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| Home - Past Webinars -
ECG Officer Training: Intermediate Training in 12 Lead
Electrocardiography |
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ECG Officer Training: |
Intermediate Training in 12 Lead Electrocardiography |
| 9 Content Hours |
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Course Description:
Cardiac care clinicians are often frustrated
in clinical practice because they typically
have had just the bare essentials in terms
of preparation for reading an
electrocardiogram (ECG). Commonly, the
preparation is a short course on arrhythmias
(and those courses often teach recognition
from only one lead, typically lead II).
Consequently, in practice, much more is
expected and necessary for competent patient
care. This 6 part course will give the
clinician a good understanding of the
12-lead ECG. Cardiac rehabilitation
clinicians as well as those working in
telemetry units, emergency departments, or
intensive care units will benefit.
Prerequisite: ECG Boot Camp (available in
our online home study catalog) or a
comparable basic course in arrhythmias and
understanding of ECG components (P, PR
interval, QRS, T wave, ST segment, etc.)
are required.
Who Should Be Interested:
Nurses, therapists or exercise therapists working in cardiac
rehabilitation, telemetry units, emergency departments, intensive care
units, or anywhere cardiac ECG monitoring is required.
Presenters:
Patricia Lounsbury, RN, BSN, MEd, CCRN, FAACVPR
Class Schedule:
- Leads, Axis, Principles of Monitoring, What’s Normal
- Wide QRSs – Bundle Branch Blocks
- Wide QRSs – Hemiblocks and Aberration
- Fat Tachs: Differential Diagnosis of Wide Complex Tachycardias
- Ischemia and Obvious Infarction
- Repolarization Rascals: Ischemia and Infarction Impostors
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#1 - Leads,
Axis, Principles of Monitoring, What’s
Normal
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Topics:
To determine what’s abnormal in a 12-lead ECG, it is imperative to know
what is normal and be able to make that determination quickly.
Determining the QRS axis on the frontal plane, if the T wave and ST
segments are directed normally, and thoroughly understanding leads and
how to manipulate them are skills fundamental to rapid 12-lead ECG
interpretation. Often not taught in arrhythmia interpretation courses,
this information is basic and necessary to understand the remaining
sessions in this series.I. Leads of the frontal plane
A. Standard, bipolar limb leads
B. Unipolar limb leads
C. Determination of axis
II. Leads of the horizontal plane
A. Two very important leads for monitoring
(V1 and V5 or V6)
B. Bipolar substitutes for V-leads
III. Lead choices for various populations
IV. Other leads (posterior, right ventricular,
etc.)
V. Rules for monitoring
A. One lead is not enough!
B. Choose lead based on patient, not policy!
Behavioral/Learning Objectives:
- Recognize a normal 12-lead ECG.
- Explain how the P wave, QRS complex, and T wave should look in all 12 leads.
- Determine the electrical axis of the ECG in seconds.
- Describe the normal precordial pattern and how it is derived.
- Explain how bipolar substitutes for the V leads are derived, e.g., MCL1, MCL5, MCL6, CM5, etc., and when they are indicated.
- List advantages of using V1 and V5 for monitoring in cardiac rehabilitation.
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#2 -
Wide QRSs – Bundle Branch Blocks |
Topics:
Wide QRS complexes are caused by a number of factors; among the most
common are bundle branch blocks (BBB). Determining whether wide beats
are a result of BBB should take only seconds and is imperative to
accurate diagnosis. Often not taught in basic arrhythmia interpretation
courses, this information is easy, fundamental and necessary to
understand the remaining sessions in this series.I. Wide QRS basics:
It’s either BBB or ventricular (or rarely
preexcitation)
II. Diagnosis of bundle branch blocks (BBB)
A. Right BBB
B. Left BBB
Behavioral/Learning Objectives:
- Explain the classification of intraventricular conduction delays and identify which may be found in healthy individuals and which may represent disease.
- Contrast the ECG characteristics and clinical significance of right bundle branch block (RBBB) with left bundle branch block (LBBB) and recognize each on the ECG.
- Differentiate BBB from ventricular ectopy.
- Describe methods to diagnose BBB.
- List leads best to identify BBBs.
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#3 -
Wide QRSs – Hemiblocks and Aberration |
Topics:
Hemiblocks, while not increasing the QRS much, change its appearance and
may indicate worsening condition. Aberration will change the QRS
depending upon the cause of the aberration, whether it is BBB or
hemiblock. Differentiating ventricular premature contractions/beats from
aberration is often difficult, but a necessary skill for cardiac
clinicians. Differentiating wide QRSs in the presence of atrial
fibrillation is also difficult because clues that help in diagnosing
VPCs, such as compensatory pauses, or premature P waves, aren’t present
in atrial fibrillation.I. Aberration
A. Definition
B. Identification of aberration on the ECG
II. Wide QRS in atrial fibrillation
A. Criteria supporting aberration
B. Criteria supporting ventricular ectopy
III. The hemiblocks
A. Anterior fascicular block
B. Posterior fascicular block
C. Hemiblock aberration
Behavioral/Learning Objectives:
- Define aberration
- Differentiate supraventricular complexes conducted with aberration from ventricular ectopy.
- Identify left anterior fascicular block.
- Identify left posterior fascicular block.
- Describe which leads best identify BBBs and which best identify fascicular blocks.
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#4 -
Fat Tachs: Differential Diagnosis of Wide Complex Tachycardias |
Topics:
The wide complex tachycardia may deteriorate within seconds to
ventricular fibrillation or be tolerated for hours. Rapid differential
diagnosis is imperative in treating this life-threatening arrhythmia.
Often not taught in basic arrhythmia interpretation courses, this
information is crucial for any practitioner responsible for treating
critical arrhythmias. ECG techniques presented will equip the
practitioner with the necessary tools to correctly diagnose the etiology
of wide complex tachycardias in well over 90% of cases.I.
Misdiagnosis and consequences of wide-QRS-complex
tachycardias
II. VT versus SVT with aberrant conduction: Rules
III. ECG differential diagnosis: 6 steps
IV. Preexcitation: 3 ways to fat tachs
V. Wide QRS tachycardia treatment
Behavioral/Learning Objectives:
- Explain various clinical physical signs useful in differential diagnosis of wide complex tachycardias.
- Determine ECG leads useful in differential diagnosis of wide complex tachycardias.
- List at least 3 criteria supporting the diagnosis of ventricular tachycardia.
- List at least 3 criteria supporting the diagnosis of supraventricular tachycardia with aberrant conduction.
- Explain characteristics of accessory pathway conducted tachycardias and ways to differentiate from VT and SVT with aberration.
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#5 -
Ischemia and Obvious Infarction
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Topics:
Myocardial ischemia and infarction are two conditions the cardiac
rehabilitation practitioner must be able to recognize and treat
competently. Ischemia and infarction manifest differently and require
astute and informed examination of the 12-lead ECG.I. Myocardial
ischemia
A. Best leads for identification
B. ECG characteristics: 7 contours
C. Diagnosing ischemia in presence of RBBB
II. Myocardial infarction
A. ECG diagnosis of ST segment elevation MI (STEMI)
B. Location of STEMI
C. Diagnosing in presence of BBB
Behavioral/Learning
Objectives:
- Recognize ST-segment elevation myocardial infarction (STEMI) on the 12-lead ECG.
- Discuss the locations of STEMI: Septal, anterior, inferior, lateral, true posterior, right ventricular.
- Describe ECG manifestations of myocardial ischemia.
- Recognize myocardial ischemia in the presence of RBBB.
- Explain when exercise should be curtailed in the presence of myocardial ischemia.
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#6 -
Repolarization Rascals: Ischemia and
Infarction Impostors |
Topics:
Left ventricular hypertrophy, electrolyte imbalances, digitalis,
pericarditis, cor pulmonale, acute pancreatitis, intracranial
hemorrhage, and normal variants are among the many impostors of
myocardial infarction and ischemia. A practitioner must be able to
differentiate ST segment elevation secondary to infarction from
aneurysm, pericarditis, and other causes. This class will be a brief
introduction to some of these impostors.I. Repolarization rascals
A. Digitalis
B. LVH
C. Potassium
D. Pericarditis
E. Ventricular aneurysm
F. Early repolarization
II. MI mimics
A. Pericarditis
B. Variant angina
Behavioral/Learning Objectives:
- Describe the ECG effects of digitalis and compare with ischemia.
- Compare and contrast the ECG in left ventricular hypertrophy, digitalis, and ischemia.
- List 3 causes of ST segment depression, not including myocardial ischemia.
- List 3 causes of ST segment elevation, not including myocardial infarction.
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Accreditation Information |
Nurses – Academy Medical Systems is
an approved provider of continuing nursing
education by the Illinois Nurses Association, an accredited approver by the
American Nurses Credentialing Center’s
Commission on Accreditation. 9.0 contact
hours will be rewarded to nursing
professionals at the completion of this
workshop.
Academy medical Systems is also a provider
approved by the California Board of
Registered Nursing, provider #CEP14413, for
9.0 hours. And we are also a provider
approved by the Florida Board of Nursing,
provider #50-19, for 9.0 hours.
Iowa Nurses – The Iowa Board of
Nurses will recognize the recorded webinars
as a home study program. They recognize our ANCC approved provider status as well as our
CA and Fl Board of Nursing provider approval
for home study products for nurses in Iowa.
All other states recognize our approved
provider status listed in the above text for
continuing education credit for nurses.
Respiratory Therapists – This program
has been approved for 9.0 contact hours
Continuing Respiratory Care Education (CRCE)
credit by the American Association for
Respiratory Care, 9425 N. MacArthur Blvd.
Ste 100, Irving TX 75063. Course #
290600000.
Dietitians - Academy Medical Systems
is a Continuing Professional Education (CPE)
Accredited Provider with the Commission on
Dietetic Registration (CDR.) Registered
dietitians (RDs) and dietetic technicians,
registered (DTRs) will receive 9.0
continuing professional education units (CPEUs)
for completion of this program/material.
Occupational Therapist - Occupational
Therapist will receive 9, continuing education hours
for completion this program and a test score of 70%
or better. AMS is an approved provider for the AOTA
, provider # 5470. This course is an intermediate
education level.
Exercise Physiologist – ACSM
recognizes AMS’s approved provider status
with the ANCC and will honor our continuing
education for Certified Exercise
Physiologist recertification purposes.
Certified Cardiovascular Techs –
Cardiovascular Credentialing International
recognizes our approved provider status with
the ANCC for continuing education courses
for CCTs.
Certified Athletic Trainers – Academy
Medical Systems is recognized by the Board
of Certification (BOC) to offer continuing
education for certified athletic trainers. 9
hours will be awarded at the completion of
this program.
Physical Therapists - PTs
in the following states will receive
9 contact hours for completion of
all 6 webinars: AK, CA, CO, CT, HI,
IA, ID, IN, KS (Cat 2), MA, ME, MI,
MN (Cat 2), MT, NE, NM, ND, OR, PA, RI, SC,
SD, UT, VA (Type 2), VT, VI, WA, WY.
Because each state’s continuing education
requirements for physical therapists is subject to
change, please verify this information with your
state board. Thank you.
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