EKG

EKG

Elective Name: EKG Elective

Elective Mentors: Dr. Liz Fierro

Elective Location: LLUMC

Elective Duration: 2 weeks

Elective Description:

This is a PGY 2 or 3 resident elective that involves intensive self-study for learning clinical EKG interpretation. The resident is responsible for first part of Amal Mattu’s book and for reading and internalizing the three articles by O’Connor on Pediatric EKG. The Park’s book on Pediatric EKG can be used as reference as needed. It also contains good practice EKGs at the end of several chapters (see below for more details regarding the mentioned books and articles).

During the first week of the elective, the resident will shadow the ED techs for at least 4 hours in order to perform a minimum of 10 EKGs.

During the second week of the elective the resident will shadow the attendings and provide the first read of the EKGs brought in by the techs. The attendings will cosign the EKGs.

Do not be afraid to question the “correct answer” to any of the EKG interpretations.

Educational Goals:

  1. Enhance expertise in the evaluation of adult and pediatric EKGs

Educational Objectives:

Patient Care and Medical Knowledge Competency Domains:

  1. Effective interpretation of adult rhythm strips to include identification of: sinus bradycardia, sinus tachycardia, PACs, PVCs, sinus arrhythmia, sinus pause, supraventricular tachycardia, ventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular blocks, multifocal atrial tachycardia, and ventricular fibrillation.

  1. Effective interpretation of pediatric rhythm strips to include identification of: sinus bradycardia, sinus tachycardia, supraventricular tachycardia, ventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular blocks, and ventricular fibrillation.

  1. Effective interpretation of the adult electrocardiogram including identification of ST-segment elevation and depression (including presumed anatomic area of injury), T wave inversion and/or flattening, bundle branch blocks and incomplete bundle branch blocks, R wave progression, prolonged intervals, electrolyte abnormalities associated with ECG abnormalities.

  1. Effective interpretation of the adult electrocardiogram including identification of Brugada syndrome, toxicologic manifestations noted on ECGs, Wellen's syndrome, accelerated idioventricular rhythms, interpretation of paced rhythms, interpretation of ST elevation MIs in the setting of LBBB, right heart strain patterns, and benign early repolarization. Interpretation of right sided and posterior leads, junctional rhythms.

Assessment Tools:

1. Complete and pass the end-of-elective EKG interpretation test (80% percent correct)

2. Sign up for spaced-repetition learning of rare EKG findings

At the end of the elective there will be a 20-question pass/fail test with a minimum requirement of 80% correct to pass the elective. The test will be multiple choice either online or on paper, non-proctered, honor system.

Upon successful completion of the course, the resident will enroll in a space repetition system where she/he will be periodically reminded of rare EKG findings, in order to stay fresh and be prepared to identify such findings should they occur in daily practice.

Tips for Success:

Read a little bit every day so that you can allow time for the material to sink in.

Contact elective mentors for any questions:


Liz Fierro

LFierro@llu.edu

Textbooks/articles (can be provided to you):

Amal Mattu and William Brady. “ECGs for the Emergency Physician”. BMJ Publishing Group 2003

Myung Park and Warren Guntheroth. “How to Read Pediatric ECGs”. Mosby. 2006

O'Connor M, McDaniel N, Brady WJ. “The Pediatric electrocardiogram. Part I: Age-related interpretation”. Am J Emerg Med. 2008 Feb;26(2):221-8. doi: 10.1016/j.ajem.2007.08.003.

O'Connor M, McDaniel N, Brady WJ. “The Pediatric electrocardiogram. Part II: Dysrhythmias”. Am J Emerg Med. 2008 Mar;26(3):348-58. doi: 10.1016/j.ajem.2007.07.034.

O'Connor M, McDaniel N, Brady WJ. “The Pediatric electrocardiogram. Part III: Congenital heart disease and other cardiac syndromes”. Am J Emerg Med. 2008 May;26(4):497-503. doi: 10.1016/j.ajem.2007.08.004.