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I've been in the ER for about 18 months now and the sad thing is I can honestly say I am still so uncomfortable with EKGs. Shame.

 

I think there are a few reasons for this. One, my EKG class in PA school was terrible. Two, the doctors in my group generally read the EKGs so that really takes away the pressure. And three, and the most obvious reason, I am not mastering them because I am clearly not doing the right things during my time off work to get there.

 

I've tried multiple resources - books, really - and none of them, even Dubin, are really sticking with me in a real world applicable way. I find myself picking up resources, starting them, and never finishing them. They tell me things I already know but when it comes to work I freeze up and I can't seem to apply this stuff. I could look at an EKG in a textbook and tell you what's going on. I can recognize the ST depression, junctional rhythm, a prolonged QT interval. It's just that in the real world when somebody slaps in EKG on my desk for some reason it always looks so different than what I've seen in the books. For example, today my attending position and I cardioverted a patient who was in rapid a-fun and afterwards we looked at the EKG and he said "oh yeah, he's back to sinus" and for the life of me I couldn't see ONE distinctive P wave... all I saw was the same fibrillatory line I saw before we cardioverted... it just doesn't click with me. Physicians will also point out abnormalities that just look like artifact to me. Or sometimes I see stuff that I think looks bad but it's artifact. It's hard to explain, but overall I just suck.

 

I think I realize that traditional books are not the best way for me to learn this stuff. I've tried soooo many books and I don't think it's the right method for this.

 

Maybe I need a course or something? I need something very structured.

 

Any suggestions?

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I'm sure you've already got the fundamentals down from all of those traditional textbooks like Dubin's, etc.  Those books are only really helpful as an introduction, in my opinion.  In residency I spent a few months on the telemetry floor and in the cardiac ICU where we read ekgs nonstop, and I really think that practice helped me the most.  Perhaps more specifically, its real practice where you attempt your own formal interpretation, and then get real feedback on each ekg... that is what helped things stick for me.  Thats why I found ECG's for the Emergency Physician 1 and 2 by Amal Mattu to be incredible worthwhile.  They are all from real patients, you attempt your own interpretation on each ekg, and they give actually helpful / clinically relevant feedback for each one.  As a student my preceptor made me do 6 of these every shift and we'd read through the discussions together.  We made it through both books and it helped me stand out big time among the other residents on the cardiology service.  

 

Of course, internal medicine / cardiology ECG interp is different from emergency medicine where we are definitely focused on things like STEMI or not?  6 things to look for in every pediatric syncope EKG?  Evaluation points for the tox/overdose patient?  Etc.  It is much more focused than on the unit.   I don't think we need to get as bogged down into the minutae that can distract us from the seeing the forest through the trees.  So, from this perspective, if you are looking for supplemental didactics on ECG, I feel that the podcasts by leaders like Amal Mattu on iTunes, emrap, youtube (the guy is all over the place) are so much more helpful than general ECG courses, because it is focused to EM and that focus will help reinforce things to make them stick.  He is a wonderful lecturer, and you can hear most of his talks for free if you search around.  

 

A few other resources:

https://ecgweekly.com - Amal Mattu's website, subscription based

http://hqmeded-ecg.blogspot.com - Dr Smith's ECG blog

http://www.stritch.luc.edu/lumen/MedEd/MEDICINE/skills/ekg/les1prnt.htm   - Decent review of basics

http://www.ems12lead.com/2014/06/23/the-most-awesome-stemi-test-on-the-internet/ - Test your STEMI or not skills

http://www.emdocs.net/foamed-resource-series-part-ecg/ - More great resources from FOAM website.  

 

Hope this helps!

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After 11 years in cards, I think the biggest thing is to always follow your system, whichever one you choose. In the field, you may feel stressed to make a call and thus skip stuff. Try to avoid that and you will be less likely to panic and miss things. It's a lot like what radiologists do: if it's anywhere in your field of view, you have to read it.

 

 

Sent from my iPad using Tapatalk

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Harvard has a webpage - all EKG's are from real patients with clinical history given.  They also do a good job of explaining things.  Fun to play with during down time. 

 

For some reason I can't paste the link but google "Harvard ECG wave maven"

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Dr. Dubin's Rapid Interpretation of EKG's. The easiest to understand EKG book ever.  Lots of pictures and easy to read and understand.  It teaches exactly what you need to know for most of clinical medicine.  You're welcome. 

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Dubins is good to learn the basics of EKGs. If you have no idea what the squiggly lines mean, Dubins is where ya start.

 

To master them you need much more in depth study such as Amal Matu's books above and others.

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