How to Read an EKG
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 3 December 2017
⏱️ 10 minutes
🧾️ Download transcript
Summary
Always remember…1, 2, 3, get an old EKG!!!
Step 1: Identify the Rate and Rhythm
* Is it sinus rhythm?* P wave before every QRS* Is it one of the tachycardias? (Refer to THIS episode)* Is it one of the bradycardias? (Refer to THIS episode)
Step 2: Look for Signs of Ischemia
* Most consistent way is to examine by anatomic region of the heart* II, III, and aVF are “inferior” leads* I, aVL, V5, V6 are “lateral” leads* V1 and V2 are “septal” leads* V3 and V4 are “anterior” leads* Check for Q waves* Check for ST segment elevation or depression* Compare the J point with baseline (TP segment)* Check for peaked T waves and T wave inversions* T wave inversions in V1 and aVR are normal
Step 3: Look at Intervals
* PR interval* Wolf-Parkinson White Syndrome* 1st degree heart block* QRS interval* Left bundle branch block* Right bundle branch block* Sodium channel blockade* QT interval* Long QT syndrome* Hypokalemia* Risk of torsades de pointes
Step 4: Get an Old EKG
* If you find anything abnormal looking, compare to an old EKG
Bonus: Scarbossa Criteria
* Identifies ischemia in patients with a left bundle branch block* 1 lead with concordant ST elevation* 1 lead with concordant ST depression (V1-V3)* Severely discordant ST elevation (>25% preceding S wave)
Additional Reading
* Basic Approach to Tachycardias (EM Clerkship)* Basic Approach to Bradycardias (EM Clerkship)* EKGs for the Emergency Physician (Amazon)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
| 0:07.1 | endless charting once you become a doctor? Do you think that doctors should be spending more |
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| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.aI. Hello, med students. My name is Zach Olson and thank you for downloading |
| 0:50.1 | this week's episode of the EM Clerkship Podcast. |
| 0:56.1 | We get EKGs on everybody. |
| 1:00.2 | If you haven't rotated through a department yet, |
| 1:02.8 | you might expect that we're just getting EKGs on patients with chest pain or shortness |
| 1:06.9 | of breath. |
| 1:07.7 | But in the real world, we order hundreds of EKGs for, it seems like |
| 1:12.4 | everything, abdominal pain and weakness and dizziness and vomiting. You name the chief complaint |
| 1:17.7 | and our triage is probably getting an EKG on it. And this is a good thing because lots of these |
| 1:24.0 | seemingly random chief complaints can actually be the first signs of a heart attack. |
| 1:28.9 | Something deadly that we can intervene on if we catch it. |
| 1:33.2 | So that's why we're getting that EKG. |
| 1:36.0 | But that means that we have to become EKG experts, not cardiology, you. |
| 1:46.3 | EKG interpretation is a core skill of emergency medicine doctors. |
| 1:51.7 | You need to become excellent at reading EKGs. |
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