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Various approaches to ECG interpretation have been described. They all encourage dedicated attention to interpretation of the heart rate, rhythm, axis, intervals, voltage, hypertrophy, and signs of ischemia in a systematic manner. Develop your own standard stepwise approach that you use every single time you interpret an ECG. With practice, you will get faster...and eventually be able to glance briefly at an ECG and extract tons of clinically useful information.
In acute care settings, we suggest you look first for time sensitive ECG findings that will influence your clinical decisions.
The following approach to STAT ECGs focuses on rapid identification of the most deadly and time sensitive findings:
The following approach to STAT ECGs focuses on rapid identification of the most deadly and time sensitive findings:
STEP ONE: HEART RATE & RHYTHM
STEP ONE: HEART RATE & RHYTHM
Is the rhythm regular, regularly irregular, or irregularly irregular?
What is the atrium doing (P waves), what is the ventricle doing (QRS complexes), and what is their relationship (PR-interval)?
STEP two: QRS analysis
STEP two: QRS analysis
Is the QRS interval narrow or wide?
Common causes of wide QRS; BBBs, Paced rhythms, WPW, Ventricular rhythms, or Hyperkalemia?
Do you see pathologic Q waves?
Voltage and proportions
Abnormally large T-waves?
STEP THREE: Looks for signs of oMI, PE, & tox/metabolic emergencies
STEP THREE: Looks for signs of oMI, PE, & tox/metabolic emergencies
KEY PEARLS:
KEY PEARLS:
Emergency ECGs are interpreted in busy environments and acute settings full of interruption and distraction. You must be systematic & focused when interpreting STAT ECGs to avoid errors and misdiagnosis!
Always compare your STAT ECG to prior ECGs when available, and look carefully at all 12 leads for subtle findings. Use this stepwise guide as a checklist, remember your can't miss ECG DDx, and when in doubt...get serial ECGs!
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