12-Lead EKG: Taking Essential Skills to Advanced Interpretation

• Apply a systematic approach to rhythm strips and 12-Leads
• Recognize common pitfalls and misconceptions that interfere with accurate interpretation
• Identify life-threatening abnormalities early in the game
• Confidently present findings to peers and physicians
• Hands-On Practice and Case Studies

Learn to recognize and understand normal, borderline and abnormal tracings at this seminar. Gain skills in identifying acute coronary syndromes (ACS), bundle branch blocks, hemiblocks, pericarditis, Prinzmetal angina, left and right atrial/ ventricular enlargement, QRS axis and much more. You will learn and practice how to look at and critically analyze a 12-lead EKG and classify tracings as normal, borderline or abnormal.

• Use QRS axis to help determine certain diagnoses
• Contrast left anterior and posterior hemiblocks
• Recognize the location of acute coronary syndromes and contrast new vs. old STEMI changes
• Relate appropriate therapy to stages of ACS
• Differentiate LBBB versus RBBB and their significance
• Compare acute STEMIs, Prinzmetal angina, pericarditis, and early repolarization
• Find chamber enlargements - RAE, LAE, RVH, LVH - and understand clinical implications
• Consider clinical management of patient problems encountered

You will leave with a systematic approach to EKG interpretation that you will apply immediately in your practice and improve the care you provide to your patients.

OUTLINE

12-Lead EKG Interpretation

• Layout of the 12-lead, 15-lead and right-sided EKG
• Difference between electrodes and leads
• Limb leads and precordial leads
• Bipolar leads and unipolar leads
• Placement of electrodes and leads
• Importance of the positive electrode
• Contiguous leads
• Cardiac conduction system
• Correlating cardiac conduction with waveforms
• Understanding the action potential
• Apply coronary artery perfusion to cardiac musculature
• Normal R wave progression
• Systematic approach to EKG review

Determining Axis

• Hex-Axial system
• Limb leads and formation of axis wheel
• 4 quadrants of Axis
• Quick approach for determining axis by quadrant
• Axis practice utilizing “Thumbs technique”
• Reasons for axis deviation

Bundle Branch Block Identification

• Utilizing Leads V 1 and V 6
• Right bundle branch block
• Complete left bundle branch block
• Causes and treatment strategies

Fascicular Block Identification/ AKA Hemiblocks

• Utilizing Leads 1 and AVF
• Left anterior hemiblock
• Left posterior hemiblock

Hands-On EKG Practice: Leads, Axis, Bundle Branch Blocks and Hemiblocks

Patterns of Myocardial Injury and Ischemia and Treatment Interventions

• Myocardial injury
• ST and T wave changes
• ST elevation myocardial infarction (STEMI) vs. non-ST elevation myocardial infarction (NSTEMI)
• Reciprocal changes
• Pathological Q waves
• Normal recovery from a STEMI
• Myocardial ischemia
• Differentiate NSTEMI from unstable angina
• ST and T wave changes
• Subtle Clues

Heart Failure

• Acute decompensated vs. Chronic
• Background and causes
• Evidenced-based guidelines and treatments

Cardiac Chamber Enlargement

• Differentiate left and right atrial enlargement
• Contrast LV and RV hypertrophy

Therapeutic Induced Hypothermia

• Evidenced-based guidelines for treatment
• Expected outcomes

Clinical management and Intervention

• Emergent Strategies
• Chronic Management Strategies

OBJECTIVES

• Discuss treatment strategies for acute and chronic heart failure.
• Relate coronary artery perfusion to cardiac musculature and the conduction system.
• Describe the Hex-axial system for determining the electrical axis of the heart and identify the causes of abnormal axis.
• Utilize a 9-step systematic approach to interpret EKGs.
• Recognize bundle branch blocks and hemi-blocks on EKG and state causes.
• Interpret ischemia, injury, and infarction pattern on a 12-lead, 15-lead and right-sided EKG.
• Integrate new evidenced-based guidelines to treat Acute Coronary Syndrome.
• Identify three common STEMI Imposters and differentiate between benign and injury pattern of ST segment elevation.
• State the criteria for therapeutic induced hypothermia.

ABOUT THE SPEAKER

Cathy Lockett, RN, MHA, BSN, CCRN, EMT, has over 35 years of critical care nursing experience. Her critical care background includes working in all aspects of critical care nursing to include medical, surgical, neurological, pediatric, cardiac/ cardiovascular care and critical care transport. She has provided care as a staff nurse, preceptor, educator, supervisor and manager. Cathy has presented on numerous topics locally and nationally to include EKG interpretation, basic and advanced arrhythmia class, hemodynamics, IABP therapy and pulmonary care. Additionally, Cathy is training center faculty for the American Heart Association in the disciplines of Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support. Cathy’s teaching style is dynamic and high energy while informal and easy to understand.

Disclosures:

Financial: Mary (Cathy) Lockett is receiving a fee for speaking at this educational activity.

Nonfinancial: Mary (Cathy) Lockett has no relevant nonfinancial relationships to disclose.

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