One of the important things about being an intern is moving from basic knowledge of reciting what you see in an EKG to interpreting what it means in a given situation. This cannot be taught in a blog post, but only by experience and lots and LOTS of practice.
As an intern I literally looked at the EKGs of every patient on our service, and would print out and notate abnormal ones (carefully sharpie-ing out patient identifiers) so I could review them at the end of the day or week. I only did this while on our inpatient service, and shortly before going back on service, because I felt so unprepared. This was in spite of starting residency with 2 weeks on cardiology service. While this helped me and isn’t a bad habit to emulate, you’ll be better off if you master the basics and do practice more regularly.
Re-learning ECG Basics
- We covered the basics on this over at FMstudent.com, so if it’s been awhile read that as a refresher.
- Review OnlineMedEd’s cardiology videos on Coronary artery disease, ACLS rhythms and ACLS easy.
- Consider using ALiEM’s eight week Bridge to EM (more info on this resource here), which has a daily EKG via ECG Wave Maven
- Look at EKGs every day. However, don’t spend more than 30 minutes a day on this to avoid loathing the learning process.
More ECG Resources
- Free – Life in the Fast Lane has a giant EKG library, focused on EM and CritCare. Which is perfect for inpatient, EM, ICU and cardiology rotations a family medicine resident is expected to do. Start with their ECG Basics and make time every day to review their Top 100 ECGs
- Free – ECG Wave-Maven is used by ALiEM for a reason. I like that you can browse the case list in quiz mode, because most of us learn by doing and getting feedback. That feedback is often that you’re incorrect, but it pushes you to learn more.
- Not free ($1 per week, or $26 for a year) but well known, ECG Weekly is more for senior residents and continued attending learning. I never used it, but love that it is presented in case format.
- There are literally TONS of free ECG and paid sites to learn from. Ask your fellow residents what they use, and why. Try a few out, and pick your poison.
Documentation
Below is a sample EKG Template for noting your interpretation of an EKG into your H&P, progress note or a significant event note. Have your senior or attending look it over before you use it – there’s a high probability they have a preferred template of their own.
On my personal EKG interpretation:
ir/regular rhythm, rate _, no axis deviation (or left/right axis deviation), appropriate intervals: PR __ QTc __. Appropriate R-wave progression. No acute ischemic ST segment depression or elevation, no T wave inversions or peaking. No significant change from prior EKG of __/__/__.
Keep practicing reading EKGs, it gets better over time!
