse, educator, and manager. She is currently working as a Clinical Research Manager at Rouge Valley Metabolic Research Associates in Toronto. Darlene also is an Educational Consultant providing workshops, seminars, and conferences on such topics as ECG Interpretation, Dysrhythmia Interpretation, Acute Coronary Syndromes and Cardiology Drugs. She is also an ACLS Course Director and runs courses throughout the province. Her company, QRS Educational Services, founded 18 years ago, provides education to nurses and other health care professionals throughout Canada. She is also the Department Head for Emergency Preparedness in the O.R. in the American College of Plastic Surgical Nursing journal.

 Darlene@qrseducation.com

(905) 706-3301     www.qrs-education.com     www.facebook.com/qrs.educationservices


ANSWER:

As an independent educator for the past 20 years, I have had the incredible pleasure of spending time with novice to expert nurses in their respective field from a variety of different hospital settings.  My response to this question comes from what I have learned from each of these individuals over the past 2 decades.

We know that the “expert” practitioner is sometimes not the best educator because of their own challenges in bringing the information to a basic level of understanding.  What makes an educator invaluable is their ability to bring the most advanced concepts to the level of understanding for the individual and tailor the education to that level.

A novice nurse entering into one of these units will likely have had some courses in rhythm interpretation as a basic entry level requirement.  However, I find that many of these nurses have not had adequate preparation time in being able to apply a systematic approach to assessing the 12 Lead ECG. When working in these types of units, promptly assessing the ECG is essential to ensure there is no time delay in notifying the physician of anything urgent.

I apply a step-wise approach in ensuring that the basics are understood before moving on to the more intricate aspects of the ECG.

The basics that I assess are:

1. Ensure the nurse understands what the P, QRS, and ST represent and their significance, if abnormal. Most importantly, I ask them to point out examples of ST elevation and depression on various ECGs.  You would be surprised at how many people do not know this very core concept and before discussing treatment management and complications, this basic concept needs to be well understood. If you only have 30 minutes to spend with a nurse on this particular day, this would be the priority, in my opinion.

2. The next step would then be to assess their knowledge and discuss what’s happening with ST elevation/depression, including the treatment strategies. This can be achieved in 30 minutes to an hour.

3. Third: anticipated complications. I can’t tell you how often I hear nurses want to give a saline bolus to a hypotensive patient experiencing an anterior wall MI.  They do not understand the pathophysiology and their actions will subsequently worsen the situation.  Apart from cardiac arrest occurring with any MI, I expect that everyone understands the ‘expected’ complications associated with the inferior and anterior wall MI. For this, I keep it very simple so retention of information remains. “The heart is comprised of 2 pumps. If the right pump fails and backs up, what will you notice? Will the chest be wet or dry? (about 1/3 of the group will say wet, which is incorrect). If the left pump fails and backs up (such as in an anterior MI), where does it back up to? Will the chest be wet or dry?” By keeping it simple, the concepts are easier to understand and retain.

4. In many of the hospitals, there is an annual recertification of the ECG basics and this is another opportunity as an educator to assist those who may be struggling. 

5. I also provide staff with reference tools so they can help themselves learn at their own pace. On my educational website: www.qrs-education.com , there are reference links and tips under the QRS Tips tab as well as our manual which you can read about in the Products page. This manual has taken the complex concepts to a more manageable level. I also promote Dawn’s website (www.ecgguru.com ) as another invaluable tool. Two examples of interactive links are:  www.practicalclinicalskills.com  and www.skillsstat.com 

I hope this has helped. Thank you.

Darlene Hutton

President, QRS Educational Services

www.qrs-education.com  

 

 IF YOU HAVE A TEACHING QUESTION FOR OUR EXPERTS, PLEASE EMAIL TO INFO@ECGGURU.COM

 

jer5150's picture

Jason's Blog: ECG Challenge for the months of July and August, 2014.

This is an ECG I performed a couple of years ago on an asymptomatic 83-year old man as an outpatient procedure. 

The computer interpreted this as:  "Marked sinus bradycardia [with] Frequent Premature ventricular complexes".  IS THE COMPUTER CORRECT?  Is there more than one plausible interpretation?  What is the differential diagnosis?

THE MOST COMFORTABLE SHIRT YOU WILL EVER WEAR

Wed, 01/15/2014 - 20:55 -- Dawn

THIS WILL BE YOUR FAVORITE SHIRT!

This is not an ordinary tee shirt.  It is made of the smoothest, most comfortable lightweight fabric, which is moisture-wicking and has a sun-protective UPF of 30.  And, it is wearable art, featuring the work of ALYSSA BEAN.  If you work in a cath lab, and wear lead aprons all day, you will love the feel of this shirt. The fabric keeps you warm in cold environments and cool in warm temperatures.  It is great for sports, boating, beach, and layering.

The ECG Guru is committed to providing high-quality resources for ECG instructors and students FREE of CHARGE and FREE of COPYRIGHT.  We do rack up some expenses keeping the website going.  We came up with the idea of fund raising while also providing a product that we know our members and visitors will LOVE. 

Go to the STORE to learn more about this shirt.

Broken Heart

Click to open: 
Heart Art, Broken Heart, Heart Leaf Illustration

Looking for an illustration for your presentation or packets?

Photograph by Alyssa Bean.  May be used free of charge and free of copyright in instructional setting.  Please contact the artist at Dawn.ECGGuru@gmail.com for any commercial use.

ECG Guru Ads - Products and Services of Interest to our Members

 

 

1924:  Willem Einthoven wins the Nobel prize for inventing the electrocardiograph.


ARE YOU INTERESTED IN ADVERTISING ON THE ECGGURU?  WE OFFER LIMITED ADVERTISING SPACE TO PRODUCTS OR SERVICES THAT WOULD BE BENEFICIAL TO OUR MEMBERS. CONTACT THE ECG GURU AT INFO@ECGGURU.COM

 

 

Subscribe to ECG Guru - Instructor Resources RSS