We are back this month with a few helpful tips when reading EKGs from Jennifer Carlquist, PA-C, and course director of The Urgent Care EKG Course!
- STEMI mimics can be sneaky. Always look for 2 leads of contiguous ST elevation and reciprocal depression. If you do not have reciprocal ST Depression, you could be dealing with pericarditis or benign early repolarization.
- Normal (non-pathological) T waves should be asymmetric, and in proportion to the corresponding QRS. If they are symmetric be worried. If they are symmetric and inverted be very worried. The differential for these findings includes: PE, ACS, ICH and Cardiomyopathy.
- QRS complexes should be narrow. If they are wide (over 120 ms), consider causes like hyperkalemia or bundle branch blocks.
- If you are not sure you see a P wave, look at the PR interval calculated by the machine. If there is an asterisk, it is most likely not a sinus rhythm. This can also be seen in junctional, idioventricular or atrial flutter rhythms.
- When you have an irregular rhythm, it is most likely atrial fibrillation (A Fib). If it is over 120 it is most likely A Fib with rapid ventricular response (RVR). This often brings patients into the clinic for palpitations.
- Remember to always think worst first so that you don’t get burned. Assume chest pain is acute coronary syndrome (ACS) until proven otherwise. Other causes to worry about include pneumothorax, PE, and aortic dissection.
This course is ideal for PAs and NPs practicing in urgent care. Whether you’re new to practice or have many years of experience, you’re sure to learn practical, evidence-based tips you can use on your next shift. You can sharpen your EKG interpretation skills, improve your accuracy, become more proficient, and boost your clinical confidence with The Urgent Care EKG Course.
Visit https://www.ebmedicine.net/ekg to learn more.
Last Updated on June 13, 2023
